Watch this video to learn some of the causes of erectile dysfunction, and explore the possible treatment options.
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What is ED? Jeffrey Brady: Erectile dysfunction is the inability to achieve or maintain erection sufficient for intercourse. That's the general definition. There are varieties or different variations of ED: mild, moderate or severe, but the general definition is just the inability to achieve or maintain an erection. Randall B. Meacham: My feeling though is that any patient who is having enough problems with sexual function, that represents an issue for them or their partner, is someone who really merits evaluation and treatment. In terms of how common erectile dysfunction is, it's been estimated that as many as 50% of men between the ages of 50 and 70 years of age suffer from erectile dysfunction, which is sufficiently severe that they would like to seek treatment for their condition. Jeffrey Brady: Whatever decade of life you are in, that is about the instance of erectile dysfunctions. So for men in 40s, it's about 40% men have erectile dysfunction, in your 70s about 70%. Studies have shown that those who are older have a more severe form of erectile dysfunction. Are the causes of ED more often physical of psychological? Frank J. Costa: Interestingly in our office a specialist, a neurologist we see more organic dysfunction that is, where the condition of erectile dysfunction is due to a physical disorder as opposed to a psychological disorder. And so that the percentage of patients is much greater in whom a physical condition is the cause of the erectile dysfunction as opposed to a psychological cause. Randall B. Meacham: Several decades ago it was believed that the majority of men that had sexual dysfunction suffered from a psychological condition, perhaps 80% of men. We now know that that's not true. In the vast majority of patients who have erectile dysfunction, I would estimate 80% or more there is a very, very significant physical reason for having sexual dysfunction. One of the things, that's very important to bear in mind however, is that in many patients there is a combination of physical and psychological issues that are in play. Let me give you an example. A patient that may have relatively mild organic or physical erectile dysfunction may find that he's unable to perform sexually in a circumstance which causes him anxiety, he becomes concerned, his partner becomes concerned. The anxiety and in some cases the depression that arises from that further contributes to the sexual dysfunctions, so you get into a cycle which is very destructive. The patient is worried about sexual dysfunction, that makes the sexual dysfunction worse, he becomes more worried and the whole thing cascades. So I would say, if I had to choose one physical or organic causes for erectile dysfunction are more common than psychogenic, but in many, many patients there is a strong component of both. Anthony Douglas: Depression is also pretty common in men with erectile dysfunction, whether it's because of it or it's a precondition. It is common and guys don't want to talk about depression as much either. So watching for the signs of depression, being comparable talking to your friends and your spouse or eventually your doctor. It's about becoming comfortable with your body, which men are not very good with. Frank J. Costa: It's important however in patients who have depression and they are at the age 50 or over, they are males that we rule out an androgen deficiency or testosterone deficiency, because many times these patients may present with lethargy or loss of sex drive or loss of interest in life, abnormal sleep patterns, and patients are diagnosed by the primary care physician as having a primary depression, where in fact it's the abnormal testosterone level that in fact contributes to these symptoms and also to the erectile dysfunction. So it's important to be very precise and make sure that in fact the testosterone levels are normal, prior to making an diagnose of clinical depression in a patient. Anxiety is something we also see in pati