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  • Writer's pictureFabio Castiglione

What is erectile dysfunction or male impotence?

erectile dysfunction London

Erectile dysfunction is a serious problem for any man. What is erectile dysfunction or male impotence and how can it lead to problems in sexual relations, often destroying marriage and causing complexes?

What is erectile dysfunction or male impotence, let's talk about it with Dr. Fabio Castiglione.

Dr Fabio Castiglione is a widely experienced consultant urologistandrologist practising at private clinics in London. His specialities include andrology, regenerative medicine, men's sexual dysfunction, shockwave therapy for erectile dysfunction, and chronic prostatitis.

The modern man attaches great importance to a harmonious intimate life which is the foundation of a strong and healthy relationship between a man and his partner. One of the possible interferences that can creep in to compromise the couple relationship is erectile dysfunction. Erectile dysfunction (ED) or male impotence is defined as the persistent inability of a man to reach and maintain sufficient tension on the penis for normal sexual intercourse. When this disorder worsens, it makes sexual intercourse almost impossible, which becomes the cause of infertility, loneliness, depression, up to deep depression. Many men with erectile dysfunction do not seek medical attention, making it difficult to estimate true prevalence. In America it is estimated that the number of men over the age of 40 suffering from some form of erectile dysfunction reaches 150 million. Obviously, it poses a huge medical and social problem.

The main symptoms of erectile dysfunction are:

  • Decreased sexual desire.

  • Weakness or absence of nocturnal and morning erections.

  • An increase in the interval between making love and the onset of an erection.

  • Premature ejaculation and decrease in the amount of sperm secreted.

  • Decrease or loss of the sensation of orgasm.

  • Long recovery between erections, the inability to perform a second intercourse.

  • An inability to reach and maintain sufficient tension on the penis for penetration.

In advanced cases, complete impotence develops.

How does the erection work?

Erection is a complex process that is activated in different ways. Let's talk about psychogenic and reflex erection. The psychogenic erection is activated by the limbic system of the brain, under the influence of erotic stimuli (visual, olfactory, auditory, etc.). Reflex erection is caused by contact with the penis, the lower spinal cord and peripheral nerves are responsible for its development. In response to stimulation, the vascular endothelium secretes nitric oxide, the arteries dilate, the blood flow to the penis increases sharply, the corpora cavernosa filled with blood constrict the veins, preventing venous outflow and an erection occurs. An important condition for this process is the normal level of sex hormones.

Erectile dysfunction can be provoked by a violation of any of these mechanisms.

The vast majority (60-70%) of erectile dysfunction cases are caused by diseases of the cardiovascular system.

The causes of male impotence

Among these are:

High blood pressure, ischemic disease, histories of acute circulatory disorders. The vessels of the genital organs are susceptible to atherosclerosis in the same way as all the others. The abnormal narrowing of the arteries in the penis interferes with normal blood flow and causes erectile dysfunction. Chronic stress, a sedentary lifestyle, smoking, diabetes mellitus and high blood cholesterol levels also have a negative impact, as these same factors cause hypertension and atherosclerosis.

Nerve conduction disorders at various levels are a common cause of erectile dysfunction. They can occur as a result of acute disorders of cerebral circulation, tumors and injuries of the brain and spinal cord, intervertebral hernias, various neurological diseases such as multiple sclerosis, etc.

Endocrine disorders. Diabetes mellitus and diabetic polyneuropathy, hypogonadism, obesity, thyroid pathology, as well as any changes in the hormonal background, accompanied by a decrease in the level of testosterone in the blood.

Injuries such as: fractures of the pelvis, damage to the corpora cavernosa, rupture of the urethra, previous surgery on the genitals.

Do you have questions on the subject: what is erectile dysfunction or male impotence? Do you want to talk to an expert? Contact Doctor Andrea Fabio Castiglione

Inflammatory diseases of the genitourinary system (prostatitis, urethritis, vesiculitis) in the absence of adequate treatment can become chronic, which often leads to erectile dysfunction and infertility.

Multiple use of drugs, also common as: psychotropic drugs (antidepressants, antipsychotics), drugs to lower blood pressure (beta-blockers, diuretics), antihistamines, lipid-lowering drugs, hormonal drugs and others. The use of drugs and alcohol has an unconditional negative effect on potency.

Rarely psychiatric diseases, such as neurosis, depression, schizophrenia that act as the cause of erectile dysfunction.

Diagnosis of male impotence

Diagnostic measures for erectile dysfunction are aimed at establishing the cause of its development and the degree of changes, which in turn allows for rational treatment planning. Very important is the anamnesis phase where the doctor tries to find out how the disease started, what could cause it. Particular attention is paid to the individual characteristics of sexual life, to "habitual" sexual intercourse, to the presence and quality of night and morning erections. Following a general medical examination and an examination of the genitals. Pay attention to the severity of secondary sexual characteristics, the nature of hair growth, structural changes in the penis and testicles, the shape and texture of the prostate gland are evaluated by rectal examination.

Other investigations

Hormone levels. Determine the content of testosterone, prolactin, gonadotropin, estradiol, follicle-stimulating and luteinizing hormones in the blood. To identify concomitant pathology, a biochemical blood test for sugar, cholesterol, etc. is performed. Sometimes, for the differential diagnosis, a drug test is performed with the introduction of papaverine or alprostadil into the corpora cavernosa.

The ultrasound examination is of great importance in the diagnosis of prostate diseases (tumors, prostatitis, etc.), which can cause erectile dysfunction. Using Doppler ultrasound, the blood flow in the corpora cavernosa of the penis and the amount of venous outflow are assessed. The technique allows to identify signs of vascular atherosclerosis, fibrotic changes or calcifications of the cavernous tissue; which is important from the point of view of prognosis.

Magnetic resonance. An even more detailed study of the morphology and blood flow in the corpora cavernosa can be done using MRI of the penis and cavernous tissue biopsy.

The X-ray contrast examination of the penis (cavernosography) allows to identify the pathological venous outflow, to evaluate the structure of the corpora cavernosa. With the aid of a computer and special sensors, the sensitive innervation of the penis can be examined, the frequency and duration of spontaneous nocturnal erections can be estimated.

The importance of prevention and accurate diagnosis!

There are two fundamental aspects that are important to understand in order to counter this disorder. Diagnosis of the causes and the speed with which a specialist is accessed. Both are relevant aspects to be able to field the best treatments for the individual case. Regarding the treatment options, we refer you to a previous article: erectile dysfunction therapy or male impotence, in which you will learn about the main treatments to combat ED.


Regardless of the form and stage of erectile dysfunction, this condition requires professional medical attention. Correct and timely treatment initiated in compliance with all medical recommendations allows in most cases to restore normal sexual function and preserve it for many years. For advice, always contact a doctor, Andrologist or Urologist, to establish with certainty what erectile dysfunction depends on and to identify the right cure for your case. Doctor Castiglione is both Urologist and Andrologist!

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