Does Erectile Dysfunction mean Impotence?


Erectile Dysfunction (ED) is defined as a consistent or recurrent inability of a man to obtain and/or maintain a penile erection sufficient for sexual activity. (J Sex Med 2010;7:1598–1607) Men do not have to have the absence of erections to have Erectile Dysfunction (ED).

This definition is elegant in its phrasing. The term “sufficient” is subjective, as would be an alternate word such as ‘satisfactory.’ No one but the person experiencing the problem can decide when experiencing a diminished erection is “satisfactory.” If a man gets erections but is unable to reach the fullness of erections he might have experienced in the past, his function might be so lessened that sex, while possible, is no longer pleasurable.

The use of the term “sexual activity” acknowledges that there are many ways people engage in sexual intimacy. It does not specify that activity is intercourse (between a man and a woman, or between two men), mutual manual stimulation, or even simple masturbation. The meaning of “sexual activity” is left to the individual.

Lastly, consider the term in its entirety: “maintain a penile erection sufficient for sexual activity.” This implies the inclusion of the partner. If the issue is one experienced by two participants then the solution may rest in a cooperative approach. This introduces an opportunity for a constructive dialogue about sex that could benefit even the best sexual relationship. Approaches to Erectile Dysfunction (ED) are most effective when they include the perspective and assistance of a partner.

The definition allows men to address their issues long before the consequences wreck havoc on their physical and emotional health, and long before it has a negative impact on their relationships.

Erectile dysfunction is not binary; it is inherently fluid and personal. Many physicians believe men needn’t suffer some indefinite period of time before they can seek help. Often, it is not just reasonable but advantageous to intervene with effective therapy BEFORE symptoms become part of a negative feedback mechanism.

Consider a young man who has difficulty on occasion with maintaining his erections. No one would consider him impotent but access to medication for intermittent use may make sense. It could be that anxiety becomes an issue with a new relationship or that stress at work proves to be more of a distraction than in the past. It might be temporary but these issues can interfere with “erotic focus” or “awareness of the sensory experience.”

Basically, it can take someone out of “the moment” making maintaining an erection more of a challenge. Anything that reduces anxiety about the process of achieving or maintaining an erection is helpful. Moreover, a robust erection supports a positive feedback mechanism that allows a man to focus on his, and his partner’s, experience and not worry about the process. The ability to use medication allows for continued sexual activity while underlying issues are approached without being clouded by concerns about losing sexual intimacy.

In conclusion, understanding that Erectile Dysfunction (ED) can be subtle, and that the consequences of even small changes can pose a challenge for many men and for their partners, would dispel the first major myth about erectile dysfunction–one that prevents so many from seeking care.