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Erectile dysfunction (ED), also known as impotence, is the inability to achieve or maintain an erection adequate for sexual intercourse. With ED, a man cannot achieve or maintain an erection at least 50 percent of the time that he attempts intercourse. This term is not used to describe the temporary inability to achieve an erection. Most men experience occasional erectile failure at some time during their lives, usually because of fatigue, temporary stress, or excessive alcohol consumption. But ED is a chronic condition and can have identifiable physical causes.

The most common cause of ED - especially in men over age 50 - is a circulation problem. Normally, blood fills the arteries and the spongy tissue in the penis, making it erect. With age, generalized atherosclerosis (hardening of the arteries) may limit blood flow to the penis. Clogged penile arteries prevent enough blood from filling the penis to make it erect.

Because the penis needs enough blood to become erect, any disorder that reduces the amount of blood that can pass through blood vessels can cause ED. ED can also result from a blood clot or surgery that impairs blood flow to the penis. In many men with ED who have normal nerve and hormone function, the blood flows into the penis properly, but flows out too quickly.

A sudden loss of the ability to get an erection often has a psychological cause. Just as an erection can result from thinking about sex, negative thoughts can prevent an erection. Typically, patients whose ED is primarily psychological continue to have erections while they sleep or when they get up in the morning.

Psychological causes of ED include:
1. Stress
2. Worry About Poor Sexual Performance
3. Conflict Between a Man and His Sexual Partner
4. Depression
5. Unresolved Sexual Orientation
6. Fear of Intimacy
7. ED itself can become a source of psychological stress. This, in turn, can worsen ED.

Typically, erectile dysfunction (ED) is diagnosed after a man tells his healthcare provider about his symptoms. ED is used to describe a chronic condition in which a person cannot achieve or maintain an erection at least 50 percent of the time he attempts intercourse. To accurately diagnose the problem and whether the cause is physical or psychological, a healthcare provider will generally ask the man about psychological factors such as stress and sexual desire, and whether or not the man is able to get an erection at times when he is not attempting to have sex.

Men usually have erections while they are sleeping. It is normal for men to have between two and six erections every night. Men who don't have erections during sleep usually have a physical cause for ED. On the other hand, men who have erections during sleep are generally diagnosed as having ED that stems from psychological causes. Because of this difference, the monitoring of erections during sleep has become an important method of distinguishing physical vs. psychological causes of ED.

The healthcare provider will also review the man's history of vascular, pelvic, rectal, or prostate surgery. Chronic conditions such as heart disease, diabetes, liver or kidney failure are considered, as well as lifestyle factors such as smoking and alcohol consumption. Also, any changes in male sex characteristics - such as breast, testicular, and penile size - and changes in the hair, voice, and skin are taken into account. Any drugs or medications the man takes are also important in diagnosing ED.

Blood samples may be taken to measure testosterone levels. Having too little testosterone can cause ED and lead to breast enlargement, loss of pubic hair, and smaller, softer testicles. Measurement of blood pressure in the legs may indicate a problem with the arteries in the pelvic area that supply blood to the penis.

The blood vessels of the penis can be evaluated by an ultrasound exam. Another test involves injecting the penis with drugs that dilate the arteries. If the injection doesn't cause an erection or if the man can't maintain an erection, the penile veins may be leaky and unable to hold blood in the penis.

Because the causes of erectile dysfunction (ED) are so varied there are no commonly accepted guidelines for avoiding ED. There are, however, a number of lifestyle changes that can reduce your risk of getting ED.

These include:
1. Eat a low-fat diet. In the same way that fat and cholesterol can clog your arteries to the heart, they can also clog other arteries - including those that permit blood to flow to the penis to create an erection. Eating a low-fat diet can also help keep weight in a healthy range, which reduces the risk of obesity and diabetes. Diabetes and obesity are both associated with ED.

2. Don't smoke. Smoking causes blood vessels throughout the body to get smaller, which reduces the amount of bloodflow to the penis. Even smoking just two cigarettes can prevent a sufficient erection. In certain studies, over 80 percent of men with ED were current or former smokers. Studies suggest that the effect depends on the amount a man smokes. ED is more than twice as common among heavy smokers than non-smokers.

3. Exercise. Exercise can improve cardiovascular health and increase overall blood flow. It also can prevent diabetes and obesity, causes of ED.

There are several medical options for treating erectile dysfunction (ED). The type of treatment depends on the cause of the ED. Physical causes can be treated with medications, mechanical devices, and surgery, if needed. Urologists (physicians who specialize in the care of the genital and urinary tracts) are typically the most knowledgeable about ED. They are usually the most qualified specialists to diagnose and treat the physical causes of ED.

ED that is caused by psychological disturbances is usually treated with psychotherapy or sex therapy. Medication may also be prescribed. Psychiatrists and psychologists are often the best types of specialists to treat ED related to mental and emotional factors.