Erectile dysfunction (impotence)

For a lay person:

Erectile dysfunction is when a man has ongoing difficulty getting or keeping an erection firm enough for sex. It becomes more common with age and is often linked to heart disease, diabetes, high blood pressure, medicines, stress or relationship problems.

For a trained medical person:

Most often vasculogenic and a marker of cardiovascular risk, with neurogenic, hormonal (hypogonadism), drug-induced and psychogenic contributions. Assessment includes history, examination, cardiovascular risk factors, glucose, lipids and morning testosterone. First-line treatment is lifestyle change and PDE5 inhibitors, with psychosexual therapy, vacuum devices, intracavernosal therapy or implants as alternatives.

In Chinese medicine:

Liu and Tseng's textbook differentiates this condition into these patterns: Kidney Yang Deficiency; Liver Qi Stagnation; Lower Jiao Damp-Heat; Cold Stagnation in Liver Channel; Blood Stasis Due to Cold at Liver Channel. Treatment follows the pattern a patient presents with, not the Western diagnosis alone.

When to get help: See a doctor, as erectile problems can be an early sign of heart disease or diabetes. Seek emergency care for an erection lasting more than four hours. Be wary of 'herbal' sexual enhancement products, which have been found to contain hidden prescription drugs that interact dangerously with nitrate heart medicines.