Impotence/Erectile Dysfunction (cont.)
Impotence/Erectile Dysfunction Causes
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, but most men with organic causes have a mental or psychological component as well.
Erection problems will 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.
- 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. Vascular disease includes atherosclerosis (fatty deposits on the walls of arteries, also called hardening of the arteries), a history of heart attacks, peripheral vascular disease (problems with blood circulation), 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.
- 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).
- Medications used to treat other medical disorders may cause ED.
- Systemic diseases associated with ED
- Diseases of the nervous system 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
- Priapism (painful, abnormally prolonged erections)
- Mental conditions associated with ED
- Widower syndrome
- Performance anxiety
- Nutritional states associated with ED
- 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
- Radical prostatectomy
- Transurethral resection of the prostate
- Cryosurgery of the prostate
- Common medications associated with ED
- Antihypertensives (for high blood pressure)
- Antiulcer drugs such as cimetidine (Tagamet)
- Hormonal medication such as Zoladex, Lupron, finasteride (Proscar), or dutasteride (Avodart)
- Drugs that lower cholesterol
- Alcohol abuse
- Mind-altering agents such as marijuana and cocaine
Stephen W Leslie, MD, FACS
Joseph A Salomone III, MD
Francisco Talavera, PharmD, PhD
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