What is Erectile Dysfunction (Impotence)?

The inability of a man to get or maintain an erection hard enough to be able to have sexual intercourse is what is commonly referred to as erectile dysfunction, also colloquially known as impotence. You can find more information below.

What is erectile dysfunction?

Erectile dysfunction, also known as impotence, is a condition in which a man cannot get an adequate erection. In this case, the penis may have trouble getting erect or it may deflate again shortly after it becomes erect.

If these and similar conditions continue for six months and two-thirds of erection attempts fail, it is considered a disorder and should be treated. If you only have occasional erection problems, this is perfectly normal.

The older a man is, the greater the risk of developing impotence. There are many physical and psychological reasons for this. In most cases, erectile dysfunction can be successfully treated with medication, mechanical aids, or psychotherapy.

What causes erectile dysfunction?

It is not known exactly how many men in the world suffer from impotence. The number of unreported cases is probably very high, as this is an issue that is not shared with anyone and many men do not go to the doctor out of embarrassment.

This is why experts estimate that around 5% of men are affected. The risk of impotence increases with age. Accordingly, approximately one in ten men in the 40 to 49 age group and one out of every three men in the 60 to 69 age group are affected.

Impotence can have many causes. Possible physical triggers include vascular diseases, hormonal disorders, nervous disorders, serious illnesses, or side effects from medication. Psychological triggers can be stress, depression or fear of failure.

In about 70% of cases, impotence is caused by a combination of physical and psychological causes. It usually occurs in young men, where the cause of impotence is purely psychological.

How does impotence occur?

Blood flow to the penis is often impaired. If the arteries responsible for blood flow to the penis become calcified with deposits, not enough blood is getting to the penis. The erectile tissue is underfilled, the penis does not harden enough in the desire for an erection, or it relaxes again quickly. Sometimes the muscles of the penis can also get sick.

Also, atherosclerosis (hardening of the arteries) is a condition that definitely causes impotence. This may be an indication of other vascular calcifications that can trigger a heart or brain infarction in the worst case.

Vascular calcification can occur with an unhealthy lifestyle. Obesity, smoking, lack of exercise and one-sided diet damage blood vessels and can have a negative impact on erectile function.

Conversely, studies show that regular exercise and a healthy lifestyle have a positive effect on impotence. Unhealthy diet and lack of exercise can also cause circulatory disorders. These include diabetes , high blood pressure, and fat metabolism disorders.

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Some conditions that result in testosterone deficiency (such as andropause ) can also cause impotence. According to recent studies, a sufficiently high level of hormones contributes to a satisfactory erection.

With age, testosterone levels decrease in men. In the case of erectile dysfunction, therefore, the doctor should consider a relevant deficiency as the cause.

Also, there are many drugs that can cause impotence. Such side effects are found, for example, in the package insert of lipid-lowering agents, beta-blockers, drainage and anti-inflammatory drugs, and antidepressants.

If you take such a drug and suspect that it is related to impotence, you should never stop or change the drug yourself. The doctor can often prescribe another preparation after consultation.

Nerves also contribute to the formation of impotence. If the nerves on the way from the penis to the brain are damaged, this can lead to impotence. These nerve pathways can be damaged, for example, during surgery, radiation in the pelvic area, or through a herniated disc.

Chronic alcohol use and diabetes can also negatively affect nerves. Diseases that affect the central nervous system, such as Parkinson’s disease, Alzheimer’s, or multiple sclerosis , can also cause impotence.

What are the symptoms of erectile dysfunction?

In this case, you should ask yourself the following three questions:

  1. Is your penis not hard enough for intercourse?
  2. Is your erection decreasing too quickly?
  3. Do you often have erection problems?

If your answer to the above questions is positive, you most likely have an impotence problem. In this case, the penis does not become hard enough to have sexual intercourse. Erectile dysfunction is sometimes accompanied by other sexual dysfunctions. These include problems such as premature ejaculation and delayed ejaculation .

Erection problems negatively affect a man’s self-esteem. If an erection does not occur in bed, the feeling that the same will happen later on creates a great pressure. This also significantly affects the quality of life of those affected.

When should you see a doctor?

Erectile dysfunction can be an early warning sign of serious diseases such as diabetes, heart attack or stroke. Therefore, if you have problems with erection for a long time, it is useful to see a doctor.

How is erectile dysfunction diagnosed?

Initially, the doctor will ask specific questions and want to see a precise picture of the disorder. Standard questions help to fully understand the symptoms.

The doctor will also want to know if he has had previous surgery or if there are diseases that could trigger erectile dysfunction, such as diabetes, high blood pressure , and problems with intervertebral discs.

In addition, the doctor will want to learn about the drugs used by the person concerned, because in some cases impotence is caused by the drugs taken. The doctor will also ask if you have spontaneous erections at night, in the morning, or at any time of the day.

The stage is then followed by a physical examination focusing on the genitals and prostate . Since many erection problems are caused by circulatory disorders, vascular impulses and blood pressure in the arms and legs are also controlled.

The blood test provides information about possible risk factors such as increased blood sugar or unfavorable blood lipid levels. It can also determine whether there is a deficiency of the male sex hormone testosterone.

The morning blood test is useful for determining what range the testosterone level is in because the hormone concentration fluctuates throughout the day. The highest values ​​are reached in the morning.

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Further research

In very few cases, the doctor needs further examinations. The blood flow in the penile veins can be checked with a special ultrasound examination and a drug that induces an erection can be injected into the penis. This test provides additional information about whether and how well an erection is achieved.

If arterial circulatory disorders are found, it may also be necessary to examine the heart. Erectile dysfunction may be an early manifestation of atherosclerosis and thus asymptomatic coronary heart disease.

Nerve exams show whether nerve disorders are likely the cause of problems. To do this, the doctor sets up weak electrical impulses, for example, and checks whether these signals are transmitted by the nerves as expected.

Spontaneous erections can be recorded with a measuring device, for example during sleep. If the values ​​are normal, this is an indication that the erection itself is possible without any problems. Psychological causes are then more likely, but physical causes are also not immediately ruled out.

How is erectile dysfunction treated?

Impotence with physical causes is treated with medication or various aids. If the cause of impotence is another disease, this disease should also be treated. In rare cases, impotence is corrected with surgery. In the case of impotence due to psychological reasons, psychological sex therapy is recommended , possibly with the partner .


To improve blood flow to the penis, doctors often prescribe a drug called a phosphodiesterase 5 inhibitor . These include the active ingredients avanafil, sildenafil, tadalafil and vardenafil . All drugs with these active ingredients inhibit the phosphodiesterase-5 enzyme in their work. They break down a messenger substance that increases blood flow to the penis when sex is aroused.

These drugs are not sexual energy enhancing drugs, they only help to get an erection when a man is sexually aroused. Possible side effects include; headache, dizziness, heartburn , nasal congestion, facial sensation, back pain, muscle pain, and visual disturbances.

Phosphodiesterase 5 inhibitors can lower blood pressure . Therefore, under no circumstances should it be taken at the same time as nitrates, such as those prescribed to heart patients, as blood pressure can drop to a life-threatening level. Those who have previously experienced stroke, liver and heart diseases should also be wary of these drugs.

Remember, your doctor will decide which medicine to take and how.

hormonal therapy

It is perfectly normal for men to have testosterone levels decreasing with age and does not need to be treated. Apart from these, if a man has impotence, it can be helpful to correct a testosterone deficiency ( hypogonadism ). Sometimes this has a positive effect on potency.

Phosphodiesterase 5 inhibitors usually work better when taken with hormone therapy. Testosterone can be injected at longer intervals or applied to the skin as a gel. This form of treatment has been controversial for some time because it has been shown to increase the risk of heart attack or prostate cancer. Existing studies continue.

drug injection into penis

If prescription tablets don’t work well or phosphodiesterase 5 inhibitors are not allowed to be taken, the doctor may inject a vasodilator agent (alprostadil) directly into one of the two erectile tissues. This erectile tissue autoinjection therapy, or SKAT for short , can be done by the person involved with a small application and is usually not painful. The active ingredient allows more blood to enter the penis.

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About 15 minutes after the injection, the erection lasts for a long time. Side effects can include bruising, penile pain, and erectile tissue infections.

This treatment is not suitable if the person suffers from certain diseases such as leukemia, sickle cell anemia or liver and kidney dysfunction, or if they have had a heart attack within the past year.

It is important that the person strictly adheres to the prescribed dose. An overdose can lead to prolonged erections ( priapism ), which needs to be treated by a doctor, and the penis can be permanently damaged.

urethral erection system

If tablet intake does not provide the desired success, the medical urethral erection system (MUSE), which is also transurethral therapy, is another option for treatment. The person inserts the active ingredient alprostadil into the urethra in the form of a mini cone. The applicator, which is like a small stick, helps it do this. The active substance reaches the erectile tissue through the wall of the urethra. After about 15 minutes, increased blood flow provides an erection that lasts for an hour.

Side effects may include pain in the penis or urethra, painful urination, dizziness, drop in blood pressure, and headache. If the partner is pregnant, transurethral therapy should be avoided because alprostadil may endanger the unborn child. Diseases such as leukemia, sickle cell anemia, blood coagulation disorders or urethritis are also against this practice.

vacuum pumps

This is erectile dysfunction vacuum therapy with purely mechanical assistance. Shortly before sexual intercourse, the person inserts a clear plastic cylinder into the penis and is connected by tubing to a pump. It creates a vacuum, the erectile tissue fills with blood and an erection occurs.

There is a rubber ring at the base of the penis that prevents blood from flowing again. This ring must be removed after 30 minutes at the latest, otherwise circulatory disorders may occur and the penis may be damaged. Men with cardiovascular diseases should use this method only after consulting their doctor.

Penile implant treatment

In some cases, only silicone implants that are surgically placed into the erectile tissue can help, these are called erectile tissue implants . This intervention is irreversible and therefore must be carefully considered and planned.

There are different variants of this treatment. The most commonly used implants are the refillable ones. In this case, a reservoir is placed in the lower abdomen. Doctors put a small pump into the scrotum. At the push of a button, the person concerned can fill the implant and create an erection.


If there are psychological causes of impotence, the person concerned should speak to a sex therapist . Counseling or psychotherapy is also recommended, as impotence can become a psychological burden for men with a physical cause.

You should only take medication to treat your erectile dysfunction after consulting your doctor. Medicines ordered online are often unsafe and contain different ingredients than specified. Do not risk your health by using them.

Can erectile dysfunction be prevented?

One of the risk factors for erectile dysfunction is an unhealthy lifestyle. These are smoking, obesity, abuse of drugs and alcohol, and a one-sided, unhealthy diet.

Adequate exercise and a balanced diet keep the vessels healthy and minimize the risk of developing erectile dysfunction. Also, the person should not put pressure on himself and should not be ashamed to receive the necessary treatment.

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