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Impotence/Erectile Dysfunction (cont.)

Impotence/Erectile Dysfunction Causes

Patient Comments

Erectile dysfunction can be caused by any number of physical and psychological factors. In general, ED is divided into organic (having to do with a bodily organ or organ system) and psychogenic (mental) impotence. Interestingly, and not surprisingly, most men with organic causes have a mental or psychological component, as well.

Male erectile problems often produce a significant emotional reaction based on confidence, self-esteem, and morale in most men. This is described as a pattern of anxiety and stress that can further interfere with normal sexual function. Such "performance anxiety" needs to be recognized and addressed by a doctor.

  • Almost any disease can affect erectile function by altering the nervous, vascular, or hormonal systems. Various diseases may produce changes in the smooth muscle tissue of the penis or influence mood and behavior.
  • Vascular diseases account for nearly half of all cases of ED in men older than 50 years of age. Vascular disease includes atherosclerosis (fatty deposits on the walls of arteries, also called hardening of the arteries), a history of heart attacks (angina, coronary artery disease, myocardial infarct), peripheral vascular disease (problems with blood circulation to the legs), and high blood pressure. Prolonged tobacco use (smoking) is considered an important risk factor for ED because it is associated with poor circulation and reduced blood flow in the penis. This is related to microvascular damage (stiffening of the artery as well as smaller caliber vessel size secondary to endovascular atherosclerotic plaques).
  • Interestingly, it has been well documented that ED is well correlated to cardiac disease. In some studies, ED can precede a heart attack by five to seven years. As such, particularly for younger men with acute onset of ED, cardiovascular investigation may also be suggested.
  • Trauma to the pelvic blood vessels and nerves is another potential factor in the development of ED. Bicycle riding for long periods has been implicated, so some of the newer bicycle seats have been designed to soften pressure on the perineum (the soft area between the anus and the scrotum). Certainly, history of pelvic bone fracture, as well as previous pelvic surgery (orthopedic, vascular, colon-rectum and prostate) may have injured the vascular supply for the penile artery.
  • Medications used to treat other medical disorders may cause ED.
  • Systemic diseases associated with ED
    • Hypertension (The most common are the use of beta-blocker medications and thiazide diuretics, which have the biggest implication on ED.)
    • Diabetes
    • Enlarged prostate (benign prostatic hyperplasia, or BPH): There is a class of medications called 5ARI (5-alpha-reductase) that have a notable impact on both libido and erectile dysfunction in men. Finasteride (Proscar) and dutasteride (Avodart) are in this drug class.
    • Psychiatric disorders (anxiety, depression, psychosis)
    • Scleroderma
    • Renal (kidney) failure
    • Liver cirrhosis
    • Hemochromatosis (too much iron in the blood)
    • Cancer and cancer treatment (related to its surgery, radiotherapy, chemotherapy which all affect peripheral nerves, small blood vessels)
  • Nervous system disorders associated with ED
  • Respiratory disease associated with ED: Chronic obstructive pulmonary disease
  • Endocrine conditions associated with ED
  • Penile conditions associated with ED
    • Peyronie's disease (penile curvature related to fibrosis to an isolated area of the corporal body)
    • Priapism (painful, abnormally prolonged erections > four hours, which results in irreversible penile spongiofibrosis)
  • Mental conditions associated with ED
    • Depression
    • Widower syndrome
    • Performance anxiety
  • Nutritional states associated with ED
    • Malnutrition
    • Zinc deficiency
  • Blood diseases associated with ED
  • Surgical procedures associated with ED
    • Procedures on the brain and spinal cord
    • Retroperitoneal or pelvic lymph node dissection
    • Aortoiliac or aortofemoral bypass
    • Abdominal perineal resection
    • Proctocolectomy
    • Radical prostatectomy for prostate cancer
    • Transurethral resection of the prostate for BPH (enlarged prostate)
    • Cryosurgery of the prostate
    • Radical cystectomy for bladder cancer
  • Common medications associated with ED
    • Antidepressants
    • Antipsychotics
    • Antihypertensives (for high blood pressure)
    • Antiulcer drugs such as cimetidine (Tagamet)
    • Hormonal medication, such as goserelin (Zoladex), leuprorelin (Lupron), finasteride (Proscar), or dutasteride (Avodart)
    • Drugs that lower cholesterol
    • Alcohol abuse
    • Mind-altering agents, such as marijuana and cocaine
Medically Reviewed by a Doctor on 7/29/2015

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