Erectile Dysfunction

Definition

Erectile Dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It can be caused by vascular, neurogenic, hormonal, psychological, or medication-related factors.

Epidemiology

• Prevalence increases with age: ~5% at age 40, ~15–25% at age 65
• Estimated that 150 million men are affected worldwide
• More common in men with diabetes, hypertension, cardiovascular disease, or depression
• Lifestyle factors (smoking, obesity, alcohol) significantly contribute

Etiology

• Vascular: atherosclerosis, hypertension, hyperlipidemia, smoking
• Neurogenic: spinal cord injury, multiple sclerosis, neuropathies
• Hormonal: hypogonadism, low testosterone, hyperprolactinemia
• Psychogenic: depression, anxiety, performance stress
• Medication-induced: beta-blockers, SSRIs, diuretics, antiandrogens
• Mixed etiology common, especially in older adults

Pathophysiology

• Vascular insufficiency → inadequate blood inflow or venous leakage
• Neurogenic impairment → disrupted penile nerve signaling
• Hormonal deficiency → decreased libido and impaired erectile function
• Psychogenic factors → altered central nervous system signaling affecting erection
• Endothelial dysfunction → impaired nitric oxide-mediated vasodilation