impotence

Impotence, more commonly called erectile dysfunction (ED), is the persistent or recurrent inability to achieve or maintain an erection sufficient for sexual intercourse. It is defined by the pattern of symptoms over a period of time rather than a single lapse. Occasional difficulties are common and do not necessarily indicate ED.

ED can affect men of all ages but becomes more common with increasing age. It may signal underlying health problems and can have a significant impact on quality of life and relationships. Risk factors include cardiovascular disease, diabetes, hypertension, high cholesterol, obesity, tobacco use, excessive alcohol, certain medications, and hormonal disorders. Psychological factors such as stress, anxiety, depression, and relationship issues can contribute, especially in younger men.

Evaluation typically begins with a medical and sexual history, physical examination, and basic laboratory tests. Tests may assess testosterone levels, blood sugar and lipids, thyroid function, and kidney or liver function. In some cases additional studies (such as nocturnal penile tumescence testing or imaging) are used to identify vascular or neurological causes.

Treatment is multifactorial and tailored to the individual. Lifestyle changes (weight loss, exercise, smoking cessation, limiting alcohol) can improve outcomes. First-line pharmacotherapy usually involves phosphodiesterase type 5 inhibitors (such as sildenafil, tadalafil, vardenafil, or avanafil), unless contraindicated. Other options include alprostadil (injections or urethral suppositories), vacuum erection devices, penile implants, or vascular or hormonal therapies when indicated. Psychological therapies may help when stress or anxiety play a major role. Managing comorbid conditions often improves ED and overall health.

ED is often treatable, and many men respond to therapy. It may also be an early warning sign of vascular disease, underscoring the importance of medical evaluation.