Erectile dysfunction
Executive summary
Erectile dysfunction (ED) is a common, often treatable medical condition defined by the recurrent inability to achieve or maintain an erection sufficient for satisfactory sexual activity, and it frequently reflects underlying physical disease rather than mere performance anxiety [1] [2]. Most men respond to first‑line treatments today, but ED should prompt medical evaluation because it can be an early warning sign of cardiovascular and metabolic disease [3] [4].
1. What ED is and how common it is
Erectile dysfunction describes persistent difficulty getting or keeping an erection adequate for intercourse; occasional episodes are common, but chronic ED affects a substantial share of men—about 40% of those aged 40–70 in some series and roughly half of men over 50 report some loss of erectile function—making it one of the most frequently presented sexual health problems in men [5] [6] [4].
2. The biology and common causes
For most men ED is rooted in physical problems—vascular disease that impairs penile blood flow and neurogenic injury are principal mechanisms—and it commonly accompanies conditions such as diabetes, hypertension, atherosclerosis, hyperlipidemia and metabolic syndrome; psychological contributors (anxiety, depression) exist but are less often the sole explanation [5] [7] [2].
3. ED as a signal of broader health risks
Because erectile function depends on healthy blood vessels and nerves, ED may be the first clinical manifestation of cardiovascular disease, and epidemiologic studies link ED with higher risks of heart attack, stroke and peripheral vascular disease, warranting cardiovascular assessment in many patients [3] [4] [8].
4. How ED is diagnosed in practice
Clinicians take a detailed medical and sexual history, perform a focused physical and cardiovascular exam, and use validated questionnaires such as the International Index of Erectile Function (IIEF) or erection hardness scales to quantify severity and monitor response to treatment; partner input is often helpful in clarifying the problem [8].
5. Established treatments and real‑world effectiveness
First‑line therapy remains oral phosphodiesterase type 5 inhibitors (PDE5‑Is) such as sildenafil and tadalafil, which improve erections for roughly seven out of 10 men and have become the cornerstone of medical management; other established options include vacuum erection devices, intraurethral agents, intracavernosal injections and penile prostheses for refractory cases [4] [9] [10].
6. Medication side effects and reversible causes
Prescription drugs are implicated in a sizeable minority of ED cases—estimated at about one‑quarter—with common culprits including many antidepressants and several antihypertensives (thiazide diuretics and beta‑blockers among antihypertensives); addressing medication causes may involve dose adjustment, drug holidays or switching agents when safe and appropriate [8] [11] [12].
7. Emerging and experimental therapies: promise and caveats
A wave of “restorative” approaches—low‑intensity shockwave therapy (LI‑ESWT), platelet‑rich plasma (PRP), stem‑cell approaches and even gene therapy—has generated interest because they aim to repair underlying tissue, but current evidence remains preliminary, with mixed results and a need for larger, well‑controlled long‑term trials before these can replace or be routinely recommended over established treatments [10] [13] [9].
8. Practical prevention and when to see a clinician
Lifestyle measures that improve cardiovascular health—smoking cessation, exercise, weight loss and glycemic and blood‑pressure control—reduce ED risk and often improve response to therapy, and anyone experiencing persistent erectile difficulty should see a healthcare provider because ED can unmask treatable systemic disease [3] [9] [2].