What Is Erectile Dysfunction?

Erectile dysfunction (ED), also known as impotence, is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance . This is more than occasional difficulty—it is a chronic issue that may significantly affect self‐esteem, intimate relationships, and overall quality of life.

Incidence & Prevalence

  • ED affects approximately 30 million men in the U.S., and 150 million worldwide, with projections reaching over 300 million by 2025 .

  • It becomes increasingly common with age: about 10% of men aged 40–70 have complete ED, while up to 50 % of men aged 65–74 experience varying degrees.

  • Large-scale surveys like the Massachusetts Male Aging Study revealed that over 50 % of men between 40–70 report some form of ED, with the worldwide affected population estimated at 152 million in 1995 and projected to steadily rise .

Causes & Etiologies of ED

ED is multifactorial, with overlapping physical, hormonal, psychological, and lifestyle components. The most common categories include:

1. Vascular (Organic) Causes

  • Atherosclerosis, hypertension, high cholesterol, and smoking lead to narrowed penile arteries, reducing blood flow needed for erection.

  • Diabetes mellitus contributes via vascular damage and peripheral neuropathy—up to 50 % of diabetic men experience ED.

2. Neurological Causes

  • Nerve disorders (e.g., multiple sclerosis, Parkinson’s disease, spinal cord injuries, diabetes, stroke) interrupt signals necessary for erection.

3. Hormonal Dysregulation

  • Low testosterone, thyroid imbalances, or elevated prolactin can reduce libido and impair erectile function .

4. Psychogenic Factors

  • Mental health issues—including stress, anxiety, depression, and relationship difficulties—can severely disrupt sexual arousal and performance .

5. Medication & Treatment Effects

  • Certain medications—such as antihypertensives, antidepressants, antipsychotics—and treatments like prostate surgery or radiation, or trauma to the pelvic nerve or vasculature can trigger ED.

6. Lifestyle & Other Medical Conditions

  • Obesity, lack of exercise, excessive alcohol, smoking, illicit drugs, and sleep disorders may contribute.

  • Other conditions like Peyronie’s disease, kidney failure, or metabolic syndrome also play a role.

The Multifactorial Reality

Often, ED is not due to a single cause but rather an interaction of factors—such as mild vascular disease combined with anxiety about performance—worsening symptoms over time.

Why It Matters

ED may be an early red flag for more serious conditions like cardiovascular disease, diabetes, or neurological disorders. A thorough evaluation enables early detection and tailored interventions.