Importance of erectile dysfunction

What is it?

Erectile dysfunction, also known as male sexual impotence, is the persistent inability to achieve or maintain an erection that allows a satisfactory sexual relationship.

It must be distinguished from other sexual problems, such as lack of desire, ejaculation disorders (premature ejaculation, delayed ejaculation, and absence of ejaculation) or orgasm disorders.

Erectile dysfunction is not a disease but a symptom. Manuel Girona de Francisco, from the Urology Service of the University Hospital La Paz, in Madrid, points out that, in the absence of a psychogenic cause, it is “a symptom of an involvement of vessels and nerves responsible for erection, whether due to smoking, diabetes, aging hypertension with age, sedentary lifestyle, overweight and obesity, etc. ” In fact, he emphasizes, ” cardiovascular diseases are an important cause of erectile dysfunction.”

This is a frequent problem that, if left untreated, can affect relationships with the couple, the family and the work and social environment.


Impotence or erectile dysfunction can be caused by:

Psychological causes

In these cases, the penis does not present any physical alteration, however, diseases such as anxiety (frequently caused by the fear of not getting an erection or disappointing the woman), depression, problems with the partner and even stress they can affect the sexual act.

Also, the excessive preoccupation by the labor, social or familiar problems implies that the necessary attention is not dedicated to the sexual act. Fatigue, lack of appetite, lack of exercise, insomnia or work failure also unbalance sexual reflexes.

Vascular causes

This guy is very usual. The penis cannot accumulate the blood necessary for an erection to occur, usually because it does not arrive in sufficient quantity. Smoking, high blood pressure, diabetes, some heart disease, and increased blood cholesterol levels can cause vascular disorders that make erection difficult.

Neurological causes

In these cases, there is an interruption in the transfer of messages from the brain to the penis because there is an injury to the nerves involved. This occurs with spinal cord injuries, multiple sclerosis or after some surgical interventions in the pelvis for more information click here

Hormonal causes

They are rare. They are usually due to a lack of male sex hormones.

Pharmacological causes

There are several medications that have as a side effect decrease the ability to have an erection. Among them, there are some drugs to treat hypertension, heart disease, and psychiatric disorders.


The main symptom of erectile dysfunction is a change in the quality of the erection, both in terms of stiffness, and in the ability to maintain an erection.

If impotence is caused by physical causes, one of the main indicators in the inability to have or maintain an erection upon waking up in the morning.

On the other hand, if it is caused by psychological causes, impotence usually occurs during a specific period of time (while the stress situation lasts, for example). If it persists for more than three months, the patient should seek an urologist specialized in andrology.


The main measure that men should take into account to avoid the onset of erectile dysfunction is the modification of lifestyle to avoid any habit that negatively impacts arteries and veins, such as smoking, alcohol consumption, and saturated fats, Sedentary life and stress.


At present, some experts establish the following classification to distinguish the different types of erectile dysfunction:





For the elaboration of a correct diagnosis, it is necessary that the patient undergoes medical examinations that allow establishing a good clinical history.

An interview with the affected person may reveal psychological factors involved in the erection disorder. It is important to rule out depression, which is not always visible. The scale for Beck’s depression and the Yesavage geriatric depression scale in the elderly are simple and easy to perform.

Personal relationships should also be analyzed to determine if there are conflicts or communication difficulties with the couple. An interview with the sexual partner of the affected can reveal very important data.

On the other hand, there are currently several tests that help establish the diagnosis of erectile dysfunction. Specialists usually use mainly two: the IIEF (International Index of Erectile Function) or SHIM (Sexual Health Index for Men), a reduced variant of the IIEF consisting of 5 questions and presents high sensitivity and specificity. A score less than or equal to 21 shows signs of erectile dysfunction.

The general medical assessment should include a history of intake of drugs, alcohol, smoking, diabetes, hypertension, and atherosclerosis, an exploration of the external genitalia to rule out the presence of fibrous bands and an assessment of the signs of vascular, hormonal or neurological diseases.

Specialists recommend measuring testosterone levels, especially if impotence is associated with lack of desire.

Laboratory tests should include the assessment of thyroid function. It may also be useful to determine the lutein hormone since it is difficult to diagnose hypogonadism based on testosterone values ​​alone.

In the case of young patients with specific problems, it may be necessary to perform more complex tests in addition to the physical examination, such as a measurement-monitoring of the penis at night, the injection of medications into the penis, or an echo-Doppler read more

Determining vascular indexes is especially beneficial for a correct diagnosis, such as the penile pressure-brachial pressure index that indicates a risk of other more serious vascular disorders, even in asymptomatic patients.

When the cause is unclear, it may be effective to perform a nocturnal penile tumescence test (NPT), although it does not usually work in elderly patients. The episodes of TNP are usually associated with the phases of REM sleep. The patient’s erections can be controlled in a special sleep laboratory; their absence is highly suggestive of an organic cause, although their presence does not necessarily indicate that during the day they have valid erections.

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