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Erectile dysfunction or male sexual impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis for sexual intercourse. Erectile dysfunction is different from other conditions that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. Men are able to ejaculate without an erection; however, erectile dysfunction is regardless of the capability of ejaculation.

There are various underlying causes that are medically reversible. We want to focus on the evaluation and treatment of erectile dysfunction.

Erectile dysfunction (ED, impotence) varies in severity; some men have a total inability to achieve an erection, others have an inconsistent ability to achieve an erection, and still others can sustain only brief erections. The variations in severity of erectile dysfunction make estimating its frequency difficult.

Many men also are reluctant to discuss erectile dysfunction with their doctors, and thus the condition is under-diagnosed. Nevertheless, experts have estimated that erectile dysfunction affects 30 million men in the Untied States over a broader age range. The causes of erectile dysfunction may be physiological or psychological. Psychological impotence can often be helped by almost anything that the patient believes in; there is a very strong placebo effect.

Due to its embarrassing nature and the shame felt by sufferers, the subject was taboo for a long time, and is the subject of many urban legends. Folk remedies have long been advocated, with some being advertised widely since the 1930s. The introduction of perhaps the first pharmacologically effective remedy for impotence, sildenafil (trade name Viagra), in the 1990s caused a wave of public attention, propelled in part by the news-worthiness of stories about it and heavy advertising.

Erectile dysfunction is characterized by the inability to maintain erection. Normal erections during sleep and in the early morning suggest a psychogenic cause, while loss of these erections may signify underlying disease, often cardiovascular in origin. Other factors leading to erectile dysfunction are diabetes mellitus, which causes neuropathy, or hypogonadism, a decreased testosterone levels due to disease affecting the testicles or the pituitary gland.

Because male impotence is somewhat open to definition, it is tough to accurately estimate the number of sufferers. There are no universally agreed-upon criteria for how consistent an erection problem has to be and for how long it has to continue in order for it to qualify as ED. Plus, it can be hard to determine the number accurately because many men don't like to about it.

But some studies suggest that 20% of men in their 50s, and about 18 million Americans between the ages of 40 and 70, have male impotence to some degree. Worldwide, it's estimated that ED affects about 100 million men. And male impotence need not be chronic to make its presence felt. Other studies suggest that almost all men experience occasional difficulty getting or maintaining an erection. In many cases, it's just temporary and needs only short term treatment.

Poor physical and emotional health can contribute to male impotence. Erectile Dysfunction also is associated with medical conditions such as diabetes, hypertension, high cholesterol and prostate disease. The more factors affect a man, the higher his risk of ED. Age can also be a concern. Male impotence is more likely to happen as a man gets older, particularly after he's 60.

Nevertheless, age itself does not cause male impotence. Rather, it is the more frequent occurrence in of certain health issues in older men, such as vascular diseases and diabetes that accounts for the increase in male impotence with age.

Erections reflect the brain's complex interaction with the penis/pelvic area. Nerves and chemicals cause the penis muscles to relax and allow blood flow to the penis to increase, resulting in an erection. Anything that interferes with this intricate process can cause erectile dysfunction.

Physiological disorders: Diabetes, high blood pressure, cholesterol elevation and some cardiovascular conditions can block blood vessels and impair blood flow to the penis. Certain hormone problems and medications can also cause ED.

A stroke or multiple sclerosis, for example, can interfere with the brain's ability to communicate with the rest of the body. Such miscommunication during sexual functioning could cause ED. If different areas of the brain, nerves, or spinal cord are damaged, proper messages will not be relayed to the penis.

Psychological: ED can stem from relationship problems, performance anxiety, stress (job, family, financial), a history of sexual abuse, guilt or fear associated with sexual behavior, and depression or other mental illnesses.