Virtual Medical Centre

Male Sexual Dysfunction (Erectile Dysfunction, Impotence)

• What is Male Sexual Dysfunction?
• Who gets Male Sexual Dysfunction?
• Predisposing Factors
• Progression
• Probable Outcomes
• How Will Male Sexual Dysfunction Affect Me?
• Clinical Examination
• How is Male Sexual Dysfunction Diagnosed?
• How is Male Sexual Dysfunction treated?
• Male Sexual Dysfunction References
• Drugs/Products Associated with Male Sexual Dysfunction

What is Male Sexual Dysfunction?

Erectile dysfunction is the inability to develop or maintain an erection that is rigid enough to allow penetration of the vagina, and therefore functional sexual intercourse. Generally, the term erectile dysfunction is applied if this occurs frequently (75% of the time) over a significant period if time (several weeks to months). If this is the case, the term impotence may also be used.

Erectile dysfunction may present in different ways. Some men are completely unable to develop an erection. Some may develop an erection that does not remain rigid enough to allow satisfactory intercourse.

There are several causes of erectile dysfunction, including certain drugs (prescription and non prescription), psychological causes, and problems with the hormones, nerves or blood vessels that supply the penis.

Other problems with male sexual function include a lack of sexual drive or desire (libido), problems with ejaculation (ejaculatory dysfunction), and lack of pleasurable sensation (orgasm) during sex. These problems will not be discussed in detail.

Who gets Male Sexual Dysfunction?

3D Animation on Impotence This animation brought to you by Blausen Medical Communications. Contact Andrew Walbank.

Erectile dysfunction is estimated to effect 150 million men worldwide, and more than one million men in Australia. Overall, 25% of Australian men report erectile dysfunction and 8.5% report severe erectile dysfunction. In one study, 9.6% reported 'occasional' erectile dysfunction, 8.9% reported erectile dysfunction occurring 'often', and 18.6% reported erectile dysfunction occurring 'all the time'. Of these, only 11.6% had received treatment. In another study, only 14.1% of men reported that they had received treatment, despite experiencing erectile dysfunction for longer than 12 months.

Erectile dysfunction is never 'normal', however it does become more common and more severe as men age. One Australian study reported the rate of erectile dysfunction in different age groups:

20-29 years: 9.2%
30-39 years: 8.4%
40-49 years: 13.1%
50-59 years: 33.5%
60-69 years: 51.5%
70-79 years: 69.2%
80+ years: 76.2%

Due to the aging Australian population, erectile dysfunction is expected to become more common.

There is no difference between the prevalence of erectile dysfunction between "white-collar" and "blue-collar" workers in Australia.

Sexual dysfunction associated with cancer

Between 10 and 88% of patients diagnosed with cancer experience sexual problems following diagnosis and treatment. The prevalence varies according to the location and type of cancer, and the treatment modalities used. Sexuality may be affected by chemotherapy, alterations in body image due to weight change, hair loss or surgical disfigurement, hormonal changes, and cancer treatments that directly affect the pelvic region.

Sexual problems are reported in many patients with prostate and testicular cancer. They are also reported in patients with cancer that does not directly effect sexual organs, including lung cancer (48% of patients), Hodgkin's disease (50%), and laryngeal (%60) and head and neck cancers (39-74%). 

For more information, see Sexual Difficulties Associated with Cancer in Men.

Predisposing Factors

The predisposing factors for erectile dysfunction are as follows:

• Age
• Medical conditions such as diabetes mellitus and cardiovascular disease
• Neurological conditions including or arising from dementia, multiple sclerosis, stroke, or spinal cord or back injury
• Pelvic trauma, prostate surgery, previous priapism, prolonged bike riding (> 4 hours/week, depending on seat and posture)
• Depression and stress
• High blood pressure
• Obesity
• Increased cholesterol
• Smoking
• Certain drugs (some antidepressants, particularly SSRIs; diuretics; and others)
• Alcohol and recreational drugs such as cocaine and heroin may initially stimulate sexual arousal, however long term use has been shown to lead to erectile dysfunction.

If a man has the risk factors for cardiovascular disease during middle age (smoking, obesity, high cholesterol), he is at an increased risk of developing erectile dysfunction.

Exercise has been shown to have a protective effect.

Progression

Around one third of men who experience erectile dysfunction find that, without treatment, it becomes worse over time. Around a third of men find that erectile dysfunction improves without treatment.

Around half of men with severe erectile dysfunction remain impotent in the long term without treatment.

These figures vary depending on the cause of the erectile dysfunction. Even if men choose not to pursue treatment for erectile dysfunction, it is important that they be investigated by a doctor, as erectile dysfunction may indicate an increased risk of cardiovascular disease.