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Erectile dysfunction (also known as impotence) is defined as an inability to achieve or sustain an erection that is adequate for sexual intercourse, an inability to ejaculate, or both. According to the National Institutes of Health, approximately 5 percent of men 40 years old and between 15 and 25 percent of men age 65 experience ED on a long-term basis. For a greater percentage of men, problems with an erection and sexual performance is an occasional occurrence and situational, mainly associated with drinking alcohol, emotional trauma, or physical exhaustion, for example. Erectile dysfunction in men is one of the most common sexual problems affecting males. However it can also be argued that erection problems also affect women, because erectile problems have an impact on both people in a sexual relationship. In fact, women generally are a significant portion of seekers of treatment for erectile dysfunction given the depression in men and other side effects that also impacts their life and quality of sexual relationship. ED Symptoms The obvious symptom of erectile dysfunction is the failure to get and maintain an erection when required. Failure to achieve an erection less than 20 percent of the time is not unusual; however when that percentage is 50 percent or greater that means it is a sign of something more serious. A sign that ED has a psychological cause is generally when men can achieve full erections when asleep (known as �nocturnal erections�) but experience problems with an erection at other times, such as when they are looking to be sexually active. How An Erection Works How do erections work? A simplified explanation is that when a man becomes aroused either physically (e.g., kissing, touching the penis) or mentally (e.g., sexual fantasies) it triggers the brain to transmit electrical signals to the penis. At that point, a complex sequence of biochemical events take place that involve various enzymes, nitric oxide, and blood flow, resulting in an erection. If there is an interruption in or problem with the sequence of events, erectile dysfunction is typically the result. Read more on how erections work Erectile Dysfunction Causes What are the causes of ED? Most causes are related to physical or environmental factors, which may include but are not limited to the use of certain medications, presence of chronic health problem, poor habits (lifestyle and nutrition), fatigue, injury or damage, exposure to environmental toxins, and poor blood flow to the penis. ED may also be the result of medical conditions such as diabetes, high blood pressure or heart disease, low testosterone as well as procedures to treat BPH (enlarged prostate). ED is also a side effect of many of the treatments for prostate cancer. Erectile dysfunction in young men is often the result of vascular disorders such as heart disease, diabetes either juvenile or type 2, side effects of certain drugs and medications, and inadequate hormones like in hypogonadism, neurological problems or severe trauma. Another important cause of ED in young men is psychological impotence. Psychological Causes of ED Psychological causes of erectile dysfunction make up about 10 to 20 percent of cases. Depression or anxiety about past sexual performances, fear of not performing sexually and pressure to perform can both impact whether you achieve and maintain an erection sufficient for intercourse. Basically, if you �think� you cannot perform sexually, chances are this will hinder your sexual performance. Counseling can be effective in overcoming any psychological issues, and in fact it is often recommended that both the man and his sexual partner attend counseling for best results. Whether erectile problems are associated with physical or psychological causes, a wide variety of treatments are available. Diagnosing ED To get an accurate diagnosis of erectile dysfunction, you should consult a knowledgeable healthcare provider with whom you feel comfortable discussing your problems. Diagnosis of ED involves several steps, including a physical examination, collection of personal, medical, and sexual history, and any tests the doctor deems necessary to help identify the cause of erectile dysfunction. Once a physician has made a diagnosis and identified the underlying cause of a man�s erection problems, the best possible treatment options can be explored. Treatment for ED Men seeking treatment for erection problems will discover there are many remedies and treatment options from which they and their healthcare provider can choose, depending on the underlying cause of the erectile problem. The success of treatment depends on several factors, including age, the causes, overall health, use of other treatments, and the state of erectile function before any sexual problems started. ED in men can be treated with a variety of options, including pills and drugs such as sildenafil (Viagra), vardenafil (Levitra, Staxyn), avanafil (Stendra), and tadalafil (Cialis), devices such as and vacuum erection devices (penis pumps) and constriction bands, injections or suppositories containing alprostadil (MUSE), penile/penis implants, natural remedies (herbal and nutritional supplements), and counseling. More than one treatment for can be used at the same time, but men should always consult their healthcare provider before starting or combining treatments. Natural Remedies for ED Traditional treatment may also be supplemented with other natural remedies such as natural supplements and vitamins and lifestyle changes. Natural supplement remedies may include carnitine, catuaba, ginkgo biloba, ginseng, horny goat weed, maca, muira puama, tongat ali, pine bark and tribulus terrestris. There are also foods and other lifestyle changes to promote blood circulation, reduce stress and aid in promoting healthy blood flow, a key component in healthy erections and erectile dysfunction. What�s Wrong With 4-Hour Erections? Some men actually have the opposite problem in relation to their erections and this can be a serious condition. The ads on TV for the major ED drugs always strongly advise you to �seek medical attention if you have an erection lasting longer than four-hours�. A serious side effect from drugs and other treatments can be a prolonged erection (known as priapism; an erection lasting longer than four (4) hours). A prolonged erection may also be caused by other treatments such as injections and MUSE suppositories. Priapism is a serious medical condition, because the penis is deprived of oxygen, which damages and destroys erectile tissue. These warnings should be taken very seriously and medical attention should be sought immediately. If you are on certain medications or treatments then your doctor may give you an information card similar to the Sloan-Kettering Wallet Card for patients using penile injections. This card details the serious nature of priapism and advises the attending medical professional of treatment options and other information.