Erectile dysfunction is the most common sexual problem that men report to their doctor. It affects up to 30 million men worldwide. Erectile dysfunction is defined as a condition in which achieving and maintaining an erection cannot result in satisfactory intercourse. Although it is not uncommon for a man to have an erection problem from time to time, erectile dysfunction that is progressive or occurs routinely is not normal and should be treated. What happens during an erection? During sexual arousal, nerves release chemicals that increase blood flow to the penis. Blood flows into two “erection chambers” in the penis, made up of spongy muscle tissue called the corpus cavernosum. During an erection, spongy tissues relax and trap blood. Blood pressure in the chambers makes the penis hard, leading to an erection. At orgasm, a second set of nerve signals reach the penis and cause the muscle tissues to contract and blood is released back into the man’s circulation and the erection subsides. Erectile dysfunction can be a major warning sign of cardiovascular disease. Some studies show that men with erectile dysfunction are at significant risk of heart attack, stroke, or problems with blood circulation in the legs. The condition can occur as a result of health or emotional problems, or both. Some known risk factors are age over 50, diabetes, high blood pressure, presence of cardiovascular disease, dyslipidemia (high cholesterol), use of cigarettes, alcohol or drugs, obesity and lack of physical activity. Although erectile dysfunction becomes an increasingly common problem with age, aging alone does not always lead to erectile problems. Some men remain sexually active into their 80s. Physical causes of erectile dysfunction can be: Insufficient blood flow to the penis – this can be due to atherosclerosis, heart disease, high blood sugar; During an erection, blood does not stay in the penis – if blood does not stay in the penis, the man cannot maintain an erection. This problem can happen at any age; Nerve signals from the brain or spine do not reach the penis – some diseases, injuries or surgical interventions can damage the nerves of the penis; Diabetes can cause damage to small vessels and nerves; Treatment of oncological diseases near the pelvis can affect the functionality of the penis; Treatment of certain health conditions can negatively affect erection. A detailed clarification of adverse drug reactions with your treating physician is necessary. Emotional state also affects a person’s sexual health. Emotions and relationships in the social environment can cause or worsen erectile dysfunction. Emotional reasons can be:Depression; Anxiety; Conflict in the social environment; Stress at home or at work; Stress from social, cultural or religious conflicts Treatment of erectile dysfunction begins with care for the health of the heart and vessels. Your doctor can point out risk factors that can be changed or improved. You may need to change certain eating habits, quit smoking, increase your exercise, or be offered alternatives to medications you are taking. Non-invasive treatments are often tried first. Most of the most popular methods work well and are safe. Treatment with phosphodiesterase type 5 inhibitors, testosterone therapy (for proven low testosterone), surgery to bypass penile artery damage in younger men is most commonly used. Surgery in older men carries certain risks.