What causes erectile dysfunction (ED)?
Since an erection requires a
precise sequence of events, ED can occur when any of the events is
disrupted. The sequence includes nerve impulses in the brain, spinal
column, and area around the penis, and response in muscles, fibrous
tissues, veins, and arteries in and near the corpora cavernosa.
Damage to nerves, arteries, smooth muscles, and fibrous tissues,
often as a result of disease, is the most common cause of
erectile dysfunction.
Diseases?such as diabetes, kidney disease, chronic alcoholism,
multiple sclerosis, atherosclerosis, vascular disease, and
neurologic disease?account for about 70 percent of ED cases. Between
35 and 50 percent of men with diabetes experience ED.
Lifestyle choices that contribute to heart disease and vascular
problems also raise the risk of erectile dysfunction. Smoking, being
overweight, and avoiding exercise are possible causes of ED.
Also, surgery (especially radical prostate and bladder surgery for
cancer) can injure nerves and arteries near the penis, causing ED.
Injury to the penis, spinal cord, prostate, bladder, and pelvis can
lead to ED by harming nerves, smooth muscles, arteries, and fibrous
tissues of the corpora cavernosa.
In addition, many common medicines?blood pressure drugs,
antihistamines, antidepressants, tranquilizers, appetite
suppressants, and cimetidine (an ulcer drug)?can produce ED as a
side effect.
Experts believe that psychological factors such as stress, anxiety,
guilt, depression, low self-esteem, and fear of sexual failure cause
10 to 20 percent of ED cases. Men with a physical cause for ED
frequently experience the same sort of psychological reactions
(stress, anxiety, guilt, depression). Other possible causes are
smoking, which affects blood flow in veins and arteries, and
hormonal abnormalities, such as not enough testosterone.
How is ED diagnosed?Patient History
Medical and sexual histories help define the degree and nature of
ED. A medical history can disclose diseases that lead to ED, while a
simple recounting of sexual activity might distinguish among
problems with sexual desire, erection, ejaculation, or orgasm.
Using certain prescription or illegal drugs can suggest a chemical
cause, since drug effects account for 25 percent of ED cases.
Cutting back on or substituting certain medications can often
alleviate the problem.
Physical Examination
A physical examination can give clues to systemic problems. For
example, if the penis is not sensitive to touching, a problem in the
nervous system may be the cause. Abnormal secondary sex
characteristics, such as hair pattern or breast enlargement, can
point to hormonal problems, which would mean that the endocrine
system is involved. The examiner might discover a circulatory
problem by observing decreased pulses in the wrist or ankles. And
unusual characteristics of the penis itself could suggest the source
of the problem?for example, a penis that bends or curves when erect
could be the result of Peyronie's disease.
Laboratory Tests
Several laboratory tests can help diagnose ED. Tests for systemic
diseases include blood counts, urinalysis, lipid profile, and
measurements of creatinine and liver enzymes. Measuring the amount
of free testosterone in the blood can yield information about
problems with the endocrine system and is indicated especially in
patients with decreased sexual desire.
Other Tests
Monitoring erections that occur during sleep (nocturnal penile
tumescence) can help rule out certain psychological causes of ED.
Healthy men have involuntary erections during sleep. If nocturnal
erections do not occur, then ED is likely to have a physical rather
than psychological cause. Tests of nocturnal erections are not
completely reliable, however. Scientists have not standardized such
tests and have not determined when they should be applied for best
results.
Psychosocial Examination
A psychosocial examination, using an interview and a questionnaire,
reveals psychological factors. A man's sexual partner may also be
interviewed to determine expectations and perceptions during sexual
intercourse.
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