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Impotence, or erectile dysfunction, is the difficulty or inability to achieve or maintain a penile erection resulting in a successful sexual intercourse. It affects many men and increases with age, but to consider an alteration is necessary to manifest persistently. The most common causes of erectile dysfunction can be both physical and psychological, or a combination of both. They can be of vascular type: men with an index of high cholesterol, smoking, diabetes or who have been treated with radiotherapy. Neurological disorders (Alzheimer's, for example) and hormonal (by utilizing medication) are given a lesser extent. There may also be a cause of affective: patients with severe forms of depression often have erectile dysfunction. Treatments, other than medication, usually include changes in lifestyle, such as quitting smoking and exercising regularly.