There is a strong association between a variety of neurological diseases and ED. Hollowing spinal injury, erections are often very unpredictable in frequency and nature. Reflex erections persist if the sacral segments of the cord are intact, but these may be poorly maintained. Voluntary erections may still occur, especially in men with incomplete and lower level lesions.

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

Many studies have shown a strong association between diabetes and ED. In MMAS, the prevalence was 28%. in treated diabetics, and in men attending diabetes clinics the prevalence varies from 27 to 59%. Overall, the risk of HO in diabetics appears to be about three times as great as that of the population as a whole. There is a strong connection between Diabetes and 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…

In a questionnaire survey, Brecher found that although 59% of men over the age of 70 years were still having regular coitus with their wives, 81% claimed to be sexually active. This suggests that as men become older the frequency of coitus declines more rapidly than does stated erectile ability and that masturbation becomes relatively more frequent

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…

Definition

The term impotence has come to encompass a wide range of disorders of erection, ejaculation and even sexual orientation or preference. Much of the discussion in this book, however, concerns the investigation and management of erectile problems, including the complete failure to achieve an erection. These conditions are described as Erectile Dysfunction (ED), which is defined here as the inability* to achieve an erection that is adequate for intercourse to the mutual satisfaction of both partners. Disorders of ejaculation and orgasm are defined in Chapter ‘97, Disorders of Ejaculation.
Epidemiological studies have demonstrated few differences in ED prevalence.