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Erectile dysfunction(impotence) means that a man is unable to have a penile erection of satisfactory firmness or duration for normal sexual activity.

Current medical research indicates that in approximately 80% of men the problem is due to physical causes.

Physical Causes :
  - Diabetes
  - Atherosclerosis
  - Hypertension
  - Side effects from medication, particularly blood pressure and antidepressant medications
  - Hormonal disorders
  - Alcohol
  - Smoking
  - Abdominal, pelvic or genital surgery

Psychological Causes :
  - Performance anxiety
  - Fear of intimacy
  - Stress
  - Marital problems
  - Anxiety
  - Depression

Diagnostic testing employed by the methods to determine the cause of the dysfunction are :

Penile Blood(arterial & venous) Flow Studies
to measure if enough blood is delivered to the penis during an erection - Duplex Doppler Ultrasound
- Intracavernous Vasoactive Agents (Pharmacologic stimulation)

Rigiscan
to determine if the impotence is due to physical or psychological factors

Hormonal Studies
  to determine if there are abnormal hormonal levels
  - Testosterone
  - Prolactin
  - LH
  - FSH problems
  - Thyroid and adrenal studies

The selection of diagnostic studies is made with the patient's specific problem and his desires considered. The patient's partner is encouraged to participate in the evaluation and treatment selection. Most men do not require all of the above tests. Appropriate treatment choices are reviewed and selected based on the patient's wishes.

Medical Treatments
1. Oral Medication : Sildenafil, Tadanafil, Vardenafil, etc. those are taken approximately one hour before intercourse. Erection occurs after arousal. But, oral medication have side effects, so they should be taken under guidance of specialist.

2. Intracavernosal Pharmacologic Agents : a painless self-injection into the penis of one or a combination of Papavarine, Phentolamine, Prostaglandin E-1 just before an erection is desired. This has side effects, too. For example, tunical fibrosis at injected site, peyronies’ disease, etc.

3. Endocrine Therapy : topical patches or injectable treatment for a hormonal condition. But this therapy usually doesn’t work alone.

Surgical Treatments
1. Penile Prosthesis : an internal device that is permanent and makes the penis hard enough for penetration. There are several types with different features. With the currently available state-of-the-art implants, a success rate of almost 95% may be expected.

2. Venous Ligation : tying off leaky veins. But this method has very high failure rate.