Cause of Erectile Dysfunction - Understanding the Causes of Erectile Dysfunction

Erectile dysfunction can be classified simply under two headings. Psychological erectile dysfunction: that is, mental; or Organic erectile dysfunction: that is, due to some form of physical or medical problem. Organic erectile dysfunction becomes more common as men get older.

Psychological causes of Erectile Dysfunction
The causes of psychological erectile dysfunction are numerous, and it is difficult to list them all, but most often erectile dysfunction is related to depression, performance anxiety, marital stress or relationship problems, marital boredom, life crisis, financial difficulties, religious repression, or some type of mental illness. Improving erectile dysfunction in these cases may require addressing the underlying causes.

Organic causes of Erectile Dysfunction
There are four major causes of organic erectile dysfunction: Vascular, Neural, Hormonal, and Drug-induced. The type of erectile dysfunction determines the treatment approach.

1. Vascular causes of Erectile Dysfunction
Endothelial function plays a very important role in the process of erection. Erectile dysfunction and coronary artery disease overlap in risk factors due mostly to endothelial dysfunction There is growing evidence that patients presenting with erectile dysfunction should be investigated for heart disease, even if they have no symptoms of cardiovascular problems
   Alterations in the flow of blood to and from the penis are thought to be a common cause of male erectile dysfunction. For instance, medical conditions such as atherosclerosis (hardening of the arteries), high cholesterol, hypertension, or diabetes reduce blood flow to the penis and genital organs thus leading to difficulty with erection or genital swelling.  Erectile dysfunction could be an early indication of oxidative stress and vascular dysfunction. A vascular problem in the penis may precede a wider, systemic problem in other blood vessels in the body. Patients with cardiovascular disease and patients with diabetes represent the largest group of patients with erectile dysfunction. Lowering cholesterol through diet, supplements, or medicines improves erectile dysfunction.
   Metabolic syndrome can increase inflammatory markers in blood and negatively influence endothelial function resulting in poor vasodilation and a higher incidence of erectile dysfunction.
   Additional factors that can impede blood flow include penile injury and surgery in the pelvic and abdominal area. Smoking can reduce genital blood flow. Some men with erectile dysfunction may have an underlying vascular disease such as atherosclerosis.
   Men who smoke risk developing erectile dysfunction — and the more cigarettes they smoke, the greater the risk of erectile dysfunction.

2. Neural causes of Erectile Dysfunction
Nerve damage from disorders such as multiple sclerosis, Parkinson’s disease, diabetes, and stroke affect the brain’s ability to respond to sexual stimulation and cause erectile dysfunction. In women, abdominal or pelvic operations can occasionally lead to nerve damage. Erectile dysfunction is common in men undergoing surgical treatment for prostate enlargement or cancer.

3. Hormonal causes of Erectile Dysfunction
Low levels of androgens, such as testosterone, are sometimes a component of erectile dysfunction. Testosterone levels decline about 1 percent each year in men, which may contribute to erectile dysfunction with aging. Testosterone also declines with age in women leading to a decrease in female libido. Replacement of androgens can sometimes be helpful in those with age related erectile dysfunction. Testosterone is available by prescription only. An over the counter hormones, such as DHEA, converts into testosterone and thus has a positive influence on erectile dysfunction. Pregnenolone is another over the counter hormone that may increase testosterone levels and thus improve erectile dysfunction. Many herbal aphrodisiacs also have a positive influence on erectile dysfunction. Routine hormone blood studies for erectile dysfunction evaluation are not needed during the initial evaluation but perhaps later if treatment modalities are not successful. Prominent diseases of the endocrine system, such as diabetes mellitus, hypogonadism, and hyperprolactinemia, may cause erectile dysfunction. Sometimes erectile dysfunction treatment with hormones such as DHEA or testosterone can be effective.

4. Drug or Medication-induced Erectile Dysfunction
Drugs that interfere with erectile function include some anti-hypertensives, SSRIs (like Prozac), sedatives, and beta-blockers. SSRIs - treatment for depression - cause erectile dysfunction mostly due to their effect on serotonin metabolism. Serotonin has an inhibitory effect on erectile function and sexuality. Beta blockers such as propranolol, atenolol, and others, are some of the most common medications that cause erectile dysfunction.
     Surprisingly, NSAIDs such as ibuprofen and naproxen also cause erectile dysfunction. Regardless of the reason for taking them, painkillers classified as non-steroidal anti-inflammatory drugs (NSAIDs) apparently increase the likelihood that middle-aged and elderly men will develop erection difficulties. A study involved 1126 men, between 50 and 70 years of age, without erectile dysfunction in 1994 when they completed a questionnaire that included, among other things, questions about erectile function and medication usage. The questionnaire was then re-administered five years later. The investigators found that the erectile dysfunction rate was 93 cases per 1000 persons per year among NSAID users compared with just 35 cases among nonusers.
     Some chemicals involved in the human sexual response include dopamine, acetylcholine, and nitric oxide. All these three natural chemicals and others can be manipulated n the treatment of erectile dysfunction. Alcohol's negative affect on sex drive increases with age. Heavy smoking is an important risk factor for erectile dysfunction in men..

Erectile Dysfunction and Medical conditions
Certain medical conditions cause erectile dysfunction or reduce libido, performance, or enjoyment. These include hypertension, diabetes, high cholesterol, cardiovascular disease, obesity, peripheral vascular disease, neurologic disorders, and insomnia.
   Sitting on a bicycle too long. Men who log several thousand miles a year on their mountain bikes suffer scrotal damage that could reduce their fertility or cause erectile dysfunction.

Alcohol as a cause of Erectile Dysfunction
Problem drinking may dampen both a man's sex life and his chances of having children. Researchers in India found that men being treated for alcoholism had lower testosterone levels and more sperm abnormalities than non-drinkers did. They also had a far higher rate of erectile dysfunction (ED) - 71 percent, versus 7 percent of abstainers. Therefore, a major cause of erectile dysfunction is excess alcohol intake.

Disc protrusion as a cause of erectile dysfunction
Successful disc surgery after 17 years of erectile dysfunction caused by a "silent" disc protrusion.
Scand J Urol Nephrol. 2007 Jun 21;:1-3 Department of Orthopaedics, Central Hospital (FSS), Førde, Norway.
A 35-year-old male with normal erectile function up until the age of 18 years subsequently suffered permanent erectile dysfunction for the next 17 years. At the age of 15 years he had fallen from a horse and landed on his buttocks. He also complained of slight voiding dysfunction. CT of the lumbar spine showed a large protrusion of the intervertebral disc L5-S1. After operative removal of the protrusion, a normal erection was achieved after 15 days and urine flow improved at 1 and 2 months and became normal after 3 months.

Isoflavones or phytoestrogens as cause of erectile dysfunction
Exposure to the phytoestrogen daidzein attenuates apomorphine-induced penile erection concomitant with plasma testosterone level reduction in dose- and time-related manner in adult rats.
Urology. 2007 Sep;70(3):613-7. Department of Reproduction and Genetics, Nanjing University School of Clinical Medicine, Jinling Hospital, Nanjing, People's Republic of China.
To investigate the impact of exposure to the phytoestrogen daidzein on erectile function and sexual hormones. The negative effects of phytoestrogens on the male reproductive system, particularly on penile erection, have hardly been evaluated. The phytoestrogen daidzein has the potential to adversely affect erectile function in a dose and time-related manner that is at least partly attributable to androgen deficiency. These findings implicate that phytoestrogens, especially isoflavones, if overconsumed for a long period, might be a cause of erectile dysfunction.

Association or cause between erectile dysfunction and Parkinson's disease
There appears to be an association between erectile dysfunction and an increased risk of developing Parkinson's disease. The autonomic nervous system, which regulates involuntary bodily functions like heart rate and digestion, is often affected in Parkinson's disease, and erectile function is partially controlled by the autonomic system. The autonomic nervous system may become impaired years before Parkinson's disease is clinically recognizable. American Journal of Epidemiology, December 2007.

Drugs as cause of erectile dysfunction
Many drugs cause erectile dysfunction including diuretics and alpha-2 agonists.
       

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