Definition:

Erectile dysfunction is defined as the inability to reach erection or sustain it long enough for satisfactory coitus.

Another definition is ” Erectile dysfunction is defined as the consistent inability to maintain an erect  penis with sufficient rigidity to allow sexual intercourse.

Erectile dysfunction is not considered a normal part of aging process.

Types of erectile dysfunction/impotence:

Erectile dysfunction may be primary or secondary.

Secondary erectile dysfunction (erectile dysfunction due to other causes eg drugs) is the commonest type.

Primary erectile dysfunction- Never had erection before. This is very rare and due to physical causes such as neurological damage.

Incidence and prevalence:

Erectile dysfunction affects 10 million American men.

Approximately 25% of all men older than 65 years of age suffer from this disorder.

According to the MMAS (Massachusetts male aging study-community survey of men between the ages of 40 and 70), 52% of respondents reported some degree of erectile dysfunction. There was complete erectile dysfunction in 10% of respondents, moderate erectile dysfunction in 25% and minimal erectile dysfunction in 17%. The incidence of severe and moderate erectile dysfunction was increased between the ages of 40 and 70.

According to the NHSLS (National health and social life survey-USA) 10% of men responded that they were not able to maintain an erection. The incidence was highest among men in the 50 to 59 age group.

Common causes of secondary erectile dysfunction:

i) Alcohol abuse

ii) Diabetes

iii)Anxiety about sexual performance.

iv)Side effects of drugs-see below.

v)Arteriosclerosis.

vi) Other physical diseases such as pelvic autonomic neuropathy, hyperprolactinaemia and rectal surgery.

Drugs associated with erectile dysfunction- eg of secondary cause

Antihypertensives

Calcium channel blockers

Methyldopa

Clonidine

Reserpine

Beta blockers

Guanethidine

Diuretics

Spironolactone

Thiazides

Antidepressents

Selective serotonin reuptake inhibitors

Lithium

Tricyclic antidepressants

Monoamine oxidase inhibitors

Cardiac

Digoxin

Anti-hyperlipidemics

Gemfibrozil

Clofibrate

Tranquilizers

Butyrophenones

Phenothiazines

H-2 Antagonists

Ranitidine

Cimetidine

Cytotoxic agents

Cyclophosphamide

Methotrexate

Roferon-A

Recreational Drugs

Ethanol

Cocaine

Marijuana

Anticholinergics

Disopyramide

Anticonvulsants

Hormones

Progesterone

Estrogens

Corticosteroids

GnRH agonists

5-alpha reductase inhibitors

Cyproterone acetate.

Investigations and management of male erectile dysfunction will be covered in a subsequent post.

The detailed causes and pathophysiology of erectile dysfunction will also be covered in a subsequent post.

References:

Lack of libido and erectile dysfunction, page 1055,Chapter 18 .Endocrine Disease-Reproduction and Sex. Clinical Medicine by Kumar and Clark ,Sixth edition.Edited by Parveen Kumar and Michael Clark.

Pages 297 to 299,Male erectile dysfunction.Chapter 14,Problems of Sexuality and Gender. Psychiatry 2nd edition Oxford Core Texts by Michael Gelder, Richard Mayou and John Geddes.

Pages 272 to 274,Chapter 43. Sexual dysfunction. Part II Cardinal Manifestations and Presentation of Diseases. Harrison’s Principles of Internal Medicine, 16th Edition by Kasper, Braunwald, Fauci, Hauser, Longo and Jameson. Volume I. Mc Graw Hill publication.

Pages 950 to 952, Male Erectile Dysfunction and Sxual Dysfunction.Chapter 23 .2006 Current Medical Diagnosis and Treatment 45th edition. Edited by Lawrence M Tierney,Jr. Stephen J. McPhee and Maxine A. Papadakis.

No related posts.

 

You are welcome to discuss this post/related topics with Dr Shihaan and other experts from around the World in our Pregnancy, Gynaecology and Baby health Forums (www.askdrshihaan.org/forums/).