What is erectile dysfunction (ED) or impotence?
What is erectile dysfunction (ED)?
ED is the inability to get or keep an erection firm enough for sexual intercourse. ED can be a total inability to achieve an erection, an inconsistent ability to do so, or a tendency to sustain only brief erections.
ED is sometimes called impotence, but that word is being used less often so that it will not be confused with other, nonmedical meanings of the term.
The National Institutes of Health estimates that ED affects as many as 30 million men in the United States.1 Incidence increases with age: About 4 percent of men in their 50s and nearly 17 percent of men in their 60s experience a total inability to achieve an erection. The incidence jumps to 47 percent for men older than 75.2 But ED is not an inevitable part of aging. ED is treatable at any age.
1National Institutes of Health (NIH) Consensus Conference. NIH Consensus Development Panel on Impotence. Impotence. Journal of the American Medical Association. 1993;270:83–90.
2Saigal CS, Wessells H, Wilt T. Predictors and prevalence of erectile dysfunction in a racially diverse population. Archives of Internal Medicine. 2006;166:207–212.
Sexual dysfunction is found in about two-thirds or more of both haemo- and peritoneal-dialysis patients (Abram et al. 1975; Bommer et al. 1976; Karacan and Salis 1980; Diemont et al. 2000).
Sexual activity decreases to occasional sexual intercourse at the time of starting dialysis, but improves after effective maintenance haemo-dialysis (Bommer et al. 1976). In transplant patients sexual problems are significantly less prevalent, but still occur in nearly 50 per cent (Diemont et al. 2000).
Dialysis patients with sexual dysfunction complain predominantly of reduction or loss of fertility, libido, erectile potency, but also inadequate satisfaction and ejaculation. In male dialysis patients about 50–60 per cent report reduced libido (Toorians et al. 1997). Partial and complete erectile impotence is found in 40–80 per cent of haemodialysis patients (Abram et al. 1975; Bommer et al. 1976; Karacan and Salis 1980; Toorians et al. 1997; Diemont et al. 2000). During the early era of dialysis therapy psychological factors seem to play a dominant role in the loss of libido and potency. If these problems are improved or solved and effective dialysis therapy improves physical fitness and ability to work, increased libido and potency can be expected in the first 2 years of haemodialysis therapy (Bommer 1976).
In patients on maintenance haemodialysis various factors may contribute to the loss of libido and potency including psychological factors, reduced arterial blood flow, venous leakage due to venous shunts, altered penile smooth muscle function, hormonal disturbances, side-effects of medication, and neurogenic dysfunction. Optimal treatment of sexual problems in the individual patient requires a careful assessment of these factors. Most diagnostic algorithms start with the differentiation between psychogenic and organic impotence. In clinical practice, however, psychogenic and organic causes of impotence are not the ends of a one-dimensional diagnostic scale but rather represent two interwoven dimensions. In most, if not all, dialysis patients sexual dysfunction results from both psychological and organic problems.