Erectile dysfunction or disorder (ED) is the inability to develop and maintain an erection for satisfactory sexual intercourse or activity.

Erectile dysfunction or erectile disorders are the preferred terms as opposed to impotence.

Signs and Symptoms

Some self-administered measures may be useful in the primary care setting to screen for and evaluate the degree of ED.

The most commonly used instrument is the International Index of erectile function, a 15-item questionnaire that has been validated in many populations and is considered the gold standard to evaluate patients for ED.

The Sexual Health Inventory for Men is a short-form, 5-item questionnaire developed to monitor treatment progress.

ED Key Information

Male sexual dysfunction can present in different ways—the most common manifestations are as follows:

  • erectile impotence: inability to sustain an erection;
  • inhibited male orgasm (ejaculatory impotence): inability to achieve orgasm inside the woman’s vagina, although he may achieve orgasm via other methods;
  • premature ejaculation: ejaculation occurs before or immediately after entering the vagina.

Usually, erectile dysfunction (ED) is defined as a persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance that often lasts for more than 6 months.

It’s important to note that even if a man can achieve an erection in private, he can still not use it for satisfactory sexual activity that is defined as ED. Many men may be able to get an erection without a partner present, but if a man cannot use the erection for a sexual activity he is defined as having ED.

A man must not be able to achieve an erection rigid enough for sexual activity on several accounts (defined as long as 6 months by the NIH), not just one time, in order to have the definition of ED.

The ability to treat a patient for ED revolves around a man’s inability to have enjoyable and satisfactory (per his account) sexual activity. The principles of ED treatment are:

  • restoring sexual enjoyment;
  • enhancing sexual function;
  • optimizing the quality of life for both a man and his partner;
  • improving personal relationships.

What are the causes of ED?

The most common causes of erectile dysfunction are:

  • hypertension;
  • cardiovascular disease;
  • dyslipidemia;
  • diabetes mellitus;
  • lifestyle factors (lack of exercise, poor nutrition, etc.);
  • alcohol use;
  • obesity;
  • physical inactivity;
  • smoking;
  • low-testosterone levels.

What are the different types of ED?

While there are a variety of conditions that cause ED, each condition affects the body differently (pathophysiology). It is important not only to define the cause of ED but also to identify the underlying pathophysiology.

There are several underlying mechanisms that cause ED. They are:

  • psychogenic ED (an erection or penetration fails due to thoughts or feelings);
  • neurogenic ED (an inability to sustain or maintain a penile erection owing to a neurological impairment);
  • vasculogenic ED (an organic erectile dysfunction and may be due to abnormalities in penile arterial inflow or venous outflow);
  • iatrogenic ED (an erectile disorder caused by smoking, poor diet, physical inactivity, and being overweight or having obesity).

Endocrine Causes:

  • low-T;
  • elevated estrogen levels;
  • elevated SHBG.


If it is determined that ED is a problem, the patient evaluation should include a detailed sexual and medical history and a physical exam. In particular, it is important to evaluate the ED within the context of ejaculatory problems.

A number of specific questions relating to sexual function can help the clinician evaluate the complaint of ED. Additional questions relating to medical history and psychosocial factors also need to be evaluated.

Once a complete sexual and medical history has been completed, appropriate laboratory studies should be conducted. In most cases, a tentative diagnosis can be established with a complete sexual and medical history, physical examination, and limited or no laboratory testing.

Hormone replacement therapy is provided by our clinic as a part of erectile dysfunction treatment among other available procedures. To learn more about the causes of ED and its treatment apply for a free consultation with one of our experts.