Erectile dysfunction (ED) is the inability to achieve or maintain a firm erection sufficient for satisfactory sexual intercourse. It may result from either physiological or psychological factors and can affect a man's ability to experience or provide sexual pleasure. Common complaints include difficulty achieving an erection, lack of ejaculation, or absence of orgasm. A typical reason for consulting a urologist or andrologist is the inability of the corpora cavernosa to fill with blood even under strong sexual stimulation, resulting in no erection.
Key Symptoms
According to WHO statistics, erectile dysfunction affects about 10% of men over the age of 21 and up to one-third of men by the age of 60 — and the prevalence continues to grow. However, only 22% of men seek medical consultation, and just 36% of those proceed with recommended treatment. Many attempt self-treatment using questionable or unproven remedies, which may offer only temporary relief or worsen sexual dysfunction in the long run. To avoid irreversible consequences and emotional distress, it is essential to see a specialist if any of the following symptoms appear:
Lack of morning erections
Premature ejaculation
Inability to achieve an erection during masturbation
Delayed erection even with strong sexual arousal
Causes and Treatment
Erectile dysfunction due to organic (physical) factors usually develops gradually and is often accompanied by a decreased interest in sexual activity. More complex cases involve psychogenic causes, such as depression, stress, psychological trauma, or chronic fatigue. In such cases, patients typically retain the ability to have morning erections and masturbate, while problems arise during intercourse with a partner. In mixed-type ED, both physical and psychological causes are present.
Common risk factors include:
Long-term smoking
Alcohol abuse
Diabetes mellitus
Hypertension
Coronary artery disease
Depression and anxiety disorders
Psychological stress and trauma
Sudden lifestyle or dietary changes
Certain medications
Sedentary lifestyle
Genital trauma or surgery
Chronic depression contributes to ED in about 25% of affected men, especially among younger and middle-aged individuals. Treatment in such cases should be multidisciplinary, including regular psychotherapy sessions.
Organic causes are more common and often result from vascular changes due to aging. Successful treatment largely depends on accurately identifying the underlying cause. Psychogenic ED can often be resolved with therapy and lifestyle adjustments. However, severe organic cases — such as those involving surgery or prostate removal — may require more complex interventions. Regardless of the cause, timely medical attention is crucial to slow progression and prevent irreversible damage.