You can't get an erect penis

Erectile dysfunction: diagnosis and treatment

Erectile dysfunction has replaced the term impotence to define the inability to achieve and maintain an erection satisfactory for sexual performance.

Many international epidemiologic studies over the past decade have reported on the incidence and prevalence of erectile dysfunction in the male population. Based on extrapolated data from the Massachusetts Male Aging Study (MMAS), erectile dysfunction affects some 20-30 million American men most of whom are older than 50 years. It has been estimated by this study that 5% of men in their 40s, 10% of men in their 60s, and 20% of men in their 70s will have complete erectile dysfunction.

This epidemiologic study of a homogeneous suburban Boston community surveyed 1709 men and reported 52% of men aged 40-70 years had some degree of erectile dysfunction. Of these, 10% had complete erectile dysfunction, 25% moderate and 17% minimal.

The prevalence of erectile dysfunction increased with age with moderate and complete erectile dysfunction increasing most markedly. The percentages of erectile dysfunction were increased further by the addition of risk factors for erectile dysfunction especially those for vascular disease including history of cardiac disease, antihypertensive or vasoactive drug use and tobacco use.

From 1987 to 1997, 847 of 1297 men at risk for erectile dysfunction and without initial erectile dysfunction at baseline were followed longitudinally for additional evaluation. In this homogeneous group of white suburban American men, the incidence of erectile dysfunction was found to be 25.9 cases per 1000 man years with annual incidence rates increasing with each decade. Incidence was 12.4 cases per 1000 man years for men age 40-49 years, 29.8 for men age 50-59 years, and 46.4 for men age 60-69 years.

The age-adjusted risk for erectile dysfunction in this group of men was higher when risk factors were added. Diabetics had a risk of 50.7 per 1000 man years, treated heart disease 58.3, and treated hypertension 42.5. The authors estimated that the number of new cases of erectile dysfunction in white American men of the same age group would be approximately 600 to 700 within each patient group.

Worldwide prevalence of erectile dysfunction

Population Age (years) % affected

Cologne, Germany, 30-80, 19.2
Spain, 25-70, 18.9
Perth, Australia, 40-69, 33.9
Krimpen, the Netherlands, 50-78, 11.0
London, UK, 16-78, 19.0

Erectile dysfunction: diagnosis and treatment

European and international studies have likewise demonstrated similar prevalence to that of the MMAS. Spector and Boyle reported 32% of British men had difficulty obtaining an erection, 20% with difficulty maintaining erection. In a younger group of men aged 18-29 years from Denmark, FuglMeyer and Fugl-Meyer reported a 5% prevalence of erectile dysfunction even in these younger individuals.

Until the early 1980s, erectile dysfunction was suspected to be principally psychological in nature. It was widely published in the 1970s that more than 90% of men with impotence had a psychological basis for their condition. Pioneering studies in the past two decades have elucidated the physiology of erectile function and its pathophysiology. These studies have changed the understanding of erectile dysfunction and erectile physiology.

Penile function as elucidated by these studies is a complex process requiring a combination of neurological, endocrinological, psychological factors, and the vascular system for satisfactory function. The causes of erectile dysfunction are, therefore, frequently overlapping and multifactorial. In order to understand the causes and treatment for erectile dysfunction, it is important to review the penile anatomy and physiology of erectile function.

Risk factors for erectile dysfunction

  • Diabetes mellitus
  • Cardiovascular disease
  • Spinal cord injury
  • Cigarette smoking
  • Depression
  • Atherosclerosis
  • Hypertension
  • Pelvic surgery/trauma
  • Medications
  • Arthritis
  • Peripheral vascular disease
  • Renal failure
  • Substance abuse
  • Endocrine abnormalities
  • Peptic ulcer disease

Home ] Anatomy of the penis continued ] [ Your penis doesn't get erect - Erectile dysfunction - diagnosis and treatment ] Prostate cancer and the PSA test ] Penis won't become erect - what you can do ] Surgery on the penis for erectile dysfunction ] Peyronies' penis and erectile problems ] Freud's theory of infantile sexuality ] Delayed ejaculation ]