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It is the constant inability to get or sustain an erection enough for satisfactory sexual performance. It has a profound effect on intimate relationships, quality of life
and overall self-esteem. It has been said to be a symptom of undiagnosed cardiovascular disease. [1;2]


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  • Obesity.
  • Advancing age.
  • Diabetes mellitus.
  • Dyslipidaemia.
  • Metabolic syndrome.
  • Cigarette smoking.
  • Excessive alcohol intake.

CAUSES [1;3]

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  • Excessive smoking and alcohol abuse.
  • Chronic diseases such as hypertension, diabetes, hyperlipidaemia, coronary artery disease, etc.
  • Major surgery on the pelvic area or pelvic organs.
  • Radiotherapy on the pelvic area.
  • Other illnesses such as Parkinson’s, strokes, central nervous system tumours, spinal cord trauma or diseases, chronic renal failure, etc.
  • Structural problems of the penis such as hypospadias, micro-penis, Peyronie’s disease, etc.
  • Hormonal imbalances such as hypogonadism, hyperprolactinemia, hyper-/hypothyroidism, hyper-/hypercortisolism, etc.
  • Drugs such as antihypertensives, antidepressants, antipsychotics, antiandrogens or recreational drugs such as heroin, cocaine, marijuana, methadone, steroids, etc.
  • Psychological: partner-related, performance-related to stress, lack of arousability, etc.
  • Traumatic causes such as penile fractures or pelvic fractures


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  • Pharmacological
  • First line: phosphodiesterase type 5 (PDE5) inhibitors such as Viagra, vacuum erection devices, shockwave therapy
  • Second line: Intra-cavernous injection therapies
  • Third line: penile prostheses/implants
  • Non-pharmacological
  • Psychotherapy.
  • Counselling.Relationship or sex therapy.
  • Treatment or management of current conditions such as diabetes, high blood pressure and hormonal control (e.g. testosterone levels).
  • Change in chronic medication if necessary.


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  • Regular exercise for weight loss and to release natural endorphins.
  • Stop smoking and reduce drinking alcohol as it contributes to impotence.
  • Visit your doctor regularly to manage your chronic conditions.
  • Ask your doctor for methods to manage stress.
  • Find a method which works for you and stick to it.
  • Stop being anxious about performance.
  • Get treatment for drug and alcohol abuse.
  • Avoid watching pornography.


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  • Be able to discuss impotence with your partner.
  • When you have a doctor’s, appointment take your partner with you for support, write down symptoms or experiences you have had during the week, write down all medications you are taking and any personal dealing such as stress or recent
    life changes, etc.
  • Seek counselling for psychological therapy for yourself and with your partner.
  • Attend sex therapy for you and your partner to find other ways of being intimate

Mayo Clinic Staff [Internet]. Erectile dysfunction. America: Mayo Clinic; [updated 2018 Mar 09; cited
2019 Aug 22]. Available from:
2. WebMD [Internet]. Understanding Erectile Dysfunction- the Basics. America: WebMD LLC;
[updated 2019 April; cited 2019 Aug 22]. Available from:
3. Heyns, C., Barnes, D. 2008. Introduction to Urology. Cape Town: Chris Heyns and Dick Barnes.

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