Erectile dysfunction (ED) is one of serious conditions in recent time among all ages but specially it worsen by aging. ED is persistent inability to attain or maintain an erection sufficient for satisfactory sexual performance. It found to affect 5% of men age 40 and this percentages increases to 15% at age 70 these experience it as sever erectile dysfunction, while mild to moderate erectile dysfunction reached to 10% of men per decade of life as 50% in 50s or 60% in 60s. 

(1) The main physiological cause of ED is blockage of blood vessels inpenis leads to decrease of blood flow to sexual organs which affect during intercourse by difficulty in attaining or maintain erection which may affect self esteem of men.

There are many medical conditions which may lead to erection dysfunction such as - Diabetes type 2 ; men with type 2 diabetes who have uncontrolled blood suger for long term, they are more likely to develop neuropathy which may affect penis cause erectile dysfunction.

           Heart and blood vessels diseases such as hypertension.
           Atherosclerosis where deposition of fats in blood vessels make it clogged affecting blood flow to sexual organs.
           Injury in prostate by surgery or prostate cancer therapy as radiation.

All of these conditions are common risk factors causes developing of ED.

(2) ED can be a side effect of some medicine as

             Blood Pressure medicines.
             Antiandrogens which decrease male sex hormone.
             In Case of therapy of prostate cancer.

Also, There are psychological conditions which make ED worse if one or more of these psychological conditions found such as :

              Fear of sexual failure
              Guilt about sexual performance or certain sexual activity
              Low self esteem which may be a result of the ED / stress which may be general or due to sexual performance.

In addition there are bad habits or life style related factors play a Role in developing ED as smoking, drinking alcohol too much or using illegal drugs and life style which not included regular exercise and obesity.

First line to treat ED is trying to alter modifiable risk factors as:

           Modifying the regimen of medication related to ED such as anti hypertensive.
           Start treatment with androgens in case of androgen deficiency.
           Start seeking psychological support in case of anxiety or depression.
           Modify life style; smoking cession, reduction of alcohol, doing regular exercise. (2)

2nd line of treatment is medical or therapeutic treatment where there are many medications used to treat ED acts on phosphodiesterase 5 (PDE5) inhibitors where it potentiate endogenous increase of CGMP which mediate smooth muscles relaxation lead to penile erection. These medication are sildenafil (generic Viagra)Tadalafil (generic Cialis)
,vardenafil (generic levitra).

3rd line of treatment are one of these methods:

Penile injection with vasoactive drug which is Alprostadil but this method doesn’t last more than an hour and it need close monitoring.

Penile implant it is not recommended until other methods are useless.

Vaccum constriction device it is used to draw blood into penis which followed by erection. This method is with minimal risk from all these methods.

EDis prevalent in all ages specially with old ages but there are different ways to treat erectile dysfunction first of all modification of life style as smoking, reduce drinking alcohol, lose weight in case of obesity, doing exercise regularly which all of these help with medication to improve ED, man should seek medical help to check for medical conditions which are risk factors for ED as diabetes, hypertension, atherosclerosis.

Then start medical treatment of sildenafil or any of PDE5 inhibitor in case of sever erectile dysfunction start one of other
treatments as penile injection , penile implant, and best of them is vaccum constriction device which is simple and with minimal risk. All of these decisions will be discussed with physician to get the most improvement in least time.

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