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Impotence is the inability to get and keep an erection firm enough for sexual intercourse. Having erectile issues from time to time is normal and shouldn’t cause alarm unless persistent and/or permanent. 

If you suspect you may have ‘Erectile Dysfunction” (ED), which is synonymous with impotency, you should speak to your doctor, even if doing so triggers personal embarrassment. Sometimes, treating an underlying condition is enough to reverse the effects, and in other cases medications or other direct treatments might be necessary.

Recent studies indicate this condition is much more common than once believed, and many more younger men than expected are now known to experience difficulty with erections, and as many as two-thirds will develop impotence at some point in their lives. If ongoing the condition can lead to stress, affect self-confidence and spawn relationship problems. It can also indicate an underlying health condition that requires treatment (and is therefore also a high-risk factor for heart disease).

Male sexual arousal is a complex process involving the brain, hormones, emotions, nerves, muscles and blood vessels. ED can result from a problem with any or all of these. Likewise, stress and mental health can cause or worsen the condition.

Sometimes a combination of physical and psychological issues cause erectile dysfunction. For instance, a minor physical condition that slows sexual response might cause anxiety, which can then lead to or worsen the dysfunction.

You should consider consulting a doctor when any or all of the following factors are present:

• Experiencing a lack of erections or other sexual problems such as premature or delayed ejaculation.

• Presence of diabetes, heart disease or any other known health condition that is linked to erectile dysfunction.

  • Experiencing other symptoms consistent with erectile dysfunction

Here is an exhaustive list of known causes:

  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
  • Parkinson’s disease
  • Multiple sclerosis
  • Certain prescription medications
  • Tobacco use
  • Peyronie’s disease — development of scar tissue inside the penis
  • Alcoholism and other forms of substance abuse
  • Sleep disorders
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Low testosterone

ED can be triggered by a multitude of issues ranging from the physical, mental and emotional. Physical conditions tend to lead the way, such as heart disease, cardiovascular ailments, high cholesterol and high blood pressure (hypertension). 

Even long-distance bicycle riders are known to experience temporary impotence as repeated pressure on the buttocks and genitals can affect the function of the nerves.

Psychological causes 

The brain plays a key role in triggering an erection, starting with feelings of sexual excitement. Here are some common complications from erectile dysfunction: An unsatisfactory sex life, stress or anxiety, embarrassment or low self-esteem, relationship problems and the inability to get your partner pregnant.

Neurological Issues

Neurological and nerve disorders, including Alzhemer’s and Parkinson’s disease, spinal tumors, multiple sclerosis (MS), stroke and temporal lobe epilepsy all have direct correlation and well researched effects on ED. In addition, emotional and mental conditions can be major factors that should not be underestimated or easily dismissed.

Other causes of erectile dysfunction are the unintended side effects of many common medications such as alpha-adrenergic blockers like tamsulosin (Flomax), beta-blockers such as carvedilol (Coreg) and metoprolol (Lopressor); cancer chemotherapy treatments such as cimetidine (Tagamet), central nervous system (CNS) depressants such as alprazolam (Xanax), diazepam (Valium) and codeine

Other common medications known to trigger ED include CNS stimulants like cocaine and amphetamines, diuretics such as furosemide (Lasix) and spironolactone (Aldactone), and selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), (Paxil) and Zoloft.

A 2007 study published in the American Journal of Medicine suggested the risk of impotence increases with age, and it’s even higher in men who have been diagnosed with one or more cardiovascular risk factors. According to the Urology Care Foundation, nearly 30 million Americans are effected by ED every year.

Cardiac-related conditions

Conditions affecting the heart and its ability to properly pump blood are also known to cause impotence. In simple terms, without sufficient blood flow, you can’t achieve an erection. Additionally, atherosclerosis, a condition that causes blood vessels to become clogged, also a known cause of impotence. 

Risk factors

As you get older, erections often take longer to develop and might not be as firm. You might need more direct stimulation to get and keep an erection. Various risk factors can contribute to erectile dysfunction, including:

  • Tobacco use, which restricts blood flow to veins and arteries, can, over time,  cause chronic health conditions that lead to erectile dysfunction.
  • Being overweight, especially if you’re obese.
  • Certain medical treatments, such as prostate surgery or radiation treatment for cancer.
  • Injuries, particularly if they damage the nerves or arteries that control erections.
  • Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions.
  • Psychological conditions, such as stress, anxiety or depression.
  • Drug and alcohol use, especially if you’re a long-term drug user or heavy drinker.

According to several studies, the most effective way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage existing health conditions. For example: work with your doctor to manage diabetes, heart disease or other chronic health conditions. See your doctor for regular checkups and medical screening tests. Stop smoking, limit or avoid alcohol and don’t use illegal drugs. Regular exercise, reduce stress and get early help if experiencing anxiety, depression or other mental health concerns.

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