Erectile dysfunction (also know as impotence) is the difficulty in achieving or keeping an erection. Erectile dysfunction affects a man's ability to have sexual intercourse or perform other sexual activities such as masturbation. Erectile dysfunction can be caused by physical and psychological problems.

During sexual arousal the brain sends signals through the body which increases blood flow to the penis causing the tissue to expand and harden (an erection). When something interferes with those signals, or the blood circulation is disrupted, erectile dysfunction can occur. There are physical and psychological factors which can cause this to happen.

The common types of health condition which can cause erectile dysfunction are:

Vasculogenic conditions – which affect blood flow to the penis such as heart disease, atherosclerosis, hypertension, diabetes.
 
Neurogenic conditions – which affect the nervous system such as Parkinson's disease, multiple sclerosis, spinal injuries or tumours.

Hormonal conditions – problems affecting levels of hormones in the body such as an over-active or under-active thyroid, hypogonadism (testosterone production) or Cushing's syndrome (cortisol production).

Anatomical conditions – problems affecting the structure of the penis such as abnormal development of the urethra (known as hypospadias) or Peyronie's disease (a condition affecting the tissue of the penis).

There are certain medications which can cause erectile dysfunction such as diuretics, antidepressants, steroids and anti-epileptic drugs.

Psychological causes of erectile dysfunction include: depression, anxiety, stress and relationship problems. Physical problems which cause ED often result in psychological problems with getting or maintaining an erection causing a vicious cycle which is difficult to break.

Smoking, obesity, excessive alcohol consumption and illegal drug use can all cause erectile dysfunction as can spending more than three hours per week cycling due to the saddle placing excess pressure on the nerves of the penis resulting in damage.

The main symptom of erectile dysfunction is the inability or difficulty in getting an erection or maintaining an erection. Certain situations may prevent an erection such as sleeping with a partner in which case the condition is primarily psychological especially when an erection is possible during masturbation or first thing in the morning.

If you're unable to get or maintain an erection under any circumstances then the underlying cause is usually physical.

For a diagnosis of erectile dysfunction you should visit your GP who will ask questions about your symptoms and whether you take any drugs or medications.

They will question you about the ED and when the problems occurs e.g. all the time or only during sex with a partner. If the problem exists all the time there is probably a physical underlying cause while the latter suggests something psychological.

The GP may carry out an examination of the penis to rule out any anatomical causes. They may also use blood tests to check for other health conditions such as diabetes or an under/over-active thyroid.

If necessary, the GP may refer you for further tests to rule out other problems such as heart disease or atherosclerosis.

Other tests for determining physical and psychological causes of ED include:

Ultrasound - to examine the blood vessels inside the penis.

Intracavernous test - injecting a hormone into the penis to increase blood flow.

Cavernosometry - injecting a dye into the penis to check for blockages in blood flow or for blood vessel abnormality.

Nocturnal tumescence test – a simple test carried out over night to see if an erection occurs at night. Perforated tape is attached at the base of the penis; if an erection occurs the tape will break. This test is beneficial in determining if the erectile dysfunction is due to physical or psychological causes.

*Source: GoToSee.co.uk

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