Erectile dysfunction (ED), or impotence, is the inability to achieve or maintain an erection long enough for the penis to enter the vagina and engage in sexual intercourse. Normally, an erection occurs when your imagination or one or more senses (vision, hearing, touch, smell, and taste) are stimulated and you become aroused.

Erection problems will usually produce a significant psychological and emotional reaction in most men. This is often described as a pattern of anxiety and stress that can further interfere with normal sexual function. This “performance anxiety” needs to be recognized and addressed by your doctor.

Erectile dysfunction is more prevalent than it may seem. It occurs to some degree in up to 40% of men 40 years old, and up to 67% in those age 70. It is a significant area of research for the pharmaceutical industry, with potential sales in the billions of dollars. In older men, physical causes play a primary role in 60% or more of all cases of erectile dysfunction. In men over the age of 60, the leading cause is atherosclerosis, or narrowing of the arteries, which can restrict the flow of blood to the penis. Injury or disease of the connective tissue, such as Peyronie’s disease, may also interfere.

Decreasing anxiety associated with intercourse, with psychologically based treatment helps to cure ED. The patient’s partner can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when ED from physical causes is being treated.

Sex counseling is an important part of erectile dysfunction management. Many professional sex counselors are skilled in working with patients with ED, but your primary care doctor and urologist may also serve in this capacity to some degree. These are usually the first professionals to learn about the problem. Men are frequently reluctant to discuss their sexual problems and need to be specifically asked.

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