When men can no longer perform as they wish
Erectile dysfunction (ED), colloquially also called impotence, refers to the persistent inability to get or maintain an erection sufficient for satisfactory sexual intercourse.
Every man experiences occasional "lapses" - it only becomes problematic when erectile function is impaired in more than two-thirds of cases over a period of at least six months.
Men between 40 and 60 are particularly affected, often undiagnosed or untreated, because shame, uncertainty, or misconceptions stand in the way of diagnosis. However, erectile dysfunction is not just a sexual problem, but often a systemic health problem - indicating cardiovascular risks, hormonal deficiencies, or psychological stress.
What is erectile dysfunction?
By definition, it is a sexual dysfunction in which:
- an erection fails to occur
- an erection is too short-lived
- or the erection is insufficient for penetration
despite existing sexual desire.
In contrast to "normal" loss of libido, the desire often remains in ED. The "ability" is disturbed, not the "will."
How does erectile dysfunction manifest in men?
- Difficulty getting an erection during sexual intercourse
- Erection "disappears" during the act
- Decreased morning or spontaneous "stiffness"
- Increasing insecurity, avoidance of intimacy
- Shame, withdrawal from the relationship
Often, a vicious cycle of fear of failure, stress, and even greater insecurity begins, which exacerbates the symptoms.
What are the causes of erectile dysfunction?
Erectile dysfunction is multifactorial. Physical and psychological triggers often work together.
Physical causes:
- Circulatory disorders (e.g., arteriosclerosis)
- High blood pressure, diabetes, lipid metabolism disorders
- Hormonal causes: Testosterone deficiency (hypogonadism), low DHEA or dopamine levels
- Nerve damage (e.g., due to prostate surgery)
- Side effects of medication (e.g., beta-blockers, antidepressants)
Psychological causes:
- Performance pressure, fear of failure
- Relationship conflicts
- Stress, lack of sleep
- Depression or chronic dissatisfaction
- Pornography addiction or sensory overload
Lifestyle factors:
- Obesity, especially abdominal fat
- Lack of exercise
- Smoking, alcohol, drugs
- Poor sleep quality
How is erectile dysfunction diagnosed?
Diagnosis begins with a detailed anamnesis interview. Important questions:
- How often does the problem occur?
- Is there a spontaneous morning erection?
- Are there nocturnal erections?
- Are there underlying diseases or medications?
Additionally useful:
- Laboratory analysis (testosterone, free testosterone, DHEA, SHBG, prolactin, cortisol, thyroid, blood sugar, lipids)
- Penile Doppler ultrasound (examination of blood flow)
- Questionnaires, e.g., IIEF (International Index of Erectile Function)
A very helpful screening tool is the AMS questionnaire, which you can use directly on our website for free:
👉 Fill out the AMS questionnaire now
How can erectile dysfunction be treated?
1. Cause-related therapy
- Treatment of underlying diseases (e.g., high blood pressure, diabetes)
- Hormone replacement (e.g., testosterone therapy for confirmed deficiency)
- Improvement of blood circulation through lifestyle changes
- Stress management and sleep optimization
- Psychotherapeutic support if ED is psychologically triggered
2. Medicinal options
- PDE-5 inhibitors (e.g., sildenafil, tadalafil): Promote vasodilation in the penis
- Vacuum pumps, penile injections, penile prostheses (in severe cases)
Use only under medical supervision – especially for cardiovascular diseases
3. Natural strategies and supplements
- L-Arginine, Citrulline: Promote nitric oxide production
- Zinc, Vitamin D, B vitamins: Improve hormone levels
- Adaptogenic botanicals (e.g., Ashwagandha, Ginseng)
- Endurance training & strength training: Promote blood circulation, testosterone production, dopamine
Erectile dysfunction as an early warning system
ED is often the first sign of silent vascular damage, approximately 3-5 years before a heart attack or stroke can occur. Therefore, it should not be seen as an isolated problem, but as a serious indication of:
- Vascular health
- Hormone status
- Overall burden on the body
What can men do specifically?
- Take symptoms seriously, do not suppress them
- Talk openly with the doctor - the earlier, the better
- Have hormone status checked regularly
- Consciously shape diet, training, and sleep
- Strengthen partnership communication
Conclusion
Erectile dysfunction is widespread, and in most cases, it is highly treatable. It is not a sign of weakness but an indication of changes in the body that deserve attention.
Those who act early can not only regain their sexual function but also stabilize heart, hormones, and mental health.
You can find out more about erectile dysfunction in our blog article “**Erectile Dysfunction: A Matter of the Mind or a Health Warning Sign?**”.
🎧 Also listen to our Men's Health Podcast with PD Dr. Jäger about causes, myths, and modern therapies for erectile dysfunction: