Perhaps the most common male sexual problem is erectile disorder or erectile dysfunction. Men tend to feel devastated when faced with poor erections. Commonly called impotence, this term has negative connotations for one's masculinity and should be avoided. Every man will experience an erectile problem at some time in his life. Many factors can impair a man's ability to have and maintain an erection. These include fatigue, stress, unemployment, alcohol, and drugs. What is erectile disorder? An erection is the first physical sign of a man's sexual arousal. It occurs when the spongy tissues of the penis become engorged with blood. A man is diagnosed with erectile disorder only when the problem is persistent or recurrent (at lease 25 per cent of the time) and causes distress or interpersonal difficulty. Erectile dysfunction tends to increase with advancing age, but age alone is not the cause. Medical causes of erectile disorder Many medical problems produce erectile disorders. These include circulatory problems such as sickle cell anemia and arteriosclerosis (hardening of the arteries). Prostate surgery, accidents affecting the pelvic area and groin injuries are also sources of the problem. It is well known that diabetes and certain hormone imbalances are common causes. About a quarter of men taking anti-depressants and certain drugs for hypertension such as beta-blockers complain of erectile dysfunction. Primary psychological causes Primary psychological causes tend to occur in men who were sexually abused when young or who had some kind of early traumatic sexual experience. These men have erectile dysfunction, but are able to achieve erections during sleep or masturbation. Such men may require penile implants. These implants are placed surgically and consist of either flexible semi-rigid plastic rods or tubes that can be inflated with liquid using a tiny pump that is placed inside the scrotum. These implants work as well for men who develop erectile dysfunction as a result of accidents or surgery.