It is often secondary to an underlying physical cause.

Complications of Erectile Dysfunction

Penile injections: Medications like alprostadil, papaverine, phentolamine, or a combination of drugs can be injected directly into the penis, producing an erection within 10 minutes. Vacuum erection devices (penis pumps): These work almost immediately to help achieve an erection. Testosterone replacement therapy: Available in gel, injection, patch, or pellet forms. To make your visit easier, you can use the Chat on WhatsApp, Book Appointment feature, or download the Care Dokter app from Google Play or the App Store to check queue numbers, schedule visits, and access more information. Penile erection is managed by two different mechanisms: The first one is reflex erection, which is achieved by directly touching the penile shaft.

Battery-powered penis pump for erectile dysfunction

The second is psychogenic erection, which is achieved by erotic or emotional stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both conditions, an intact neural system is required for a successful and complete erection. Stimulation of penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. In some cases, the psychological effects of insufficient rigidity / ED may stem from childhood abuse or sexual trauma. However, the most common psychological causes of insufficient rigidity / ED include: The Characteristics of Psychological Insufficient Rigidity / Erectile Dysfunction Include: Being able to achieve or maintain an erection with one partner but not with another.

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Having strong and lasting erections in the mornings and during masturbation but not during love making.

Treatment for Erectile Dysfunction

Based on the mechanism of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease. Source: National Institute of Diabetes and Digestive and Kidney Diseases Structural Changes of the Penis before and after Erection: Insufficient rigidity / erectile dysfunction is caused by physiological or psychological factors, or both. About 80-90% of cases of insufficient rigidity / ED are caused by physiological origin, which are further classified into vascular (related to blood flow) and non-vascular factors. It is estimated that 70% of insufficient rigidity / ED cases may be attributable to vascular diseases alone.

Vascular causes

A penis requires a healthy blood supply in order to erect. Even only a minor obstruction will lead to a serious erection problem. This is described as the lack of adequate penile blood supply, which is a result from the following factors: Source: The National Institute of Diabetes and Digestive and Kidney Diseases Type 2 Diabetes mellitus occurs when the pancreas does not make enough insulin, or when body tissues cannot utilize insulin effciently, resulting in an abnormally high blood glucose level. Advancing thirst, tiredness, weight loss, blurred vision and others are symptoms of diabetes. The condition will also lead to insufficient rigidity / erectile dysfunction by inducing damages of blood vessels and nerves involved in erection. Tendency to affect younger men with unstable relationships or unsettling past experiences.

Physical examination
Blood pressure measurement
Blood tests for hormones
Urinalysis for diabetes
Neurological exams
Vascular health assessment
Penile Doppler ultrasound
Psychological evaluation
Medical history questionnaire
Identifying underlying causes
Differential diagnosis process

Other Possibilities That Cause Insufficient Rigidity / ED A variety of risk factors can contribute to insufficient rigidity / erectile dysfunction.

Treatment Type	Description	Typical Use
Oral Medications	PDE5 inhibitors like sildenafil, tadalafil	First-line treatment for many men
Vacuum Erection Devices	Mechanical pumps creating vacuum to draw blood	Non-invasive, for short-term use
Injections	Alprostadil or other agents injected into penis	For men unresponsive to pills
Psychotherapy	Treats underlying psychological issues	Complementary to physical treatments

Conditions like cardiovascular disease, high blood pressure, or diabetes can contribute to problems with blood flow to the penis, causing ED. Associated with problems related to the nervous system, conditions like multiple sclerosis, Parkinson’s disease, or spinal injuries can cause this type of ED.

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Hypertension is a condition in which the blood pressure is persistently higher than normal (140/90 mmHg), even when you are resting or relaxing. Smoking, physical inactivity, obesity, stress, excess alcohol intake and a family history of hypertension are risk factors of hypertension. Most people with hypertension do not have any symptoms. According to the Population Health Survey of the Department of Health, 60% of males with hypertension do not know they have the disease. Hypertension is usually diagnosed unexpectedly in a routine health check-up.

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When severe, hypertension will cause headache, dizziness, and visual problems. Impotence is also one of the symptoms of hypertension. It is because penile arteries are damaged by excessive blood pressure. Normally, these arteries dilate in response to sexual stimulation, allowing more blood to flow into the spongy tissue of the penis to produce an erection. The excessive pressure in these arteries may cause tiny tears, which are subsequently repaired by the body. If the ED is related to psychological factors rather than physical ones, it’s termed psychogenic.

Some men find relief through natural remedies, but evidence may be limited.
Erectile dysfunction can be an early warning sign of cardiovascular disease.
Lifestyle counseling is often part of comprehensive ED management.
Regular exercise improves overall endothelial function.
Medications like PDE5 inhibitors are most effective when taken properly.
Psychological therapies are effective for ED with psychological causes.
Surgery is considered when pharmacological and non-invasive options are ineffective.

Anxiety, depression, and relationship issues are often the cause. Hormone imbalance, such as low testosterone levels, can lead to Hormonal ED. Please wait while loading the accessibility menu. Care & ServicesWe offer the highest quality of care and expertise in all specialty care areas.Explore Our ServicesSpecialty CareImaging ServicesOur radiology experts offer imaging services from CT and MRI scans to ultrasound and X-ray throughout the New York City area. Learn about our imaging services and how to schedule an appointment. We offer the highest quality of care and expertise in all specialty care areas.

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The healed arteries have thicker walls to better resist the elevated blood pressure. These bayer vardenafil thicker blood vessel walls, though, will impose extra resistance to blood flow into the erectile tissues of the penis. Cardiac Disease is one of the main killer diseases among men in Hong Kong, causing 3,442 deaths in 2008. Coronary heart disease accounted for approximately two thirds of all heart-disease-related deaths in men. Coronary heart disease (CHD) is a type of heart disease due to the occlusion of the coronary arteries.

Causes of ED

The coronary arteries serve to supply oxygen and nutrients to the heart muscles. When the arteries become narrow and stiff because of fatty plaques, blood supply to the heart will be reduced and the heart muscles will be damaged. A number of risk factors, including smoking, high-fat diet, physical inactivity, high blood pressure, high cholesterol levels, obesity, diabetes mellitus, stress and family history of coronary heart disease, which may work independently or in combinations, can lead to coronary heart disease. Smoking is associated with insufficient rigidity / erectile dysfunction by damaging the blood circulation system in the penis. As insufficient rigidity / ED is shown to be highly prevalent among smokers in clinical studies, it is hypothesized that quitting smoking can help prevent insufficient rigidity / ED, and improve the condition in insufficient rigidity / ED patients. Our radiology experts offer imaging services from CT and MRI scans to ultrasound and X-ray throughout the New York City area.

Testosterone Replacement Therapy: For ED Linked to Low T

Since insufficient rigidity / erectile dysfunction can be an early symptom of such underlying medical conditions, it is essential for patients to seek prompt diagnosis and treatment. It is however, not uncommon to see insufficient rigidity / ED in an otherwise completely healthy person, both physically and psychologically. It is postulated that the penile circulation is intrinsically precarious, being an end-artery it may not be surprising that blood flow to the penis be partially occluded as men age. Although this may not cause major health problems, erection problems may arise due to the hindered penile blood flow. Psychological factors are responsible for about 10%-20% of all cases of insufficient rigidity / ED. LocationsFind care close to you at our locations throughout the New York City area and in Florida.Find a LocationHospitals Find care close to you at our locations throughout the New York City area and in Florida.

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Work with a doctor to manage diabetes, heart disease, or other chronic health conditions Quit smoking, limit or avoid alcohol, and avoid illegal drugs Seek medical help for anxiety, depression, or other mental health issues The first step in treating erectile dysfunction is identifying the underlying cause. A doctor will help determine the most appropriate treatment method. Cardio exercise: Engaging in moderate to intense cardio activity for at least 45 minutes, three times a week, can help improve mild ED. This can include brisk walking, jogging, swimming, cycling, or jumping rope. Quitting smoking: Men with mild ED often see improvement within a few months of quitting smoking.

Miriam Hadj-Moussa, MD

Sex therapy or counseling: Useful for addressing psychological causes of ED. Oral medications: Such as sildenafil, vardenafil, tadalafil, or avanafil, which help improve blood flow to the penis. These typically begin to work within an hour. Low-intensity shockwave therapy (LiSWT): A non-invasive treatment using sound waves to improve blood flow. Results are usually seen within two months. Conditions We TreatExplore our approach to diagnosing and treating adults and children.View All ConditionsCommon Categories Explore our approach to diagnosing and treating adults and children.

When to See a Doctor

Prostatitis is an inflammation of the prostate gland. It can be sudden and acute, or reoccurring and chronic. This disease is often accompanied by a strong and frequent urge to urinate, difficulty in urinating (hesitant urination often results in only small amount of urine), and / or pain in the lower back or abdomen. Prostatitis can also cause insufficient rigidity / erectile dysfunction due to reduced blood flow. Other associated physical conditions or causes are less common.