Impotence or Erectile Dysfunction: Symptoms, Causes, Risk Factors, Complications, Prevention and Treatment

It is the inability to obtain and maintain an erection firm enough for a sexual relationship.

Having erection problems from time to time is not necessarily cause for concern. However, if erectile dysfunction is a continuous problem, it can cause stress, affect your self-confidence and contribute to relationship problems.

The problems of getting or maintaining an erection can also be a sign of an underlying health problem that needs treatment and a risk factor for heart disease.

If you are concerned about erectile dysfunction , talk to your doctor, even if you are embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction.

In other cases, medications or other direct treatments may be necessary.


The symptoms of erectile dysfunction may include persistence with:

  • Problems to get an erection.
  • Problems to maintain an erection.
  • Reduction of sexual desire.

When to see a doctor?

Consult your doctor if:

  • You have doubts about your erections or are experiencing other sexual problems, such as premature or late ejaculation .
  • You have diabetes, heart disease or another known health condition that could be related to erectile dysfunction.
  • It has other symptoms along with erectile dysfunction.

Causes of Impotence

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels.

Erectile dysfunction can be the result of a problem with any of these. Similarly, concerns about stress and mental health can cause or worsen erectile dysfunction.

Sometimes, a combination of physical and psychological problems causes erectile dysfunction. For example, a minor physical condition that delays your sexual response can cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

Physical causes of erectile dysfunction

  • Heart disease.
  • Clogged blood vessels ( atherosclerosis ).
  • High cholesterol.
  • High blood pressure
  • Diabetes.
  • Obesity.
  • Metabolic syndrome: a condition that involves an increase in blood pressure, high insulin levels, body fat around the waist and high cholesterol.
  • Parkinson’s disease
  • Multiple sclerosis.
  • Certain prescription medications
  • The consumption of tobacco.
  • Peyronie’s disease: development of scar tissue inside the penis.
  • Alcoholism and other forms of substance abuse.
  • Sleep disorders.
  • Treatments for prostate cancer or enlarged prostate.
  • Surgeries or injuries that affect the pelvic area or the spinal cord.

Psychological causes of erectile dysfunction

The brain plays a key role in unleashing the series of physical events that cause an erection, beginning with feelings of sexual arousal. Several things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

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

Risk factors of impotence

As a man ages, erections may take longer to develop and may not be as firm. You may need a more direct touch to your penis to get and maintain an erection. Various risk factors can contribute to erectile dysfunction, which include:

  • Medical conditions, particularly diabetes or heart conditions.
  • Tobacco use, which restricts the flow of blood to the veins and arteries, can, over time, cause chronic health conditions that lead to erectile dysfunction.
  • Being overweight, especially if you are obese.
  • Certain medical treatments, such as prostate surgery or radiation therapy for cancer.
  • Injuries, especially if they damage the nerves or arteries that control erections.
  • Medications, including antidepressants, antihistamines, and medications to treat high blood pressure , pain, or conditions of the prostate
  • Psychological conditions, such as stress, anxiety or depression.
  • Use of drugs and alcohol, especially if you are a long-term drug user or a heavy drinker.


Complications that result from erectile dysfunction may include:

  • An unsatisfactory sexual life.
  • Stress or anxiety
  • Shame or low self-esteem
  • Couple problems
  • The inability to impregnate your partner.

Impotence treatment

The good news is that there are many treatments and most men will find a solution that works for them. The treatments include:

Pharmacological treatments:

Men can take a group of medicines called PDE-5 inhibitors (phosphodiesterase-5). Most of these pills are taken 30 to 60 minutes before having sex, the best known is the blue tablet sildenafil (Viagra).

Other options are: Vardenafil (Levitra) Tadalafil (taken as a once-a-day pill called Cialis) avanafil (Stendra). PDE-5 inhibitors are only available by prescription.

A doctor will check the heart conditions and ask about other medications that are taken before prescribing. Side effects associated with PDE-5 inhibitors include:

  • Redness
  • Visual abnormalities.
  • Hearing loss.
  • Indigestion.
  • Headache.

Less common medication options include prostaglandin E1, which is applied locally either by injecting it into the penis or inserting it into the opening of the urethra.

Most men prefer a pill, however, so these locally acting drugs tend to be reserved for men who can not take oral treatment.

Vacuum devices

Vacuum-erection devices are a mechanical way of producing an erection for men who do not want or can not use medication treatments or who are not working.

The penis becomes stiff by using a vacuum pump sealed around it that draws blood. This is avoided after leaving the penis through the use of an accompanying band. The lack of spontaneity with the use of vacuum devices means that many men prefer other treatments.

Surgical treatments

Penile implants: they are a final option reserved for men who have not been successful with other treatments.

Vascular surgery: another surgical option for some men is vascular surgery, which attempts to correct some causes of blood vessel dysfunction. Surgery is a last resort and will only be used in the most extreme cases. Recovery time varies, but success rates are high.

Do dietary supplements and alternative treatments work?

The short answer is no. There are no studies that suggest exactly, or evidence to support the use of dietary supplements, such as herbal pills.

How to prevent impotence

Making healthy lifestyle choices and managing any existing health condition is the best way to prevent erectile dysfunction. For example:

  • Work with your doctor to control diabetes, heart disease or other chronic conditions.
  • Consult your doctor for regular check-ups and medical review exams.
  • Stop smoking, limit or avoid alcohol, and do not use illegal drugs.
  • Exercise frequently
  • Reduce stress.
  • Get help for anxiety, depression or other mental health concerns.