Secondary erectile dysfunction occurs when a man who previously could attain and sustain erections no longer can. Transient erectile dysfunction for any reason may lead to secondary psychologic difficulties that compound the problem. Erectile dysfunction may be situational, involving place, time, a particular partner, some perceived competitive defeat, or damaged self-esteem. The psychologic factors that may accompany organic disorders cannot be overlooked and must be considered in every case. They may be the cause or the consequence of erectile dysfunction.
Venous leaks make it difficult for blood to remain in the penis during erection.
More extensive surgical prostatic resection can be associated with a higher prevalence of erectile dysfunction. The patient can be monitored for nocturnal erections in a special sleep laboratory. Absence of nocturnal erections strongly suggests an organic basis. However, the presence of nocturnal erections does not necessarily equate to usable erections when awake. It may be helpful to assess vascular indices.