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Erectile dysfunction (ED), also known as impotence, is a type of sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual activity. ED can have psychological consequences as it can be tied to relationship difficulties and self-image. A physical cause can be identified in about 80% of cases. These include cardiovascular disease, diabetes mellitus, neurological problems such as following prostatectomy, and drug side effects. Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but can often be helped. In psychological impotence, there is a strong response to placebo treatment. Even if the pharmaceutical industry had developed a drug to treat erectile dysfunction of psychological origin, it would probably have been withdrawn if it had caused erections in all men. This is similar to the way that antidepressant drugs are often ineffective in patients with mild depression. Psychological causes are thought to be important in about 10% of people with erectile dysfunction. The most important psychological causes of erectile dysfunction are performance anxiety and depression. Both can lead to a vicious cycle as performance anxiety causes erectile dysfunction, and erectile dysfunction can lead to performance anxiety.

Causes

Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection. It is generally caused by underlying physical or psychological problems. Common causes include:

• heart disease
• clogged blood vessels (atherosclerosis)
• high cholesterol
• high blood pressure
• diabetes
• obesity
• metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
• parkinson’s disease
• multiple sclerosis
• certain prescription medications — such as antidepressants, heart medications, and nicotine patches
• substance abuse, including alcohol and marijuana
• sleep disorders
• relationship problems

Risk factors

A number of factors increase your risk of developing erectile dysfunction. These include:

• age — the older you are, the more likely you are to experience erectile dysfunction
• smoking — smoking cigarettes, cigars, or marijuana can damage your blood vessels, affecting blood flow to your penis
• alcoholism and other forms of substance abuse — alcohol abuse can damage your nervous system, resulting in erectile dysfunction
• injury to your penis, bladder, prostate, or pelvis — an injury to your penis can cause erectile dysfunction
• chronic health conditions — such as heart disease, diabetes, or kidney disease — can damage your blood vessels and affect blood flow to your penis
• treatments for cancer — such as surgery, radiation, or chemotherapy — can damage your blood vessels and affect blood flow to your penis
• mental health conditions — such as anxiety, depression, or stress — can affect your sexual performance

Complications

Erectile dysfunction can have a negative impact on your quality of life. It can:

• decrease your self-esteem
• cause relationship problems