Erectile dysfunction (ED) or impotence means inability to get or keep an erection long enough for sexual intercourse.

ED can be the first sign of a serious condition such as heart disease.

Causes of ED:

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these.

 In general, ED can be organic or psychogenic.

Causes of organic erectile dysfunction can include:

  • Ischemic heart disease
  • Hypercholesterolemia
  • Hypertension
  • Diabetes
  • Obesity
  • Parkinson's disease
  • Multiple sclerosis
  • Low testosterone
  • Peyronie's disease (development of scar tissue inside the penis)
  • Some medications
  • Alcoholism and drug abuse
  • Surgeries or injuries that affect the pelvic area or spinal cord

Causes of psychogenic recectile dysfunction can include:

  • Depression
  • Anxiety
  • Stress

Tests and diagnosis

A detailed medical history and a physical examination are sometimes sufficient to start treatment. However, there are few tests should be done before treatment including a blood test and penile Doppler.


A variety of options exist for treating erectile dysfunction. Before taking any medication for ED, patients should be evaluated by the urologist.  

Oral medications
Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra)

These medicines work in much the same way as each other by increasing the blood flow in the penis to get an erection in response to sexual stimulation. They vary in dosage, how long they work and their side effects.

Possible side effects include flushing, nasal congestion, headache, visual changes and stomach upset.

Other treatment options include:

  • Alprostadil injection into the penis which produces an erection that lasts about an hour. Side effects include bleeding from the injection, prolonged erection and formation of fibrous tissue at the injection site.
  • Alprostadil penis suppository (Muse) in the penile urethra. The erection usually starts within 10 minutes and lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra, and formation of fibrous tissue in the penis.
  • Vacuum penis pumps can be useful for some patients.
  • Penile implants involve surgically placing devices into the two sides of the penis. This treatment is usually not recommended until other methods have been tried first.
  • Blood vessel surgery. In rare cases, leaking or obstructed blood vessels can cause erectile dysfunction and surgery is necessary to repair them.
  • Psychological counselling for psychogenic ED.
  • Lifestyle modification including stopping smoking, losing weight, doing exercise, reduing alcohol intake.