Erectile dysfunction, often referred to as impotence, is the consistent inability to achieve and maintain an erection for sexual activity. While there may be no erection, the desire, sex drive, the ability to achieve orgasm and the capacity to ejaculate may still be present. Erectile dysfunction can cause significant distress, affecting the quality of life of those affected, and also that of their sexual partners. It often leads to depression and lack of self-esteem and self-confidence. These psychological effects may in turn perpetuate the disorder.