Many people do not like the term impotence because of its negative connotation. It is also rather vague and imprecise, which is one of the reasons it has been largely replaced by other terms in the medical literature. In common parlance, erectile dysfunction is often used as a synonym for impotence, but the two terms are not actually interchangeable, as one is more strictly an erectile failure than the other. Furthermore, neither term adequately characterizes the full range of male sexual disturbances. Sexual dysfunction is a broader term that encompasses ejaculatory problems, lack of orgasm, decreased libido, ED, and other conditions that preclude normal sexual functioning or satisfaction.
A potent (sexually functional) man is defined as one who has a high level of desire and is able, for a majority of his sexual encounters, to achieve an erection of sufficient quality to permit penetration, intercourse, orgasm, and ejaculation. He should be able to maintain his erection for at least the minimum time necessary to satisfy both partners. Conversely, a man who cannot develop an erection of sufficient rigidity or duration for intercourse to the full satisfaction of both parties is sexually dysfunctional; more precisely, he is suffering from ED. Beyond this, there is no single standard or average that can or should be applied.
Classifying male sexual dysfunction
The most common male sexual dysfunctions are:
- Erectile dysfunction
- Premature ejaculation
- Retarded or absent ejaculation
- Inhibited sexual desire
- Absence of orgasm
- Deviations and perversions
Sexual dysfunction may be primary, which means that it has persisted for all of a person's life (though it may not have been apparent until he or she became sexually active), or secondary, which means that a person who previously functioned well, sexually speaking, subsequently developed the dysfunction.
Erectile dysfunction definition
ED is the inability of a male to achieve or to maintain an erection of adequate quality and duration to permit satisfactory sexual performance and sexual gratification. It can occur in a man whose libido (sex drive) is intact (and therefore unfulfilled), or it can be associated with decreased or absent sex drive. ED is not a disease per se, but rather the clinical manifestation of one or more organic and/or psychogenic conditions. ED is not necessarily an all or none problem; rather, it is usually a matter of degree, ranging from minor to complete. It cuts across race, nationality, and socioeconomic factors; occurs at all ages; and varies in severity and duration from man to man. Almost all married men experience occasional episodes of ED.
Some "sexperts" contend that a man should fail in at least 50% of his sexual encounters before he is considered to have ED, but they would get an argument from men who are unsuccessful 99% of the time and would see 50% as a vast improvement. Others say that a minimum of five minutes of erection firm enough for intercourse denotes normal erectile function, but they would also get an argument, especially from men who cannot maintain an erection for 15 minutes or more - these men, though far from "impotent", are disappointed with their sexual function and may consider themselves to have ED, however illogical that may seem to others.
Patterns of ED differ among men. Some men lose their erections when they get anxious; some can achieve erections only during foreplay; others may gain an erection only to lose it at the moment of penetration or during intercourse. Some men may have erections through masturbation, or only in deviant situations (e.g., with pornography or during unusual sexual encounters), but fail to achieve or maintain erections under normal circumstances or with their primary sexual partner - such a man is anatomically potent, but psychologically he has ED.
Erectile dysfunction categories
The International Society of Impotence Research and the American Urological Association's treatment guidelines have both classified ED into five categories:
- Vasculogenic (arterial, cavernosal, and mixed)
- Psychogenic (situational and generalized)
- Drug induced
The etiologies, treatments, and therapeutic outcomes are different for each of these five categories as well as for primary versus secondary ED.
The prognosis for a man with ED depends on the condition's duration, the underlying causes, the man's willingness to seek medical advice and accept treatment, and the presence of aggravating conditions such as obesity, heavy smoking, lack of exercise, chronic alcoholism, drug addiction, unacknowledged homosexuality, or sexual deviations. Additional physical and psychological factors can also influence therapeutic success.
Any organic or psychological disorder that affects the brain, nervous system, vascular system, endocrine system, or genitourinary system - or, even more specifically, affects any part of the penis - can lead to a man's inability to develop or maintain a firm erection for a period long enough for successful sexual intercourse.
Prevalence and epidemiology
In the United States alone, ED affects about 15-30 million men. About 48% of the American male population over the age of 50 may suffer from ED, with the incidence increasing with age to reach about 75% in men 70 or older.
It is estimated that in total, about 150 million men worldwide suffer from some degree of ED, and it is projected that this number will double by the year 2025, as the male population becomes increasingly older. These figures, however, doubtless underestimate the true global prevalence of ED.