Male sexual dysfunction may be divided into disorders of the libido (hypoactive or hyperactive), erectile dysfunction, and ejaculatory disturbances. Erectile impotence is a major concern to middle-age and older men. Erectile impotence may or may not involve other aspects of sexual function in the male such as ejaculation, semen emission, orgasm, and libido. It can have numerous etiologies that range from physical causes such as diabetes mellitus, endocrine disease, atherosclerosis, and spinal cord lesions to psychological causes such as depression, stress, and performance anxiety. However, physical causes predominate. In many cases there is an overlap of symptoms and etiologies.