What is Erectile Dysfunction? Expert Explanation & Treatment Options

“Erectile dysfunction (ED) is a term used to describe the inability to get an erection. More specifically, it refers to the difficulty in achieving and maintaining an erection that is satisfactory for penetrative intercourse.

If a person experiences any difficulty achieving good erections, by definition, that is erectile dysfunction. The causes can vary, ranging from psychogenic (related to psychological factors) to organic (related to physical factors).

It’s important to understand that erectile dysfunction is solely about the physical ability to get and maintain an erection sufficient for penetration. It does not relate to other aspects of sexual experience, such as sexual desire (libido) or the sensation of enjoyment or orgasm. The issue is simply that the penis doesn’t get hard enough or stay hard enough to remain penetrated during intercourse.”

• Definition – The persistent or recurrent difficulty in achieving or maintaining an erection sufficient for sexual intercourse.
• Scope – Any level of erection difficulty may fall under ED, especially when it affects one’s sexual satisfaction or intimacy.
• Causes – Can be psychological (e.g., performance anxiety, depression) or organic (e.g., vascular, hormonal, neurogenic).
• Distinction – ED is a functional erection issue. It does not refer to libido, orgasm, or ejaculation.

The EAU provides detailed criteria and updated treatment recommendations in its 2024 Guidelines on Sexual and Reproductive Health:

• Official Definition – “The consistent or recurrent inability to attain and/or maintain a penile erection sufficient for satisfactory sexual performance.”
• Clinical Threshold – It’s not occasional performance anxiety, but a pattern that impacts sexual health.

The EAU divides the etiology of ED into three broad categories:

• 🩺 Psychogenic ED (Anxiety, stress, depression)
• ⚕️ Organic ED (Vascular disease, diabetes, neurological disorders, hormonal imbalance)
• 🔄 Mixed ED (A combination of both)

A significant portion of ED cases today fall into the vascular or metabolic syndrome-related category.

“ED is now recognized as a potential early indicator of cardiovascular disease (CVD).”

Men under age 60 presenting with ED should be screened for cardiovascular risk factors including diabetes, high blood pressure, and high cholesterol.

• Detailed sexual and medical history (Pattern of ED onset, severity, and duration)
• Physical examination (Genital assessment, secondary sexual characteristics)
• Basic laboratory testing (Fasting glucose, lipid profile, testosterone)
• Cardiovascular risk assessment (Especially for men under 60)
• Psychosocial evaluation (In selected cases)

Advanced diagnostics (like penile Doppler ultrasound or nocturnal tumescence testing) are recommended if initial treatments fail or the diagnosis is unclear.

The guideline outlines a stepwise treatment approach:

1. First-line treatments:
   • PDE5 inhibitors (e.g., Sildenafil, Tadalafil)
   • Lifestyle modifications (weight loss, quitting smoking, exercise)
2. Second-line treatments:
   • Vacuum erection devices
   • Intracavernosal injections (e.g., Alprostadil)
   • Intraurethral therapies
3. Third-line treatment:
   • Penile prosthesis surgery, recommended in severe, treatment-resistant ED

If you or your partner notice persistent difficulty achieving or maintaining an erection, this should not be ignored. ED can be:

• A symptom of underlying systemic disease
• A psychological burden on self-confidence and intimacy
• A reversible condition with the right treatment

“Early diagnosis often leads to simpler, more effective treatment. Do not hesitate to consult a urologist or sexual medicine specialist.”