Erectile dysfunction (impotence): causes, symptoms, diagnosis and treatment

By Cristiano Antonino On Jun 5, 2023

The fundamental characteristic of male erectile dysfunction (sexual impotence, also called erectile dysfunction) is a persistent or occasional inability to achieve an erection or to maintain it long enough for sexual intercourse

For one to be able to speak of impotence or erectile dysfunction, the abnormality must cause significant discomfort or interpersonal difficulties.

It must not be exclusively attributable to the direct physiological effects of a substance (including drugs) or general medical problems.

Characteristics of erectile dysfunction

How it manifests itself

There are different types of erectile dysfunction (sexual impotence).

Some individuals manifest an inability to have an erection from the very beginning of sexual experience.

Others have an adequate erection and then lose tumescence when attempting penetration.

Still others have an erection good enough for penetration, but lose tumescence before or during subsequent thrusts.

Some men who suffer from erectile dysfunction (sexual impotence) may only manage to get an erection during masturbation or when waking up.

Masturbatory erections may also fail, but this is rare.

Effects on the relationship

The erection difficulties of impotence are often associated with sexual anxiety, fear of failure, concerns about sexual performance, and a reduced subjective feeling of sexual arousal and pleasure.

Problems with sexual impotence or erectile dysfunction can impair marital or ongoing sexual relationships and may be the cause of unconsummated marriages and infertility.

Sexual impotence

Erectile dysfunction is very common; it is reported to be about 10% prevalent in the general population, which can rise to more than 50% with increasing age (70 years).

Causes of erectile dysfunction

The causes of impotence are many and include organic factors, in particular vascular (circulation) and neurological problems, and psychological factors, in particular performance anxiety.

It is therefore important, first of all, to conduct a careful medical test, in order to ascertain the presence of organic causes, and then to move on to the psychological aspects, which in the vast majority of cases have a significant impact.

The presence of spontaneous erections at night and upon waking, as well as the ability to achieve and maintain an erection during masturbation, however, are unequivocal proof that there are no organic causes of erectile dysfunction, but that the problem is psychological in nature and, as such, must be addressed with specific behavioural therapy.

In this case, the problem is psychological in nature and, as such, should be addressed with specific cognitive-behavioural therapy.

Psychological factors involved

fear of failure
fear of being abandoned or unloved
inability to surrender to one’s own bodily sensations
excessive involvement, novelty and performance anxiety
stress and worries
dysfunctional beliefs (e.g. ‘the man must always be ready and actively manage sexual intercourse’)

Evaluation and treatment of erectile dysfunction

The treatment of erectile dysfunction (sexual impotence) requires a complex course of action that passes through a phase of careful assessment of the problem.

This is aimed at ruling out possible medical causes, leading to cognitive-behavioural (or task-related) treatment.

This is the only psychological therapy that has shown good efficacy in treating these erection disorders.

Medical tests

The main medical tests to rule out the various possible organic causes of erectile dysfunction are:

Nocturnal erectrometry, useful to check for involuntary erections during sleep.
Hormone assays, particularly of prolactin and testosterone, which can affect erections.
Penile echocardiography, arteriography and cavernosography, useful for assessing any vascular dysfunction.
Sacral evoked potentials, to assess the integrity of the nerve pathways involved in the erection reaction.
Papaverine test, i.e. the injection of this vasodilating substance into the penis, useful for assessing its functioning.

In the case of organic causes, the urologist or andrologist will assess the advisability of pharmacological, hormonal or surgical remedies for erectile dysfunction (or impotence).

Psychotherapy in the treatment of erectile dysfunction

If, on the other hand, the problem is clearly psychological, as is most often the case, the most suitable solution is a course of cognitive-behavioural psychotherapy.

During this, the main factors maintaining the problem will be addressed, such as performance anxiety, stress and other dysfunctional vicious circles.

This is a very direct form of therapy to the problem, which is addressed through specific techniques.

This, however, does not neglect, where necessary, the analysis of deeper psychological aspects, connected to the subject’s personality structure, his relationships, his ideas and beliefs regarding sexuality, his life history and the socio-cultural context in which he grew up.

Sexual Disorders: An Overview Of Sexual Dysfunction

Sexually Transmitted Diseases: Here’s What They Are And How To Avoid Them

Sexual Addiction (Hypersexuality): Causes, Symptoms, Diagnosis And Treatment

Sexual Aversion Disorder: The Decline In Female And Male Sexual Desire