Causes of Erectile Dysfunction
To understand what causes erectile dysfunction or ED, it is important to first review how an erection occurs. For a man to have an erection, a complex process takes place within the body.
- An erection involves the central nervous system, the peripheral nervous system, psychological and psychological factors, local factors with the erection bodies or the penis itself, as well as hormonal and vascular (blood flow or circulation) components. The penile portion of the process leading to an erection represents only a single component of a very complex process.
- Erections occur in response to touch, smell, auditory and visual stimuli that trigger pathways in the brain. Information travels from the brain to the nerve centers at the base of the spine, where primary nerve fibers connect to the penis and regulate blood flow during erections and afterward.
- Sexual stimulation causes the release of chemicals from the nerve endings in the penis that trigger a series of events that ultimately cause muscle relaxation in the erection bodies of the penis. The smooth muscle in the erection bodies controls the flow of blood into the penis. When the smooth muscle relaxes, the blood flow dramatically increases, and the erection bodies become full and rigid, resulting in an erection. Venous drainage channels are compressed and close off as the erection bodies enlarge.
- Detumescence (the process by which the penis becomes flaccid) results when muscle-relaxing chemicals are no longer released.
If one or more of the above physical and/or psychological processes is disrupted, erectile dysfunction can result. Erectile dysfunction describes a man's inability to achieve and maintain an erection of his penis sufficient for mutually satisfactory intercourse with his partner.
In general, the cause of erectile dysfunction is divided into 2 types. Many men will have both:
- Psychological (mental) causes
- Physical or organic (having to do with a bodily organ or an organ system) causes
The normal erection process. Click to view larger image.
Psychological Causes of Erectile Dysfunction
Erection problems usually produce a significant psychological and emotional reaction in most men. This is often described as a pattern of anxiety and stress that can further interfere with normal sexual function. This "performance anxiety" needs to be recognized and addressed by your doctor.
For some men, erectile dysfunction develops with age or may be related to depression or another psychological cause, such as widower syndrome.
Certain feelings can interfere with normal sexual function, including feeling nervous about or self-conscious about sex; feeling stressed either at home or at work; or feeling troubled in your current relationship. In these cases, psychological counseling with you and your sexual partner may be successful. One episode of failure, regardless of cause, may propagate further psychological distress leading to further erectile failure.
Stephen W Leslie, MD, FACS
Bradley Fields Schwartz, DO, FACS
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