What is erectile dysfunction?

It is called erectile dysfunction when it is not possible for the man to produce and maintain a satisfactory erection over an extended period of time. The penis relaxes after a short time or does not even reach a sufficiently erected state for intercourse. This makes a fulfilling sex life almost impossible. Erectile dysfunction will come after about six months in which, in the majority of cases, no erection sufficient for sexual intercourse has been diagnosed. Short-term erectile dysfunction, which subsides after a few weeks, are not referred to as erectile dysfunction. Temporary erectile dysfunction may occur, for example, in mental health problems, such as partnership conflicts or other difficulties.

Who is affected by erectile dysfunction?

Erectile dysfunction is a shameful topic for many men. There is limited data on the incidence of erectile dysfunction in German men. In 2000, a study was conducted with results of a questionnaire for erectile dysfunction published, which was answered by 4,883 men between 30 and 80 years. It became clear that erectile dysfunction affects elderly men more often than younger men. In the 30- to 39-year-old group, only 2.3 percent reported having erectile dysfunction. In the age group of 50- to 59-year-olds it was 15.7 percent, among the 60- to 69-year-olds already one in three was affected.

How is an erectile dysfunction diagnosed?

The diagnosis of erectile dysfunction can already be made after a thoroughly collected medical history by the doctor. Crucial here is that for about half a year in the vast majority of attempts no erection is achieved, which allows satisfactory sexual intercourse.

Are further tests performed after the diagnosis of an erectile dysfunction?

Patients with erectile dysfunction suffer more than average from cardiovascular diseases such as high blood pressure, diabetes mellitus or increased blood cholesterol levels. Therefore, your doctor will ask more questions after the diagnosis of erectile dysfunction and may want to take a blood sample.

Erectile dysfunction can also be caused by medication, past surgery or psychological problems. The treating physician will ask about all these issues to find the reason for the erectile dysfunction.

What are causes of erectile dysfunction?

Erectile dysfunction can have physical causes – this is especially true for erectile dysfunction in middle and older age. Mention is especially the hardening of the arteries (atherosclerosis) as the main cause of erectile dysfunction. Atherosclerosis is caused by high blood pressure(Hypertension), and a present arteriosclerosis indicates a significantly increased risk of heart attack and stroke. For this reason, it is so important that the attending physician not only treats the erectile dysfunction but also examines the overall physical condition of the person affected. Other possible physical causes of erectile dysfunction are past surgeries in the abdominal and pelvic area and ulcers (tumors) in the abdominal and pelvic area.

Younger people report psychological problems more often than older people. Stress at work or in the relationship can play a role, but any other unresolved problems or conflicts can negatively affect the erection.

Often, the causes of erectile dysfunction cannot be accurately diagnosed. Psychological problems can, in many cases, increase physical factors, so that the erection is negatively affected. This, in turn, reduces self-esteem and increases insecurity during intercourse. In this way, many sufferers get into a negative loop of physical and psychological nature.

Which risk factors can cause impotence?

Some factors that lead to erectile dysfunction are preventable, others not. The following risk factors exist for an erectile dysfunction:

High blood pressure and high cholesterol levels (cardiovascular diseases)
Diabetes: Type 2 (the most common form, usually goes hand in hand with obesity)
Mental stress
Long-term smoking, alcohol excesses, and drug abuse – all of which worsen the arteries
Medicines for hypertension and depression (among others)
Treatments for prostate cancer
Injuries or damage to the nerves in the pelvic region (lower abdomen), which control the erection

Which physical causes are responsible for erectile dysfunction?


The most common reason for erectile dysfunction is arteriosclerosis. Causes of atherosclerosis include high blood pressure, high cholesterol and lack of exercise. Narrowed arteries and veins prevent unhindered blood flow throughout the body, including in the erectile tissue of the penis. If the erectile tissue does not fill up properly with blood, the erection of the penis will not be sufficiently hard.


Diabetes mellitus” is characterized by very high blood sugar levels. These lead to a thickening of the inner walls of the blood vessels, which means that not enough blood can flow into the erectile tissue. The most common form of diabetes is type 2 diabetes, which is favored by overweight, lack of exercise and poor diet.

Low testosterone level

Also, too low a testosterone level is a rare but possible cause of erectile dysfunction. A low testosterone level can lead to other symptoms such as depression, less desire for sex, as well as a lack of strength and endurance.

Neurological diseases

Neurological conditions such as multiple sclerosis and Parkinson’s disease or pelvic surgery can also cause persistent erectile dysfunction by damaging the signal transmission of the nerve tracts.

What are the most common physical causes of impotence?

Not infrequently, impotence is indeed the symptom of a more serious health problem, such as atherosclerosis (blood vessel disease, for example, due to a high cholesterol level or unhealthy diet). Likewise, diabetes and high blood pressure are other causes of erectile dysfunction.

There are many different physical causes that can lead to impotence. There may also be several causes together, so all risk factors should be considered. Certain causes are riskier and therefore more likely to promote impotence than other causes. In our list, we give an overview of individual risk factors and the probabilities with which they can lead to erectile dysfunction.

  • Cardiovascular disease 33%
  • diabetes 25%
  • Injuries & Nerve Diseases 11%
  • Operations on the pelvis 10%
  • Side effects of drugs 8th %
  • Smoking & alcohol 7%
  • Hormonal disorders 6%

What is my risk of getting erectile dysfunction?

The exact risk of erectile dysfunction cannot be determined. It is clear that older men are more often affected by erectile dysfunction – due to the generally poorer vascular state in old age and the more prevalent pre-existing conditions. However, those who eat healthily, regular exercise, refrains from smoking and too much alcohol and adequately treated any high blood pressure, which minimizes his risk of suffering from erectile dysfunction in the future.

It is important to know that even men without erectile dysfunction have erection problems from time to time. Reasons can be eg fatigue or heavy alcohol consumption. After sufficient rest, the penis rebuilds satisfactorily, so that in the cases described no treatment of erection problems is necessary.

How to distinguish between psychological and physical causes of erectile dysfunction?

In addition to physical causes, emotional factors can also cause erectile dysfunction. If there are any doubts as to whether physical causes of the erectile dysfunction exist, a simple test can often be groundbreaking in the differentiation between mental and physical causes of erectile dysfunction.

The doctor will ask you to put a small ring of paper around your penis before bedtime. During sleep, healthy men experience penile erections while sleeping. The paper ring will tear during an erection because the penis diameter during erection is much larger than in the relaxed state. In this way, it can be tested whether – even without therapy – purely physically an erection is even possible.

Another indication of mental causes of erectile dysfunction is the information about the masturbation of the person concerned. If a hard erection is achieved in masturbation, but not for sexual intercourse, this suggests a mental cause. However, one should not forget that physical and psychological factors are often interrelated and mutually influential, so that disruptive therapy should always include the physical and emotional.

What are psychological causes responsible for erectile dysfunction?

Mental problems are often the cause of erectile dysfunction in young men. The following mental problems may be found:

  • depressions
  • stress
  • pressure to perform
  • fears
  • low self-esteem
  • Problems in the partnership
  • Traumatic experiences in the past

How are erectile dysfunction and depression related?

Depression can be both a cause and the result of erectile dysfunction. A lasting sadness in the expression of pessimism, helplessness, feelings of guilt, irritability, hopelessness, and anxiety give indications of the possible existence of a depressive episode.

Those affected suffer from low self-esteem and self-esteem, fatigue and fatigue, general loss of enthusiasm and interest, loss of appetite and reduced desire for sex (loss of libido). If a depressive episode and erectile dysfunction occur at the same time, the depressive episode is usually treated first – as soon as the mood improves the erectile dysfunction usually disappears.

When should erectile dysfunction be treated?

If erectile dysfunction persists for an extended period, a doctor should be consulted. Many sufferers are reluctant to talk about this embarrassing subject – treating erectile dysfunction effectively and may be a harbinger of more serious illnesses such as a heart attack.

What can the doctor do?

If you decide to seek medical advice, the doctor will first try to find out the causes of your erectile dysfunction. To do this, he first needs to determine the severity of your erectile dysfunction. It is important that you answer all questions truthfully so that the correct diagnosis can be made.

In the second step physical causes for your potency problems should be excluded. You will be asked questions about certain pre-existing conditions such as diabetes or the intake of medication. It also measures your blood pressure.

Subsequently, the doctor will suggest a treatment option.

What treatment options are there?

Erectile dysfunction can be treated with medication. Most drugs for impotence are called PDE-5 inhibitors. These inhibit the enzyme phosphodiesterase-5, which dilates the blood vessels and the cavernosum of the penis can more easily fill with blood. An effect only starts when the man is sexually stimulated.

The most well-known active substances are sildenafil, tadalafil, and vardenafil, which are contained in Viagra (sildenafil), Cialis (tadalafil) and Levitra (vardenafil).

Viagra has been approved by Pfizer as the first PDE-5 inhibitor for the treatment of erectile dysfunction. The effect lasts 30 to 60 minutes after ingestion and lasts for an average of 4 hours. Since June 23, 2013 Sildenafil is approved in Germany as a generic. As a result, the price has been significantly reduced with the same effectiveness.

Cialis can be taken as an alternative to Viagra or Levitra. It has about the same mode of action, with the duration of the effect with 24 to 36 hours is significantly longer. Cialis is often referred to as a “weekend pill” because it works over a longer period of time and sufferers can get an erection several times on weekends with only one pill.

Levitra is very similar to Viagra in its effect. After a sexual stimulation, an erection occurs after about 30 to 60 minutes. The duration of action is also 4 hours.

What are alternative treatment options there?

Another treatment option is the cavernous autoinjection therapy (SKAT). This method is used for erectile dysfunction caused by neurogenic, vascular, or psychogenic problems. The patient injects an individualized dose of medication into the penis to create an erection.

The penis pump makes the penis stiff by creating a negative pressure. In this way, blood flows into the penis and an erection can be built up. The penis pump is used just before sexual intercourse and creates a vacuum using a pump. Subsequently, a jail ring is used to maintain the erection and, in this way, can perform the sexual intercourse normally for a certain period of time.

An operative alternative is the penile prosthesis . The erectile tissue is replaced with implants, which can be inflated. The pump is inserted into the scrotum. The penile prosthesis is an option especially for those patients who refuse to take medication or who can not tolerate the medication.

If psychological problems are a cause of the erectile dysfunction, relieving conversations with the doctor and possibly psychotherapy can restore full erection ability.

What can affected people do against erectile dysfunction?

If you notice an erectile dysfunction, you should seek professional help at an early stage. Further complications of arteriosclerosis may be prevented, and improvement of erectile dysfunction will be faster and more reliable if erectile dysfunction is treated quickly.

In addition, they should be careful not to order drugs or aids from the Internet if you can not accurately verify the source. Illegal treatment options from the Internet can often result in serious health damage.

What side effects can the PDE-5 inhibitors cause?

The PDE-5 inhibitors Viagra, Cialis and Levitra often cause headaches, dizziness and blurred vision. In addition, some patients complain of a stuffy nose.

Who can not take PDE-5 inhibitors?

PDE-5 inhibitors should not be taken with some hypertension and heart medications. The doctor will ask for it. Similarly, the use of heart attacks is very dangerous. The doctor will interview the affected person in detail in order to detect possible risk constellations and if necessary to propose an alternative method of treatment.