But this definition doesn’t take account of the fact that many men occasionally have erection problems - when they are tired, stressed, or not attracted to their partner, for example.

Perhaps a better definition is that a man has erectile dysfunction when he cannot reliably get an erection firm enough for penetration more than 50% of the times he and his partner wish to make love.

The American Psychiatric Association’s definition of sexual disorders emphasizes the fact that erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection. So does the definition of erection problems depend on whether a man can get an erection all the time, half the time, or some other percentage? And what degree of stiffness is his penis required to display before he has a problem?

There’s no clear answer to any of these questions, but they do serve to put into context the fact that a man might not think he has a problem if both he and his partner are happy with the way their sex life works out, regardless of whether he has an erection or not. But suppose, in contrast, that a couple want penetrative sex every time they make love, and a man has an erection than is 50% rigid on 50% of the occasions he and his partner want sex. Does he have an erection problem? Maybe yes, maybe no. This emphasizes the element of subjectivity in the definition. 

The rate of erectile dysfunction has not changed significantly since the first comprehensive study done by Alfred Kinsey in 1958, when about 10% of men were found to have a problem with their erections. In a more recent study, there was a significant correlation between age and the scores for erectile function, orgasmic function, sexual desire and intercourse satisfaction. The prevalence of moderate and severe cases of ED were 1.8% and 0% respectively for men aged 23–29; 2.6% and 0% for men aged 30–39; 7.6% and 1.0% for men aged 40–49; 14.0% and 6.0% for men aged 50–59; 25.9% and 15.9% for men aged 60–69; and 27.9% and 36.4% for men aged 70–79 years. (Ken Marumo, Jun Nakashima, Masaru Murai (2001) Age-related prevalence of erectile dysfunction in Japan: Assessment by the International Index of Erectile Function International Journal of Urology 8 (2), 53–59. Not much has changed between 1958 and 2001!

Obviously the prevalence of erection problems gets older as men age - with the exception of problems that are due to performance anxiety among younger men, whose erection difficulties tend to be more transient and short-lived, being caused by sexual and personal circumstances (i.e. over-excitement, anxiety about the partner, fear of discovery, and so on) rather than health or medical issues such as age-related diabetes or circulation problems.

This kind of erection failure is rather simple to explain: it is an anxiety-based response. Anxiety can effectively turn off the sexual response in young men because it is a product of the activity of the  sympathetic nervous system, which opposes the sexual responses controlled by the parasympathetic nervous system. In effect, therefore, one can say that over-arousal is the cause of many young men’s erection problems, though this refers more to emotional arousal than sexual arousal. Paradoxically, over-arousal can also cause premature ejaculation: the essence of both problems is that a man’s normal sexual response has been over-ridden by his anxiety.

We discussed the effect of an over-sensitive penis in the debate on premature ejaculation. Can it also be a factor in erectile dysfunction? But first of all we need to define what we mean by an over-sensitive penis: in reality, of course, there is no such thing. It is a short hand term for a penis which sends nerve impulses to a man whose brain is already over-excited, too sexually aroused. As with premature ejaculation, corrective action requires some reduction in the sensitivity of the nervous system so that it can take more stimulation with no disruption of  a man’s sexual circuitry!

The irony here is that anxiety - fear, worry, call it what you will - about losing your erection actually stimulates a man’s level of nervous system activity so that he is actually somewhat more likely to lose it! This means that relaxation, or at least a methodology that can help to reduce one’s nervous and emotional arousal during sex,  may be part of the answer. Obviously relaxation and hypnosis may be of help here; so is the experience which comes with age and having had a number of lovers.

Young men of course tend to be very aroused, and may in addition both fear discovery (especially in societies where pre-marital sex is frowned upon) and pregnancy. All of this can stimulate their nervous systems so that they are more likely to be sensitive to any suggestion by their lover that strikes at their sexual confidence: and makes them lose their erection. Fear and sex do not mix well!

A man who loses his erection may find that this happens instantly during sex: he cannot reduce his anxiety enough to reduce the stimulation he’s receiving to a point where he no longer feels so aroused that he loses control of his sexual responses.

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Remember one in ten men have a problem achieving and or sustaining an erection at some point in their lives. The important thing is if you have a problem that does not seem to be improving, you get help. You have read what impotence is, you have looked at the possible causes of it. Now lets look at the many treatments available for impotence.