Many men are unaware of the relationship between ED (impotence) and their overall health. ED not only include ability to engage in sexual intimacy but also includes problems with libido, and abnormal ejaculation.
ED is defined as the consistent inability to attain or maintain a penile erection of sufficient quality to permit satisfactory sexual intercourse.
The process of diagnosis and treatment begins with a careful sexual history. Men with a sexual problem will probably be asked:
- Are you currently having sexual relations?
- With whom do you have these relations (men, women, or both, and how many partners)?
- When was the last time you had intercourse?
- Are you satisfied with the quality and frequency of your sexual experiences?
The answers will clarify what aspects of sexual dysfunction are occurring and inform the rest of the evaluation. If libido is intact but ED is a complaint, then what underlying medical conditions or medications may be contributing to the problem? If libido is affected, are there significant psychologic or emotional contributing factors that need to be addressed as well as measuring the serum testosterone level.
Although sexual problems are not necessarily caused by aging; it is true that aging is associated with an increase in sexual issues. As early as 40 years of age, up to 40% of men report some impaired sexual function. Inability to attain or maintain an erection consistently for satisfactory intercourse was reported in 67% of males over 69 years of age in another study. Testosterone decline is common with age. While this may play a hormonal role in sexual dysfunction, it is important to thoroughly evaluate all possible causes before initiating testosterone replacement therapy for sexual dysfunction alone.
Similarly as men age, interest in sex may decline due to lack of novelty as well as an increase in stress that often occurs in older men. Fatigue, lack of privacy in the family setting, and unresolved anger with a partner may all be determinants of sexual problems in the older male. More critically, loss of interest in sexual activity and loss of libido may be manifestations of depression. Depression can cause sexual problems, but the reverse may also be true.
In addition to these factors, diabetes, blockage of the blood vessels, and adverse effects from medications, both prescribed and recreational (marijuana and cocaine) may all play roles in sexual functioning. Disease states such as hypertension, diabetes, heart disease, and obesity can affect the blood flow into the penis. Blockage in any of the major arteries feeding the blood supply to the penis can lead to inability to obtain and maintain an erection. Diabetes, for example, this can also affect the mechanism of erection and cause ejaculatory disorders such as backward ejaculation of the fluid to the bladder instead of out of the tip of the penis at the time of orgasm.
Medications that are often identified as causes of erectile disorder which include medications used to treat depression, blood pressure lowering medications, cholesterol medications, and drugs used to treat prostate cancer. Excessive alcohol use is the most common substance that can lead to ED, though cocaine, heroin, and marijuana have all been linked as well.
Bottom Line: ED is a common problem affecting millions of middle age and older American men. The diagnosis can often be attributed to underlying disease states. A careful history and physical examination will help to elucidate the problem and start you on the road to successful treatment.