Erectile dysfunction is the inability of men to have enough erection to have sexual intercourse. Sometimes the erectile dysfunction is inability to keep an erection firm enough to have sexual intercourse, but other times this erectile dysfunction is referred as impotence. Occasional erectile dysfunction is not uncommon. Many men have experienced this situation when they are in stress [1,2]. But if the erectile dysfunction is happening all the time, this could be a sign that there is serious health problem and men should visit their doctor. Sometimes the erectile dysfunction can be a sign of emotional or relationship difficulties.  These difficulties may need to be addressed by a professional. Not all the male problems are caused by erectile dysfunction. Other types of male sexual ED include: lack of interest in sex, premature ejaculation and delayed or absent ejaculation.
Erectile dysfunction – Symptoms, Types & Causes
Symptoms of erectile-dysfunction: Here are the symptoms of the erectile dysfunction:
- Reduced sexual desire;
- Trouble keeping an erection;
- Trouble getting an erection.
How common is the erectile-dysfunction? Most studies had shown that up to 30 million American men are affected by erectile dysfunction.  The risk of having an erectile-dysfunction is increasing as the years are passing by. When men are older their chances to have erectile dysfunction are very high.  Even this fact is more known with the older people, but there still have older men which are not having this problem. As you are getting older you might have difficulties with an erection. But this does not mean that is sign of erectile dysfunction. Many studies have shown that the healthier the man is the better is his sexual life.
- Psychological Erectile Dysfunction (This type of the erectile-dysfunction starts in a brain);
- Priapism (Priapism is not a persistent type of erectile-dysfunction. Usually the priapism is painful erection that lasts more than four hours. This type or erectile-dysfunction occurs without sexual stimulation.);
How does a man get an erection? When men have erection, this is cause of increased blood in the penis. This blood flow is result of sexual thoughts or direct contact with the penis. When men are sexually excited, the muscles in the penis relax. This relaxation allows for penis to get more blood throughout the penis arteries. The blood in the penis feeds two chambers inside the penis called the corpora cavernosa. When the arteries are filled with blood, the penis is growing rigid. Erection ends when the muscles are contracting and the accumulated blood can flow out through the penis veins.
Causes of Erectile Dysfunction: Erectile dysfunction can happen at any stage of problems when the penis is erected. Sometimes this is happening because the penis arteries are damaged. They cannot allow the blood to fill the penis. There are many causes of erectile dysfunction, such as
- Diabetes 
- Stress 
- Anxiety 
- drug use
- alcohol use 
- smoking 
- cardiovascular disease
- relationship problems 
- damage from cancer or surgery
Every man knows that when they are getting older it is harder for them to have longer erections. Sometimes is needed more direct touch with your penis to have an erection. This can be caused of underlying health conditions or it is caused because they are taking medicines.
When to see a doctor? Always is a good idea to visit your family doctor when you have erectile problems. If you have concerns about your erections, than you should visit your family doctor and he or she will make it all the testes that are need to be done. If you have other sexual problems, including here ejaculatory dysfunction, such as delayed or premature ejaculation, than you must go to your doctor and talk about your problems. If you have heart disease, diabetes or another known health condition (that you might have at the moment or you had in the past) that might be linked to erectile dysfunction, than you must go to your doctor and to be sure if you are having erectile dysfunction or not. If you have other symptoms along with erectile dysfunction, you should also visit your family doctor.
 Bryan-Thomas J. Relationship of stress to male impotence. International Journal of Scientific and Research Publications. 2018;8(2):503-7.
 Hedon F. Anxiety and erectile dysfunction: a global approach to ED enhances results and quality of life. International Journal of Impotence Research. 2003;15:S16-S19.
 Dimeo P. Psychosocial and relationship issues in men with erectile dysfunction. Urologic Nursing: Official Journal of the American Urological Association Allied. 2007;26(6):442-6.
 Harvard Health Publishing. Erectile dysfunction. Retrieved from www.health.harvard.edu/topics/erectile-dysfunction
 Mulhall JP, Luo X, Zou KH, et al. Relationship between age and erectile dysfunction diagnosis or treatment using real-world observational data in the United States. International Journal of Clinical Practice. 2016;70(12):1012–8.
 Penson DF, Wessells H. Erectile dysfunction in diabetic patients. Diabetes Spectrum. 2004;17(4):225-30.
 Wang XM, Bai YJ, Yang YB, et al. Alcohol intake and risk of erectile dysfunction: a dose–response meta-analysis of observational studies. International Journal of Impotence Research. 2018;30:342-51.
 Cao S, Yin X, Wang Y, et al. Smoking and risk of erectile dysfunction: Systematic review of observational studies with meta-analysis. PLoS One. 2013;8(4):e60443.