These are dysfunctions in which a man is unable to initiate or maintain erection until ejaculation. Erection requires an intact parasympathetic reflex at S2 and S3 and Ejaculation requires an intact sympathetic L1 root.

Causes
Organic causes include:

• Spinal cord or cauda equina disease
• Multiple sclerosis
• Generalised vascular disease e.g. Leriche syndrome
• Trauma causing nerve or vascular damage (radical prostatectomy, fractured pelvis, abdominoperineal resection)
• Endocrine disease:
• Diabetes mellitus
• Hypogonadism
• Hyperprolactinaemia
• Hypertension and antihypertensive drugs

Psychological causes:

• Depression
• Problems with expressed sexual orientation
• Problems within a relationship

Management
1. Medication.
• Oral – including Viagra.
• Penile injections.
• Penile suppositories (intraurethral pellets).
2. Vacuum erection devices.
3. Penile implantation.
4. Correction of penile curvature.