Erectile Disorder is a sexual dysfunction in which a man has persistent difficulty achieving or maintaining an erection sufficient for satisfactory sexual activity. This may include reduced rigidity, intermittent inability to maintain an erection, or complete failure to obtain an erection. The problem often causes personal distress and can affect relationships.
Key Features
- Difficulty obtaining an erection during sexual activity
- Difficulty maintaining an erection until completion of sexual activity
- Reduced rigidity of the penis during attempts at sexual intercourse
- Symptoms present for at least 6 months
- Causes clinically significant distress and is not better explained by medication, substance use, or another medical/mental condition
Possible Symptoms
- Inability to start sexual activity because an erection cannot be achieved
- Erection that is lost shortly after penetration or before orgasm
- Soft erections that prevent satisfactory intercourse
- Anxiety, embarrassment, reduced sexual confidence, or avoidance of sexual situations
What Causes It?
Erectile Disorder can arise from a combination of physical, psychological, and relational factors, including:
- Vascular disease (reduced blood flow to the penis)
- Diabetes, high blood pressure, high cholesterol
- Neurological conditions (e.g., spinal cord injury, neuropathy)
- Hormonal imbalances (low testosterone)
- Medications (certain antidepressants, antihypertensives, etc.)
- Excessive alcohol use, smoking, or recreational drugs
- Performance anxiety, depression, stress, or relationship problems
Severity Types
- Mild: Occasional difficulty achieving/maintaining erection; mild distress
- Moderate: Frequent difficulty with erection and noticeable distress or relationship impact
- Severe: Persistent inability to obtain or maintain an erection; significant emotional and relational impact
Diagnostic Features
Diagnosis is primarily based on the individual's report of erectile difficulties despite adequate sexual stimulation and desire. Symptoms should be present for approximately 6 months and cause significant distress. Clinicians will also consider medical history, medication review, physical exam, and relevant tests to rule out medical causes or substance effects.
Associated Features
- Performance anxiety and anticipatory worry about sexual encounters
- Decreased sexual desire secondary to repeated failures
- Partner frustration or decreased relationship satisfaction
- Coexisting mental health conditions such as depression or anxiety
Erectile Disorder is commonly treatable. Management may include lifestyle changes (stop smoking, reduce alcohol, exercise), medical treatments (e.g., oral PDE5 inhibitors when appropriate), hormonal evaluation and replacement if indicated, psychological therapies (CBT, sex therapy), and addressing relationship issues. A combined medical and psychosexual approach often gives the best results.