The term "erectile dysfunction" was given by the National Institute of Health in 1992. Up to the that time it used to be called as "impotence". The word "impotence" was changed as it was having adverse psychologic effect on humans and failing to comprehensively encompass sexual function disorders 

Erectile dysfunction is lack of sufficient sexual arousal, poor hardening of the penis and inability to sustain erection. In case of erectile dysfunction, the penis does not sufficiently harden in order to start and maintain sexual intercourse that will please both man and woman. Erection (hardening) starts with sexual excitement. Any sexual arousal causes complex mental, nervous, heart and hormonal activity growth leading to increased blood flow into the penis, resulting in penis growth and hardening.

The penis consists of 3 cylindrical form elements (2 in sides and 1 in the medium bottom part). Urethra goes through the middle part and has no role in erection; other 2 parts grow and harden for sexual intercourse.

Erection problems arise in different forms: sometimes they start from the first sexual contact and persist; sometimes it comes out from specific problems. In some cases, erection stops (penis dies) during sexual intercourse, but men do not face any problems during masturbation. Sometimes erection comes in the morning after wake-up, sometimes it does not happen for long time. All of these are recognized as erectile dysfunction.

60% of men face with short or long-term erectile dysfunction (impotence) in their lives. With aging problem of hardening (erection) becomes more visible. Hardening (impotence) problem adversely affects lifestyle, quality of life of a man or family. Some men accept it normally and if they are not happy with their partners or do not care about it, if they do not have other excitements or problems of life, hardening issue is not significant for them.

At early ages and in active lifestyle men, it is the main problem of life. It makes their lives dramatic, leads to depression and even suicide.

Nowadays, erectile dysfunction is a treatable problem. Even in elderly men, correct treatment gives good effective results. It is important not to hide the problem and timely counsel with a doctor by sharing the feelings and complaints, and get proper counselling and treatment.

Causes of erectile dysfunction (impotence):

1. Organic
2. Psychological
3. Both
4. Idiopathic

The main causes of erectile dysfunction are organic factors. What are the organic factors?

1. Diabetes mellitus
2. Neurologic i.e. nerve system disorders
3. Anatomic disorders of the penis
4. Hormonal problems. These problems arise from the change in the quantity of hormones regulating genital the system and secreted from the pituitary gland or testicles.
5. Vascular diseases (vasoconstriction). These are formed in two ways. Vascular problems preventing blood flow into the penis and rapid (without hardening) drain out of the blood collected in the penis. According to the research held by the American Minnea Cardiovascular Institute, existence of the erectile dysfunction (impotence) problem is an early signal of possible cardiovascular system diseases after couple of years. As per the research, if the cause of erection problem is vascular, it is also recommended to conduct examinations for cardiovascular diseases in patients.

Organic risk factors:

*Diabetes mellitus is a lifetime disease. Diabetes mellitus exists in visible or latent form in 5% of the population. The cause of erectile dysfunction in case of diabetes mellitus is the changes ongoing in vessels and nerves. 33% of all organic erectile dysfunctions come to the portion of diabetes mellitus.

Patients with untreated diabetes mellitus face the following problems:

1. Frequent urination
2. Dry mouth and excessive thirst (frequent urination causes body dehydration)
3. Vaginal itch in women (increased sugar level in the blood decreases body immunity)
4. Numbness in the genital area and legs (due to the changes in nerves in diabetes mellitus)
5. Functional disorders of the bladder and urination (difficult urination and urinary incontinence)
6. Most important – erectile dysfunction

*Smoking : As we know, smoking causes different diseases, including erectile dysfunction (impotence). That is because smoking has a systemic pathological effect on all vessels starting from then leg vessels up to the brain, lungs, heart and penis.

*Consumption of alcoholic beverages hampers the erection. Little alcohol excites sexual arousal, but increased consumption substantially hampers the erection (hardening).

*Drugs: Some blood pressure, depression and narcotic drugs cause erectile dysfunction.

*Accidents, injuries, operations, and their complications also cause erectile dysfunction (impotence).

*Peyronie’s disease causing bending and indentations on the penis also leads to erectile problems.

*If penis gets trauma while erected (hardened), this may also cause serious erection problems. Penis might be broken, bent and get other traumas.

*Hernia of the intervertebral disc (damages to the spinal cord) also may cause erection problems.

*Exposure to radiation. Testes are damaged and cause erection problem on the other side.

*Age : Aging causes erection problems as well, as it diminishes all functions of the body. Even theoretically, there is a sexual performance difference between 20- and 25-year old men. Sexual performance decreases with age. However, one cannot say that all old men will have erection problems, but young men will not. There is a byword: sexual arousal does not die, it grows old as well.

Old men accept their ages, but do not put up with ending of the sexual life !!!

*Vascular hardening - (atherosclerosis). In case of cardiovascular diseases, organs do not get enough blood supply due to the narrowing of blood vessels. Poor blood supply cause malfunctioning of organs and the same applies to the penis making it unable to harden.

*Hypertension - (high blood pressure)

*Heart diseases

*Renal insufficiency and other chronic diseases

*Operations in the past – particularly after the prostate operations, because during the operations vessels and nerves to the penis may be damaged, which will cause its incomplete hardening

Psychological causes of erectile dysfunction

Erectile dysfunctions solely arising from psychological problems make up to 15% of the overall number. Sometimes psychological factors arise not in the beginning, but at later stages. Poor sexual knowledge, influence of others and other independent factors may cause this issue. In particular, problems coming from women are substantial in this case. One of the major problems is the lack of harmony between man and woman in the family.

Major causes of the psychologic problems are worry, fear, shame, bad mood, anxiety, haste etc. Causes from the fear of the “performance” and “can I do it” in first sexual contacts are very important. If a man once had an issue with hardening of the penis, he may think about it as a big problem and may have fear of repetition of the same issue, which will increase his stress and cause psychological erectile dysfunction (impotence), or if a man over-respects and admires a woman or thinks she is unreachable, he may be unable to have sex with that woman even in existence favorable conditions. This is called “Madonna syndrome” i.e. saint woman syndrome.

• Depression – in depression man has a poor condition, bad mood and cannot enjoy anything
• Performance anxiety – Feel of anxiety starting from the first minutes or even couple hours before the sexual contact like “will it harden” and other questions, has a great psychological effect.
• Problems in the family
• Suspicion about love affair of the woman causes performance anxiety in the man. Love affairs of the man makes him feel guilty in front of his wife, or he wants to show, prove himself by having love affairs aside in case he has erectile dysfunction with his wife during a sexual intercourse, and all these may cause erectile dysfunction.
• Lack of arousal in woman, depression of the partner and other negative affecting causes complicates the problem
• Addictions (porn films addiction)
• Having more than one sexual problems like premature ejaculation in conjunction with erectile dysfunction or low libido
• Causes of the development of erectile dysfunction
• Poor sexual knowledge, incorrect information, traumatic sexual contacts, sexual myths, negative influence of the family etc. play role in formation of erection (hardening) dysfunction
• It reveals out that even in case of educated men with wide worldview, there is lack of the sufficient knowledge. These are the major factors contributing to the formation of erectile dysfunction
• Sexual myths do not only arise from poor sexual knowledge, role of incorrect sexual information is great as well

For example:

• A man always wants sex and always ready for it
• It is also important to be successful in sex like in other activities
• Making love means sexual connection, what is left aside is not important
• Making love causes hardening of penis
• Loosing hardening of the penis of a man means that woman is less active

One of the major causes of erectile dysfunction is pampered children in families, particularly the fact that these children do not get sexual knowledge as it is deemed “shameful”, “sinful” or “bad”. In general, children grown in such families became incapable in front of women and themselves, and build their families without any changes.

The causes of the first night syndrome are marriage without enough knowledge of each other, insufficient sexual knowledge, and customs like “yenge” etc.

For a sound sexual contact, man and woman shall be able to share freely their sexual desires and feelings. Insight and support of the woman of her man having erectile dysfunction (impotence) is an important factor in treatment. Negative attitude, high demands and asking from the man things he is incapable of doing, will lead to long-term continuation of the erectile dysfunction (impotence).

What to do in erectile dysfunction. How is it diagnosed?

In fact, cause of the erectile dysfunction (impotence) is easily identified in most men. Once properly diagnosed it can be successfully treated. Firstly, it is necessary to identify is it organic or psychologic. Here it is important to know whether it is a longstanding or sudden case. If erectile dysfunction (impotence) arises in every case, every time and with every partner, it is an indicator of the advanced erectile dysfunction.

Erectile dysfunction (hardening) occurs as primary and secondary. Lack of libido, premature ejaculation, sexual problems in woman (mainly vaginal) and cases arising from the family conflicts are attributed to the secondary. Initially, patient is examined and then, if necessary blood is collected for hormonal and other analysis. Diagnosis is clarified based on the complaints of the patient and findings of the examination. Proper treatment is applied in accordance with the causes of the problem.

What to pay attention in case of erectile dysfunction?

• Does erection problem occur during sex with the partner or with other partner or does erection (hardening) problem occur during masturbation?
• Is there any erection problem under favorable conditions, in good place and desired partner?
• Did erection problems occur gradually or suddenly?
• Does erection problem increase or decrease depending on the selected position?
• Is there any past operation or medicine intake before the erection problem?
• Is there any erection in the morning after wake-up?
• Is there low libido and orgasm (ejaculation) disorder?
• If erection problem is primary, does it occur both in sexual contact and hand masturbation?
• Role of the woman in erectile dysfunction (impotence)
• Is there any role of the woman in erectile problem of the man?
• Sexual intercourse is an interesting topic for both man and woman. Part of the problem with man depends on woman as well. Approach of the woman to sexual relations, passivism even more complicates the man’s erection problem.
• What the man needs in case of such problem?
• In case of erectile dysfunction in the man, the woman has three choices: first, she acts as if there is no problem and even when the man says it, she responds that she never has felt it so far and it is not important for her. Second choice is that the woman says that she is happy with hardening and if the man worries about it, she will help him. The third choice is to say that she is quite worried about the problem.

Treatment: Treatment is selected depending on the cause. First, it has to be identified whether the issue is organic or psychologic. There are multiple stage treatment options. If tablets are unsuccessful then injections are tested, and as a last remedy, penile prosthesis is selected. Treatment is regularly done with drugs, injections, vacuum device and penile prosthesis operation.

There are many drugs in the pharmacies and one should use it carefully. The best solution is to take the drugs prescribed by the doctor. Taking medicines without knowledge may be harmful and lethal due to their side effects, for example, certain drugs are prohibited to take in cardiovascular diseases.

Vacuum device: It is a tube shaped device and put on the penis while switched off. Due to the negative pressure, it increases blood flow into the penis and so hardens it.

Penile prosthesis: Penile prosthesis is last but correct remedy. It is a lifetime treatment solution. There are two types of it. One is malleable and non-inflatable, which always remains slightly hard. Second type is inflatable prosthesis. Link to Penile Prosthesis