Malignancies affecting either partner may adversely affect male erectile function ( Fig. 1.31 ). This may be directly due to physical, often neurological, problems following extensive pelvic surgery, or to psychosexual problems arising from changes in self image and esteem. The latter problems are often seen in patients with stomas or in women who have undergone mastectomy or hysterectomy. Pelvic radiotherapy and chemotherapy may also reduce sexual function.

1.31 Malignancies associated with ED

The incidence of ED in men with chronic renal failure is approximately 40%. There is evidence that men on haemodialysis are more likely to have problems than those who have had a transplant, and also that a significant number (approximately 75%) of these men will experience improvement in their erections following transplantation.
Arthritis, HIV, endocrine diseases causing ED…

Cardiovascular disease can affect potency by a variety of mechanisms. Erectile dysfunction occurs in up to 45% of men following myocardial infarction, but there is evidence that a similarly high incidence exists in men before they suffer heart attacks. Psychological factors may play a significant role in this type of erectile failure, the men and their partners being afraid of the exertion of sexual activity. 85% of men with vascular accidents develop impotence

Broadly speaking, ED can be defined as being the consequence of either organic or inorganic (i.e. psychogenic) disease. Although 30 years ago it was thought that the majority of cases were psychogenic in nature, in the 1970s and 1980s many experts believed that ED always had an organic cause. Today experts say that impotence is caused both by psychological and physical problems…

There is now abundant evidence that sexual function declines with increasing age even though interest in sexual activity may remain. This decline in function was described by Kinsey et al. in 19488, who found a steady decrease in the frequency of coitus with increasing age. Their data of the effect of age on sexual function are shown in Fig. 1.1. These data, however, have been criticized for being obtained from a very select population. The study included relatively few men over the age of 55 years…