Erectile dysfunction
Erectile dysfunction is defined as the inability to achieve or sustain an erection that's hard enough or lasts long enough to complete sexual intercourse or another chosen sexual activity. It affects at least one in ten men.
Many men suffer for years without seeking treatment. This may be because they're too embarrassed to seek help or they're unaware that there are treatments available.
What causes it?
Most men will experience an occasional failure to get an erection. This can usually be put down to stress, tiredness, anxiety or too much alcohol. In these circumstances it's nothing to worry about.
In the past it was thought that more frequent impotence was caused by almost entirely psychological factors, but we now know that physical conditions are present in about 70 per cent of cases. However, the majority of men with erectile dysfunction experience a combination of psychological and physical causes.
Physical Causes
Diabetes : Diabetes can cause nerve and artery damage that can make achieving an erection difficult. Between 35% and 50% of men with diabetes experience ED, according the National Institutes of Health. Some estimates are higher, stating that up to 75% of men with diabetes will experience at least some degree of ED during their lifetime and the risk increases with age.
Kidney disease: Kidney disease can cause chemical changes to occur in your body that affect hormones, circulation, nerve function, and energy level. Often times these changes will lower a person's libido (sex drive) or sexual ability. Drugs used to treat kidney disease may also cause ED.
Neurological diseases: The nervous system (the body's system of nerves) plays a vital part in achieving and maintaining an erection and it is common for men with diseases such as stroke, multiple sclerosis (MS), Alzheimer's disease, Parkinson's disease and spinal cord injuries to experience ED. This is due to an interruption in the transmission of nerve impulses between the brain and the penis.
Vascular disease: Vascular diseases are those that affect the blood vessels. These diseases include atherosclerosis (hardening of the arteries), hypertension, and high cholesterol. These diseases, which account for 70% of physically-related causes of ED, all restrict blood flow to the heart, the brain and, in the case of ED, the penis.
Prostate cancer : Prostate cancer doesn't cause ED on its own, but treatment (radiation, hormonal manipulation, or surgery to remove the cancer) can lead to erectile problems.
Psychological causes
If you experience a sudden onset of impotence and can still achieve erections in some circumstances but not in others, the cause may be psychological. Psychological causes can include:
stress and anxiety from work or home
problems within your relationship
worrying about poor sexual satisfaction
depression
sexual boredom
performance anxiety
unresolved sexual orientation
Treating ED?
Most physicians suggest that treatments proceed from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Quitting smoking, losing excess weight, and increasing physical activity may help some men regain sexual function.
Cutting back on any drugs with harmful side effects is considered next. For example, drugs for high blood pressure work in different ways. If you think a particular drug is causing problems with erection, tell your doctor and ask whether you can try a different class of blood pressure medicine.
Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered.

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