Definition

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex. Having erection trouble from time to time isn't necessarily a cause for concern. But if erectile dysfunction is an ongoing problem, it may cause stress, cause relationship problems or affect your self-confidence.

Symptoms

Erectile dysfunction is the inability to maintain an erection firm enough for sex, on an ongoing basis. Symptoms related to erectile dysfunction may include:

• Trouble getting an erection
• Trouble keeping an erection
• Reduced sexual desire

When to see a doctor
A family doctor is a good place to start when you have erectile problems. See your doctor if:

• Erectile or other sexual problems are an issue for you or your partner
• You have diabetes, heart disease or another known health problem that may be linked to erectile dysfunction
• You have other symptoms along with erectile dysfunction that may not seem related

Causes

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health problems can cause or worsen erectile dysfunction. Sometimes a combination of physical and psychological issues cause erectile dysfunction. For instance, a minor physical problem that slows your sexual response may cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

Physical causes of erectile dysfunction
In most cases, erectile dysfunction is caused by something physical. Common causes include:

• Heart disease
• Clogged blood vessels (atherosclerosis)
• High blood pressure
• Diabetes
• Obesity
• Metabolic syndrome, a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
• Parkinson's disease
• Multiple sclerosis
• Low testosterone
• Peyronie's disease, development of scar tissue inside the penis
• Certain prescription medications
• Tobacco use
• Alcoholism and other forms of substance abuse
• Treatments for prostate cancer or enlarged prostate
• Surgeries or injuries that affect the pelvic area or spinal cord

Psychological causes of erectile dysfunction
The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

• Depression, anxiety or other mental health conditions
• Stress
• Fatigue
• Relationship problems due to stress, poor communication or other concerns
  
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