Health Information
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Understanding This Symptom
Medical Definition
Subject Matter Expert Verified
Erectile dysfunction (ED) is the persistent inability to achieve or maintain sufficient penile rigidity for satisfactory sexual performance.
It involves complex interactions between vascular, neurological, hormonal, and psychological systems, where endothelial dysfunction and reduced nitric oxide bioavailability lead to inadequate cavernosal smooth muscle relaxation, preventing adequate arterial inflow and venous occlusion during sexual stimulation.
Quick Facts
What Optimal Health Looks Like
Understanding how your body functions when healthy helps identify dysfunction
Healthy erectile function requires a precisely coordinated cascade: sexual stimulation triggers neuronal (parasympathetic) and endothelial (nitric oxide/NO) signaling, causing cavernosal smooth muscle relaxation.
This allows increased arterial blood flow into the corpora cavernosa, expanding the sinusoids and compressing subtunical venular channels against the tunica albuginea, trapping blood (veno-occlusive mechanism) to produce rigidity.
Simultaneously, sympathetic tone decreases to permit erection.
Healthy function requires intact penile innervation (pudendal nerves), adequate testosterone (free T > 65 pg/mL), normal endothelial NO production, healthy vascular endothelium, and balanced autonomic nervous system function.
Healthy Function
Your body is designed to maintain balance and self-regulate
How This Develops
Endothelial dysfunction - Reduced nitric oxide (NO) synthesis from endothelial nitric oxide synthase (eNOS) and increased oxidative stress from reactive oxygen species (ROS) degrade cGMP signaling pathways essential for smooth muscle relaxation
Vascular insufficiency - Atherosclerotic changes in penile arteries (often reflecting systemic cardiovascular disease) reduce arterial inflow; endothelial dysfunction impairs vasodilation
Cavernosal smooth muscle impairment - Structural changes in smooth muscle cells, increased collagen deposition, and impaired relaxation mechanisms (PDE
Neurogenic factors - Autonomic neuropathy (diabetic, toxic, or age-related) damages parasympathetic innervation; reduced neural NO production impairs signaling
Hormonal deficiency - Low testosterone reduces sexual desire (libido), impairs NO synthase activity, and affects cavernosal tissue responsiveness; estrogen excess (relative or absolute) antagonizes androgen receptors
Psychogenic contributions - Performance anxiety, depression, relationship stress, and CNS inhibitory signals can suppress erectile response through sympathetic overactivity
Understanding the mechanism helps us target the root cause rather than just treating symptoms.
What Happens If Left Untreated
Understanding the consequences helps you make informed decisions about your health
Short-Term Consequences
Days to weeks
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Time Matters
Don't wait for symptoms to worsen. Early intervention leads to better outcomes.