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Erectile dysfunction - What is it?

Erectile dysfunction (or impotence) is quite common with about 15% of patients over the age of 50 experiencing occasional or regular inability to get or maintain an erection. 

What do you need to create a normal erection
?

The correct social and psychological setting is essential.

There needs to be adequate blood flowing into the penis but also a mechanism that prevents blood from leaving. This whole process is controlled by a network of very fine nerves and testosterone (the male hormone) is also very important. 

What are the causes of erectile dysfunction?

Psychological

It doesn’t take much to inhibit sexual activity and sometimes even a small amount of anxiety about relationships, jobs, money and health can affect performance. 

Depression can also have a profound effect on sexual performance; in fact anti-depressant drugs can themselves inhibit erections. Sometimes concern about sexual performance reduces the ability to get an erection. This can prey on your mind and makes things worse and so a vicious circle is sometimes created.

Insufficient blood flow

This is a common problem particularly in smokers where the blood vessels narrow through a condition called atherosclerosis. It is also common in diabetics. Without enough blood supply to the penis, erections are not as strong as they should be.

Venous leaks

It is veins that drain the blood away from the penis. Normally there is a mechanism that shuts them down to allow the blood to accumulate in the penis. This can sometimes be deficient so the pressure in the penis can't increase enough for a good erection.

Abnormal nerve function

There are many diseases that affect the way nerves work. Again, a common one is diabetes but patients with multiple sclerosis, spinal cord injuries and a host of other conditions can be affected. Without the nerves to control the blood vessels in the penis, erections are absent or deficient.

Hormonal abnormalities

Lack of testosterone will prevent erections. There are many causes for this. Testosterone is produced in the testes but is controlled by hormones produced from a gland under the brain called the pituitary. Diseases or tumours of the pituitary will upset the testosterone drive.

Hormone levels may drop with conditions such as the Male Menopause or Metabolic syndrome.

Low hormone levels can make you feel tired and less energetic. The sex drive (libido) may be reduced so that you have less interest in sex than you used to. The erections are commonly affected, but replacing the testosterone usually helps to put things back to normal.