Fortnightly Review: Impotence: diagnosis and management of male erectile dysfunction

Abstract

Impotence is defined as the persistent failure to develop erections of sufficient rigidity for penetrative sexual intercourse. The disorder is strongly related to age, with an estimated prevalence of 2% at age 40 years rising to 25-30% by the age of 65.1 Although no data are available on the prevalance of impotence in men over 75, it is probably over 50%. As the proportion of men aged over 65 is predicted to more than double in many developed countries in the next 30 years and the incidence of diabetes, which is one of the commonest causes of impotence,2 is also rising, doctors are likely to spend more time in the diagnosis and management of erectile dysfunction. Although impotence does not affect life expectancy, it can have a strong negative effect on well being and quality of life. It also often affects a man's interactions with his family and associates. The problem tends to be compounded by unrealistic expectations of continuing sexual prowess, partly as a result of most men's reluctance to admit to or even discuss the problem with their peers. Some men even hide their difficulties with erections from their partner, who may make the problem worse by misinterpreting the apparent lack of sexual interest as a sign of unfaithfulness. Once the problem is faced, however, some couples are happy simply to accept impotence as an inevitable consequence of the passage of years. But increasing numbers of men aged 50-75, especially those with younger partners, are now requesting medical help to resolve the problem. Recent advances in our ability to diagnose and treat a number of specific causes of erectile dysfunction have improved the prospects for the durable restoration of sexual function, although many impotent men, and their general practitioners, are still unaware of this. Erection of …