Male sexual dysfunction is one of the most common health problems affecting men and is more common with increasing age. Chronic ED affects about 5% of men in their 40s and 15-25% of men by the age of 65. Transient ED and inadequate erection affect as many as 50% of men between the ages of 40 and 70.

Erectile dysfunction (also called "impotence") is the inability to get or keep an erection firm enough for sexual intercourse. Erectile dysfunction, or ED, can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections.

Causes

The development of an erection is a complex event involving integration of psychological, neurological, endocrine, vascular and local anatomic systems. There are many underlying physical and psychological causes of erectile dysfunction. Most men with physical causes usually have an associated psychological component. Various diseases may affect erectile function by altering the nervous, vascular, or hormonal systems or by influencing the patient's psychologic mood and behavior. Reduced blood flow to the penis and nerve damage are the most common physical causes. Underlying conditions associated with erectile dysfunction include the following:

Physical health conditions
Problems with the nervous system can affect the transmission of signals from the brain to the blood vessels in the penis. This occurs in conditions including multiple sclerosis, spinal cord injury and Parkinson's disease. The nerves involved in sexual arousal can also be damaged in surgery to the pelvic area, such as removal of the prostate. In a small number of cases, problems with hormone levels, can also affect erection.
- Vascular diseases account for nearly half of all cases of erectile dysfunction in men older than 50 years.
  Vascular diseases associated with erectile dysfunction unclude:
  Atherosclerosis (fatty deposits on the walls of the arteries can prevent adequate blood from entering the penis)
  Veno-occlusive disease (venous leak) (problems with keeping the blood within the penis)
  Peripheral vascular disease (problems with blood circulation)
  Arterial hypertension
  History of heart attacks
  Blood vessel trauma
  High cholesterol levels
- Systemic diseases associated with erectile dysfunction:
  Diabetes mellitus is a major cause of erection problems. About 60% of men with diabetes experience erectile dysfunction. Chronic high levels of blood sugar associated with diabetes mellitus often damage small blood vessels and nerves throughout the body, which can impair nerve impulses and blood flow necessary for erection.
  Scleroderma (stiffening or hardening of the skin)
  Kidney failure
  Liver cirrhosis
  Hemachromatosis (too much iron in the blood)
  Dyslipidemia
  Hypertension
- Neurologic diseases. Problems with the nervous system can affect the transmission of signals from the brain to the blood vessels in the penis. Diseases that affect the nervous system and are commonly associated with erectile dysfunction include:
  Multiple sclerosis
  Spinal cord and brain injuries (paraplegia, stroke)
  Parkinson's disease
  Alzheimer's disease
  Epilepsy
  Guillain-Barre syndrome
- Respiratory disease associated with erectile dysfunction include:
  Chronic obstructive pulmonary disease
  Sleep apnea
- Conditions of the penis:
  Peyronie's disease (a rare inflammatory condition that causes scarring of erectile tissue)
  Epispadias
  Priapism
  Infections, including sexually transmitted diseases may also lead to erectile problems.
Traumatic Causes. Trauma or injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to erectile dysfunction by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa. Injuries to the penis may also result in scar tissue formation as well as penis curvature during an erection. Bicycle riding for long periods has also been implicated as a cause of erectile dysfunction.
Some types of prostate or bladder surgery. Surgery of the colon, prostate, bladder, or rectum may damage the nerves and blood vessels involved in erection.
Medications. A great variety of prescription medication are known to cause or contribute to erectile dysfunction:
- blood pressure medication (especially beta-blockers)
- heart medication (such as digoxin)
- antihistamines
- antidepressants
- tranquilizers
- antipsychotics (for psychological illness)
- anticonvulsants
- appetite suppressants
- anti-ulcer medications (cimetidine)
- sleeping pills
Psychological conditions also influence the ability to get and maintain erections. Anxiety and guilt are the most common psychological causes of erectile dysfunction. Depression, worry, stress, low self-esteem, and fear of sexual failure all contribute to loss of libido and erectile dysfunction. One episode of failure, regardless of cause, may propagate further psychological distress leading to further erectile failure. Psychological factors in impotence are often secondary to physical causes, and they magnify their significance. Experts believe that psychological factors cause 10 to 20 % of erectile dysfunction cases.
Substance abuse. Chronic use of alcohol, tobacco, marijuana and abusing drugs often causes erectile dysfunction and decreased sexual drive.
- Alcoholism. Drinking too much alcohol commonly affects the ability to get and maintain an erection. It interferes with the production of the male hormone testosterone, which can reduce libido.
- Smoking. Prolonged tobacco use (smoking) is considered an important risk factor for erectile dysfunction because it is associated with poor blood circulation and its impact on cavernosal function.
Hormone Disorders account for fewer than 5% of cases of erectile dysfunction. An imbalance in hormones, such as testosterone, prolactin, or thyroid, can cause erectile dysfunction. Hormonal abnormalities such as hyperthyroidism (overactive thyroid gland), hypothyroidism (underactive thyroid gland), hypogonadism (leads to lower testosterone levels), increased prolactin (a hormone produced by the anterior pituitary gland), steroid abuse by body-builders may cause impotence. Rarely is low testosterone alone responsible for poor erections. Testosterone stimulates desire, but is believed to have little effect on erections.
Age. All studies demonstrate a strong association with age, even when data are adjusted for the confounding effects of other risk factors. Erection problems tend to become more common with age, but it can affect men at any age and at any time in their lives. Physical causes are more common in older men, while psychological causes are more common in younger men.

Treatment options

In around 95% of the cases, a suitable treatment can be found. Erectile dysfunction is treatable at any age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for erectile dysfunction.

PDE-5 inhibitors - Viagra, levitra & Cialis
There are three oral medications approved for the treatment of erectile dysfunction: sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). All three medications belong to a class of drugs called phosphodiesterase (PDE) inhibitors. These drugs vary in dosage, duration of effectiveness and possible side effects. All three drugs are generally well tolerated. All these agents block the enzyme phosphodiesterase-5 (PDE-5). Blocking this enzyme helps maintain levels of cyclic guanosine monophosphate (GMP), a chemical produced in the penis during sexual arousal. Balanced levels of GMP causes the smooth muscles of the penis to relax and increases blood flow. This allows a natural sequence to occur - an erection in response to sexual stimulation. These medications don't automatically produce an erection. Instead they allow an erection to occur after physical and psychological stimulation.

Oral PDE-5 inhibitors, unless contraindicated, should be offered as a first-line of therapy for erectile dysfunction. PDE5 Inhibitors are a good choice for men at any age and in any ethnic group who are in good health and who do not have conditions that preclude taking it (such as the use of nitrates or alpha-blockers). The success rates of all three drugs vary between 70% and 90%.

Natulal erectile dysfunction treatment remedies
There are a number of natural herbal remedies used to treat erectile dysfunction. One of such remedies is Ikawe for men (which means 'Warrior" or "Strong") produced by Native Remedies. Ikawe is a specially formulated All Herbal Formula containing selected phytoceutricals and adaptogens to optimize male sexual functioning, boost sexual performance and counteract the effects of modern living, drugs and environmental pollution. Ikawe is formulated to enhance sexual performance, stamina and desire, strengthen erections and greatly improve overall sexual and systemic health.