Erectile Dysfunction: The Complete Guide to Impotence for Men

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erectile dysfunction

Erectile dysfunction, as known as impotence, is a sexual disorder referring to the inability to get and/or maintain a firm erection for sexual activity. It can be an underlying result of other diseases, medications or aging. Erectile dysfunction is not rare among Hong Kong males and often leads to poor self-image and sex life, one should not be afraid of such health issue and should learn more about it as early as possible in order to prevent erectile dysfunction.


What is Erectile Dysfunction?

Erectile dysfunction, or impotence, is defined as being unable to achieve or keep an erection firm enough for sexual intercourse. Erection, a process in which the penis becomes engorged, enlarged and firm, is mediated by the release of nitric oxide in the body upon sexual arousal. When the amount of nitric oxide rises in trabecular arteries and penile smooth muscles, internal pudendal arteries and other penile blood vessels dilate to increase blood flow of the corpora cavernosa of the penis, allowing the penis to erect and enlarge. Failure of such vasodilation, blood flow promotion or any of the above mechanisms would lead to the inability to erect fully, resulting in erectile dysfunction.

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Causes of Erectile Dysfunction

Erectile dysfunction is mainly caused by the inability to dilate blood vessels of the penis. The following causes may contribute to such lack of penile vasodilation:

  • Smoking: Smoking damages blood vessels, reducing blood supply to the penis and corpora cavernosa, hence causing erectile dysfunction.
  • Alcohol consumption: Alcohol will interrupt the signal transduction in one’s nervous system and the release of male sex hormones. Therefore, drinking alcohol can be a barrier to erection, leading to erectile dysfunction.
  • Diabetes: Similar to smoking, diabetes will increase blood sugar level and damage blood vessels, thus limiting the blood supply for an erection. Diabetes can lead to peripheral neuropathy which further compromises erectile function. 
  • Concomitant diseases: Other diseases may contribute to erectile dysfunction, for example, hypogonadism, atherosclerosis, hyperprolactinemia, etc. A relation between COVID-19 and erectile dysfunction is also suggested. If impotence goes unnoticed or untreated, the underlying causes can be left undiagnosed and may develop into serious conditions afterward. Therefore, seek medical help right away when erectile dysfunction is suspected.
  • Medications or substance abuse: The use of medications like opioid analgesics, cancer drugs and diuretics, and substances like amphetamines, heroin and MDMA may give rise to erectile dysfunction.
  • Psychological factors: Excessive guilt, stress, fear or other factors that contribute to poor mental health may lead to a lack of sex drive hence erectile dysfunction.

Risk Factors of Erectile Dysfunction

The below factors may induce a higher risk of erectile dysfunction, including:

  • Overweight: There is a higher chance of occluded blood vessels if you are overweight, hence reducing blood supply to the erectile tissue of penis.
  • Age: Those above 50 years of age will be more likely to encounter erectile dysfunction. Such risk may increase with age after 50.
  • Medical procedures: Pelvic surgeries or any surgeries involving the penis and male reproductive system, in particular prostate cancer surgery, may increase the risk of erectile dysfunction as blood supply and nerves to the penis might be interrupted or damaged.

Signs and Symptoms of Erectile Dysfunction

Regarding erectile dysfunction, its signs and symptoms are relatively obvious. The signs and symptoms are usually persistent which include:

  • Difficulty in getting and/or staying erect of penis
  • Lower libido 
  • Psychological conditions: Erectile dysfunction may lead to poor mental conditions like embarrassment, anxiety, depression, lower self-image and thus shame. As a result, unsatisfactory sex life and spousal relationship may occur.

Complications of Erectile Dysfunction

If erectile dysfunction is left untreated, the most significant complication is infertility. Therefore, for those who plan to reproduce offsprings, medical help should be sought as soon as possible.

Diagnosis of Erectile Dysfunction

Erectile dysfunction can be simply diagnosed based on the absence of erection. However, the underlying causes should be further investigated, including distinguishing physiological and psychological origins, and excluding any concomitant diseases. The following tests and examinations can help to look into the problem:

  • Physical examination: The physician will examine the male genitalia and nervous system around the groin area. For example, physical examination to see if involuntary erection is possible like “morning wood” and manual stimulation. The physician will also check for groin hernia which may require further treatment. 
  • Psychological examination: Questionnaires will be disseminated for evaluating one’s mental condition and looking for any psychological causes of erectile dysfunction. For instance, depression, anxiety and stress may be barriers of erection.
  • Laboratory tests: Blood test and urine test will be taken. A sample of blood and urine will be examined to investigate the levels of chemicals, such as glucose, lipid and testosterone, to understand the underlying cause of erectile dysfunction.
  • Ultrasound Imaging: By applying ultrasound waves, a healthcare professional can check for the presence of any possible occlusions in penile blood vessels or damage of the male reproductive system. However, this is not frequently required clinically.

Treatments of Erectile Dysfunction

Erectile dysfunction does not have to be treated with medications albeit being a common problem. Usually, the erectile dysfunction can be treated through the following approaches, depending on the severity and underlying causes: 

  • Phosphodiesterase-5 inhibitors: It is usually the first-line and, by far, the most common treatment for erectile dysfunction. The most well-known example is oral sildenafil, also known as Viagra. It can increase the production and release of nitric oxide to dilate the penile blood vessels and allow effective erection. 
  • Treating underlying causes: Erectile dysfunction may be triggered by other diseases, psychological reasons or medications. For instance, if it is caused by cardiovascular problems like narrowing of blood vessels, statins can be prescribed in an attempt to reduce further atherosclerosis. On the other hand, if it is due to psychological reasons, counseling by psychologists may be applicable to resolve the problem. If such erectile dysfunction is induced by medications, related drugs should be avoided, or a change of prescription options and dosage may be necessary.
  • Alprostadil: Unlike phosphodiesterase-5 inhibitors, Alprostadil is a substance resembling prostaglandin E1 used as a second-line treatment. It is injected into the penis or administered into the urethra as a suppository. It is occasionally combined with sildenafil to enhance the therapeutic effect. Alprostadil is a stronger agent than sildenafil.
  • Penis pump: It is a second-line treatment to impotence. The mechanism of the penis pump is by creating a vacuum space to improve penile blood flow. It is applied right before sexual intercourse in case pharmacological interventions fail. A compression ring should then be used to maintain the blood flow and sustain the erection.
  • Penile implant: Rods are inserted into the spongy tissues of the penis to allow it to erect. It is most effective but reserved as the last resort for erectile dysfunction.
  • Lifestyle modification: Studies have shown that aerobic exercise can improve erectile dysfunction. It is sufficient as moderate intensity. Other lifestyle modifications should also be adopted, including the cessation of smoking and alcohol, healthy diet and losing weight.


What is the most effective treatment for erectile dysfunction?

For erectile dysfunction, also known as impotence, the most effective treatment is penile implant but it is reserved for the most severe cases. For most cases, oral phosphodiesterase-5 inhibitors like sildenafil (Viagra) are therapeutically enough.

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This article was medically reviewed by Dr. Vera Chung 鍾楊醫生. Dr. Chung is a female urologist practicing at the Hong Kong Urology Clinic. She qualified in 2003 from the University of Hong Kong and was trained as a urologist in Queen Elizabeth Hospital and obtained the Fellowship of Royal College of Surgeons of Edinburgh in 2011. Dr. Chung was promoted to associate consultant in Pamela Youde Nethersole Eastern Hospital in 2012. From 2013 to 2015 she has completed a two-year European Board of Urology (EBU) Fellowship in endourology and laparoscopy at Nuffield Department of Surgical Sciences, University of Oxford. In Oxford, Dr. Chung also consolidated her training in the management of continence and prolapse problems in the Department of Gynecology.

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This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.

Dr. Chung Yeung Vera
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