Erectile dysfunction (ED) is the inability to get or keep a firm erection sufficient for sexual intercourse.
In an erection, impulses from the brain and local nerves cause the muscles of the corpora cavernosa, two chambers in the penis, to relax and allow blood to flow in through the arteries and fill the spaces. The engorged chambers expand the penis and the tunica albuginea, a membrane covering the two chambers, helps to sustain the erection. The erection ends when muscles in the penis contract to stop the inflow of blood and open the veins for blood outflow.
These may be classified into several categories :
Patient history. A person’s medical and sexual histories will help define the degree and nature of ED. The medical history can disclose diseases leading to ED, and a simple recounting of sexual activity may identify problems with sexual desire, erection, ejaculation or orgasm.
Use of certain drugs can suggest a chemical cause as drug effects are a frequent cause of ED.
Physical examination. A physical examination can give clues to systemic problems. For example, if the penis is not sensitive to physical touch, a problem in the nervous system may be the cause. Abnormal secondary sex characteristics, such as unusual hair pattern or breast enlargement, can point to hormonal problems, which would mean the endocrine system is involved.
The doctor may discover a circulatory problem by observing a decreased pulse rate in the wrist or ankles. Unusual characteristics of the penis itself could suggest the source of the problem—for example, a penis that bends or curves when erect could be the result of Peyronie’s disease.
Laboratory tests. Tests for systemic diseases include blood counts, urinalysis, lipid profi le, and measurements of creatinine and liver enzymes. Measuring the amount of available testosterone in the blood can yield information on problems with the endocrine system and may explain why someone has decreased sexual desire.
Psychosocial examination. A psychosocial examination, using an interview and a questionnaire, can reveal psychological factors. A man’s sexual partner may also be interviewed to determine expectations and perceptions during sexual intercourse.
Treatment options may include :