Difficulty Getting Or Maintaining An Erection

What Causes Erectile Dysfunction?

Erectile dysfunction can have various causes, ranging in severity from 'minor' to 'generally fatal'.  Finding the true cause means ruling out or confirming each possibility – in other words, diagnosis.

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Diagnosis is usually a complex process due to the sheer number of possible causes and related symptoms.  In order to diagnose erectile dysfunction, we could:

  • Research the topic
  • Find a doctor with the time
  • Use a diagnostic computer system.
The process is the same, whichever method is used.

Step 1: List all Possible Causes

We begin by identifying the disease conditions which have "erectile dysfunction" as a symptom.  Here are seven possibilities:
  • Male Menopause
  • Prostate Cancer
  • Low Testosterone
  • Adrenal Fatigue
  • Dehydration
  • Heart Disease
  • Cigarette Smoke Damage

Step 2: Build a Symptom Checklist

We then identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
diagonal creases on earlobes
sleeping more than necessary
red palms/fingertips
high sensitivity to bright light
allergies to certain foods
smoking over a pack a day
severe fatigue after slight exertion
infrequent daytime urination
frequent colds/flus
rapid pulse rate
... and more than 120 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of erectile dysfunction:
Cause Probability Status
Low Testosterone 91% Confirm
Male Menopause 30% Unlikely
Dehydration 19% Unlikely
Cigarette Smoke Damage 3% Ruled out
Heart Disease 3% Ruled out
Prostate Cancer 3% Ruled out
Adrenal Fatigue 2% Ruled out
* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

In the Reproductive Symptoms section of the questionnaire, The Analyst™ will ask the following question about difficulty getting or maintaining an erection:
Do you have difficulty achieving or maintaining an erection?
Possible responses:
→ No / never / prefer not to say / don't know
→ Very rarely I will fail to maintain full erection
→ I occasionally fail to achieve/maintain erection
→ I usually/always fail to achieve/maintain erection
Based on your response to this question, which may indicate rare difficulty maintaining erection, some difficulty getting an erection or severe difficulty getting erections, The Analyst™ will consider possibilities such as:
Andropause/Male Menopause

Impotence or erectile dysfunction is one of the most common symptoms of andropause.

Coronary Disease / Heart Attack

A buildup of plaque in the penile arteries can lead to difficulty achieving or maintaining erection.  A long-running study of over 2,000 men found that erectile dysfunction is associated with a more than threefold higher risk of heart attack.  Lead researcher Dr. Steven J. Jacobsen, a professor of epidemiology at the Mayo Clinic, reported the findings Nov. 11, 2003 at the American Heart Association's annual conference in Orlando, Florida.  According to Jacobsen, "We can't say that it is cause-and-effect, but erectile dysfunction is a marker for future events of cardiovascular disease."  Overall, men with a heart attack from 1979 to 1995 were 3.5 times more likely to have erectile dysfunction in 1996 than men who did not have a heart attack.


All activity within the body requires adequate hydration – including erection maintenance.  Although dehydration is usually not the only cause, there are various ways in which it can worsen ED.  Dehydration reduces blood volume and causes blood vessels to become narrower, restricting blood flow to all parts of the body, including the penis.  Sexual arousal also requires the right state of mind; even mild dehydration can cause confusion, irritation, tension, anxiety, mood swings, and lethargy, none of which are conducive to getting or maintaining an erection.

Low Male Testosterone Level

Without sufficient testosterone the penile muscles atrophy, with the result that insufficient blood is trapped for developing or maintaining an erection, which in turn leads to poor performance and the anxiety that follows.  One study found that low testosterone is a factor in 20% of men under 30 with erectile problems.

Cigarette Smoke Damage

Men with high blood pressure who smoke are 26 times more likely to be impotent than non-smokers.  Even former smokers with high blood pressure (hypertension) are 11 times more likely to be impotent than non smokers. [Study conducted by Dr. John Spangler, MD at Wake Forest University Baptist Medical Center]

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