Erectile dysfunction

There is a machine, there is will power to work it and move it but it won’t move because certain things aren’t right and if you try to force it without correcting the deficiencies, you won’t make it that far and this will disappoint everyone but it will mostly disappoint and crush your ego as a man. This allegorical representation mirrors and is typical of erectile dysfunction/impotence whose badge and signature is a flaccid male penis.

Erectile dysfunction is characterized by the inability to maintain an erection of the penis during sexual activity.

Causes: There are numerous reasons to explain the causes of erectile dysfunction but for about 80% of the cases, there is always an underlying physical cause. This will follow diseases such as:

  1. Cardiovascular disease: High blood pressure that is persistent for long periods can damage the lining of your arteries and interfere with blood flow which in turn affects the ability to get and maintain an erection.
  2. Diabetes: This is due to the effect of diabetes on the blood stream and possible damage of nerves that control an erection.
  3. Drug side effects: Prescription drugs such as SSRIs, Beta blockers, alpha-2 adrenergic receptor agonists, thiazides, hormone modulators and 5-alpha reductase inhibitor, many of which are taken chronically for the treatment of long term illnesses, these can cause erectile dysfunction.
  4. Prostatectomy surgery
  5. Hypogonadism (Low testosterone): Although disorders of the endocrine system are the rarest in all known major causes of erectile dysfunction.
  6. Hyperprolactinaemia due to prolactinoma
  7. Neurogenic disorders e.g. Diabetic neuropathy, temporal lobe epilepsy, multiple sclerosis, Parkinson’s disease, multiple system atrophy.

There are other causes of impotence, although limited, where failure of an erection is due to psychological causes characterized by thoughts and feelings. Feelings maybe due to a poor self-image and thoughts that tend to become an overwhelming distraction, thus affecting the psyche and hindering prolonged erections.

These psychological causes may also include perfection anxiety, stress and other mental disorders.

Lifestyle habits such as smoking which promotes arterial narrowing and chronic alcoholism and/or liver disease which may induce hyper estrogenic state resulting in low freely circulating testosterone may cause of erectile dysfunction.

Impotence can cause problems such as relationship difficulties and also affect a person’s self-image.

Diagnosis: This is usually through history of symptoms and a physical examination to determine underlying causes which determines mode of treatment and its outcome. There is a need to distinguish between psychological and physiological causes of erectile dysfunction, as the presence of involuntary erections is important in eliminating the possibility of psychogenic causes of erectile dysfunction.

Full erections such as in nocturnal penile tumescence when asleep, which is a time when psychological causes are less present or all together absent gives great insight into the condition.

Treatments: The treatment and its outcome usually depends on actions taken to treat underlying cause.

If the cause is psychological, counseling of patients has proven helpful to help lower stress and anxiety.

Working out and aerobics have been shown to be helpful in erectile dysfunction during the midlife stage.

Treatments other than surgery do not usually fix the underlying physiological problem but are used as needed before sex.

Sildenafil, tadalafil and vardenafil are prescription drugs of the PDE5 inhibitors class that are used to treat erectile dysfunction. Penile injections of papaverine and alprostadil (which also exists as a suppository to be inserted into the urethra) have also been used to treat erectile dysfunction. The most common side effect is priapism which is a persistent erection that continues hours beyond or isn’t caused by sexual stimulation.

Prosthetic implants which involved insertion of artificial rods into the penis have been used, often as last resort treatments.

There are many remedies available on market that have been proposed to help with erectile dysfunction but many of these other “Natural” or “Herbal” remedies haven’t undergone the rigorous research and studies to ascertain their effectiveness in managing erectile dysfunction. Many have been found to have been adulterated with drugs such as sildenafil which poses a great health risk for the consumers using these products and it’s however advisable that one seeks medical advice before using these products.


  1. Chowdhury SH, Cozma AI, Chowdhury JH. Erectile Dysfunction. Essentials for the Canadian Medical Licensing Exam: Review and Prep for MCCQE Part I. 2nd edition. Wolters Kluwer. Hong Kong. 2017.
  2. Wespes E (chair), et al. Guidelines on Male Sexual Dysfunction: Erectile dysfunction and premature ejaculation. European Association of Urology 2013

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