What Are Physical (Organic) Causes of Erectile Dysfunction (ED)?
Physical causes of impotence are thought to be more common than psychological causes. However, as stated before, they often coexist. The inability to achieve an adequate erection can cause psychologic troubles, which then make it even more difficult to achieve an erection the next time.
Erectile dysfunction related to medical/physical causes is often treatable but less commonly curable. In some cases of medication-induced erectile dysfunction, changes in medication may improve erections. Similarly, in men with a history of arterial trauma, surgical intervention can restore erectile dysfunction. In most cases of ED associated with a medical condition, treatment allows one to have an erection "on demand" or with the aid of medications/device (but not spontaneous).
In the evaluation of physical causes of ED, the health care provider is assessing for conditions that may affect the nerves, arteries, veins, and functional anatomy of the penis (for example, the tunica albuginea, the tissue surround the corpora). In determining a physical (or organic) cause, your health care provider will first rule out certain medical conditions, such as high blood pressure, high cholesterol, heart and vascular disease, low male hormone level, prostate cancer, and diabetes, which are associated with erectile dysfunction. Medical/surgical treatment of these conditions may also cause ED. In addition to these health conditions, certain systemic digestive (gastrointestinal) and respiratory diseases are known to result in erectile dysfunction:
Fully restoring sexual health with treatment of a medical condition (such as high blood pressure with diet and/or exercise or by controlling diabetes or other chronic diseases) may not be possible. Identification and treatment of these conditions may prevent the progression of ED and affect the success of various ED therapies. Nutritional states, including malnutrition, obesity, and zinc deficiency, may be associated with erectile dysfunction, and dietary changes may prove a sufficient treatment. Masturbation and excessive masturbation are not felt to cause ED, however, if one notes weak erections with masturbation, this may be a sign of ED. Some men who masturbate frequently may have troubles with achieving the same degree of stimulation from their partner, but this is not ED.
Almost any disease or condition can affect erectile function by altering the nervous, vascular, or hormonal systems.
- Diseases that affect the nervous system (brain, spinal cord, nerves in the pelvis and penis) that may be associated with erectile dysfunction include the following:
- Cardiovascular diseases account for nearly half of all cases of erectile dysfunction in men older than 50 years. Cardiovascular causes include those that affect arteries and veins. Damage to arteries that bring blood flow into the penis may occur from hardening of the arteries (atherosclerosis) or trauma to the pelvis/perineum (for example, pelvic fracture, long-distance bicycle riding).
- Vascular disease includes atherosclerosis (fatty deposits on the walls of the 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 a common health risk factor for erectile dysfunction because it is associated with poor circulation and its impact on cavernosal function.
- Blood diseases, such as sickle cell anemia and leukemias, are also associated with erectile dysfunction. Individuals with sickle cell disease are at increased risk for priapism (an erection lasting six hours or longer that is associated with penile pain and can cause penile damage leading to ED).
- Diabetes mellitus may affect blood vessels and lead to ED.
- Radiation therapy to the pelvis for cancers such as prostate cancer can affect the blood vessels to the penis.
- Traumatic arterial injury
Problems with the veins that drain the penis can also contribute to erectile dysfunction. If the veins are not adequately compressed, blood can drain out of the penis while blood is coming into the penis and this prevents a fully rigid erection and maintaining an erection. Venous problems can occur as a result of conditions that affect the tissue that the veins are compressed against, the tunica albuginea. Such conditions include Peyronie's disease (a condition of the penis associated with scarring [plaques] in the tunica albuginea that may be associated with penile curvature, pain with erections, and ED), older age, diabetes mellitus, and penile trauma (penile fracture).
- An imbalance in your hormones, such as testosterone, prolactin, or thyroid, can cause erectile dysfunction. The following hormonal (or endocrine) conditions are commonly associated with erectile dysfunction: