Erectile dysfunction (impotence) is an inability to achieve or maintain an erection of the penis required to achieve satisfactory coitus (sexual intercourse).
Erections may last for a few minutes up to half an hour. There are several causes for a short-lived erection. These include, stress, mood, fatigue, outside distractions, excess alcohol prior to attempted coitus, drug/substance abuse .
Priapism is an abnormal persistent erection of the penis – usually painful and is not related to erectile dysfunction where an erection for purpose of coitus is not achieved. Priapism causes penile erection for hours or more and may require medical intervention.
There are numerous (often complex) conditions that result in an inability in achieving and/or maintaining penile erection – ranging central and peripheral nervous system pathways, cardiovascular, respiratory, hormonal and psychological and psychiatric pathology.
Any abnormality in these systems, whether from medication or disease, has a significant impact on the ability to develop and sustain an erection, ejaculate, and experience orgasm.
Age and erectile dysfunction
Age plays a significant role in the onset of erectile dysfunction (Massachusetts Male Aging Study):
- 40 – 70 years – 52%
- 50 – 60 years – 60%
- 70+
Comorbidity
Comorbid disease plays a significant role in penile dysfunction, the most important of which are:
- Stress
- Hyperlipidaemia,
- Diabetes mellitus
- Hypertension and anti-hypertension drugs
- Depression and anti-depressant drugs
- Coronary artery disease and atherosclerosis
- Alcohol excess immediately prior to intercourse
- Alcohol dependence
- Sleep apnoea
- Chronic obstructive pulmonary disease
Treatment
Drugs
Oral medication (phosphodiesterase type 5 (PDE5) inhibitors) should be used as first-line therapy. These include –
- Sildenafil
- Vardenafil
- Tadalafil
- Avanafil
Penile injections
- Coverlet, etc.
- Injected, implanted, or topically applied medications
- External vacuum and constriction devices
- Surgery
External devices
- Vacuum devices to draw blood into the penis.
- Constriction devices placed at the base of the penis to maintain erection.
Pre-coital stimulation (foreplay)
- Fellatio
- Fantasy play
- Partner-assisted masturbation
Sources, references & citations
- Sooriyamoorthy T, Leslie SW. Erectile Dysfunction (Impotence). 2020 Jan. [QxMD MEDLINE Link]. [Full Text].
- Eddy Device: Medically reviewed by Matt Coward, MD, FACS — By Danielle Dresden — Updated on Feb 15, 2023
- [Guideline] Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, et al. Erectile Dysfunction. American Urological Association. Available at https://www.auanet.org/guidelines/male-sexual-dysfunction-erectile-dysfunction-(2018). 2018; Accessed: October 13, 2020.
©Jack van Niftrik 2023
