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Erec­tile dys­func­tion (ED) or impo­tence is sex­u­al dys­func­tion char­ac­ter­ized by the inabil­i­ty to devel­op or main­tain an erec­tion of the penis dur­ing sex­u­al activ­i­ty. A penile erec­tion is the hydraulic effect of blood enter­ing and being retained in sponge-like bod­ies with­in the penis. The process is most often ini­ti­at­ed as a result of sex­u­al arousal, when sig­nals are trans­mit­ted from the brain to nerves in the penis. The most impor­tant organ­ic caus­es are car­dio­vas­cu­lar dis­ease and dia­betes, neu­ro­log­i­cal prob­lems (for exam­ple, trau­ma from prosta­te­c­to­my surgery), hor­mon­al insuf­fi­cien­cies (hypog­o­nadism) and drug side effects. Psy­cho­log­i­cal impo­tence is where erec­tion or pen­e­tra­tion fails due to thoughts or feel­ings (psy­cho­log­i­cal rea­sons) rather than phys­i­cal impos­si­bil­i­ty; this is some­what less fre­quent but can often be helped. Notably in psy­cho­log­i­cal impo­tence, there is a strong response to place­bo treat­ment. Erec­tile dys­func­tion can have severe psy­cho­log­i­cal con­se­quences as it can be tied to rela­tion­ship dif­fi­cul­ties and mas­cu­line self-image gen­er­al­ly. Besides treat­ing the under­ly­ing caus­es such as potas­si­um defi­cien­cy or arsenic con­t­a­m­i­na­tion of drink­ing water, the first line treat­ment of erec­tile dys­func­tion con­sists of a tri­al of PDE5 inhibitor drugs (the first of which was silde­nafil or Via­gra). In some cas­es, treat­ment can involve prostaglandin tablets in the ure­thra, injec­tions into the penis, a penile pros­the­sis, a penis pump or vas­cu­lar recon­struc­tive surgery. The Latin term impo­ten­tia coe­un­di describes sim­ple inabil­i­ty to insert the penis into the vagi­na; it is now most­ly replaced by more pre­cise terms, such as erec­tile dys­func­tion (ED). The study of erec­tile dys­func­tion with­in med­i­cine is cov­ered by androl­o­gy, a sub-field with­in urol­o­gy. Research indi­cates that erec­tile dys­func­tion is com­mon, and it is sug­gest­ed that approx­i­mate­ly 40% of males suf­fer from erec­tile dys­func­tion or impo­tence, at least occasionally.