• Affects at least half of all men over the age of 40 years to some degree
• Prevalence of moderate to severe ED increases with age (see Table 12.1)
• Erectile function is a complex mechanism
• ED is a multi-factorial phenomenon—factors are rarely present in isolation but commonly occur in a synergistic combination
• Causative factors can be broadly classified as—
■ Psychogenic—due to a variety of stressful psychological and lifestyle problems
■ Organic a. Vascular—most common cause. Risk factors include hypertension, diabetes mellitus, atherosclerosis, hyper-lipidemia, obesity, pelvic injury, and smoking b. Neurogenic—causes include diabetes mellitus, alcoholism, multiple sclerosis, stroke, depression, Parkinson's disease, spinal cord injury, brain trauma c. Endocrine—androgen deficiency and hyperprolactin-emia d. Drug-induced—a large proportion of therapeutic and recreational drugs may cause ED, especially cardiac, hormonal, and psychotropic medications e. Structural—Peyronie's disease, penile fracture, congenital penile abnormalities f. Iatrogenic—pelvic surgery or radiotherapy, TURP, medications g. Systemic disease—renal failure, liver cirrhosis, chronic debilitation, etc.
Approximate prevalence (%)
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