Erectile Dysfunction

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anatomy of the male organ

What causes Erectile Dysfunction (ED)?

Erectile dysfunction is defined as the consistent or recurrent inability to acquire or sustain an erection of sufficient rigidity and duration for sexual intercourse. A penile erection involves interactions between many systems within the body, including the circulatory system, nerves, hormones and psychological systems. And when men are having difficulty with an erection, the problem can lie in any or several of these systems. Let's address each system separately and discuss what problems can occur.

Circulatory system

Circulatory system

Normal erections require normal blood flow into the penis and normal dilation or relaxation of certain areas of the penis to allow for increased blood flow. When one of these systems does not work well, either the blood flow to the penis is inhibited, or the relaxation mechanism doesn't work. Well, erections will not be adequate for sexual activity.

Did you know, that Ed can be an early warning sign for cardiovascular disease This means that you may be at greater risk for things like heart attacks and strokes. This would make sense, because if the penis has difficulty with blood flow to certain areas, the heart or brain also may be having difficulty receiving blood normally. So naturally since chronic conditions such as diabetes and chronic kidney disease increase someone's risk for cardiovascular disease. These conditions are also associated with a risk for Ed. Basically, anything that's bad for your heart is also bad for your penis. So high blood pressure smoking, elevated cholesterol and obesity also have a higher risk for Ed, and conversely exercise is associated with a lower risk for Ed.

The next system involved is the neurological system or the nerves. When a man has sensual visual input nerves send signals to the spinal cord, located between the T11 and L2.

Another type of erection can occur with touch. To the genital area, which sends signals to the sacral spinal area. From there impulses travel to the pelvis, which then instructs increased blood flow to the penis. So, if a man has had a lower spinal cord, injury or stroke, these nerve impulses will be inhibited and erections won't occur. Furthermore, if a man has had damage to their pelvis from either an accident, prostate surgery or radiation treatment, this can also inhibit or damage the nervous system and nerve signals will be damaged. Usually this type of erectile dysfunction develops suddenly there's a marked decrease in inability to maintain an erection after an event occurs.


Role of hormones

Hormones and testosterone plays the largest part. If a man has low testosterone, his libido or desire for sex will be diminished. Also testosterone is a hormone necessary to help relax certain areas of the penis, so blood flow can increase to those areas.


Role of psychology

Things such as depression, stress and problems within a relationship can all contribute to ed and that develops very suddenly often has an emotional source which can be helped with counseling it's. important for your doctor to understand, whether the issue is stemming from low libido or a lessened desire for sex, or whether the desire is there, but they can't maintain an erection.

The treatments are different, and I would also add, that the rise in pornography use can lead to an increase in erectile dysfunction. If greater and greater visual stimulization is needed to evoke arousal, then physical sex with a human partner just isn't as stimulating. And lastly, it's estimated, that up to 25 percent of men's erectile dysfunction may be caused by the medications. They're taking some of these medications include antidepressants, especially the Ssris and common blood pressure medications, such as thiazide diuretics, such as chlorthalidone or hydrochlorothiazide. Also alcohol use, especially heavy alcohol use and recreational drugs are also associated with erectile dysfunction.

Medical evaluation for erectile dysfunction

Most evaluations for Ed. will involve a history and physical exam and then laboratory studies. First, your doctor will ask you some questions:

Did your Ed start all of a sudden or has it developed over time ?

If Ed started all of a sudden, it's likely caused by performance anxiety or psychological issues with your sexual partner and counseling will be recommended.

Whether you're having nocturnal erections and if you can recall having awoken with erections in the last month?

If so this may mean, the problem is psychological or interpersonal between you and your sexual partner, and it's not vascular or a neurological issue along these same lines. It's important for your doctor to ask about your desire to have sex versus your ability to obtain and maintain an erection. A decreased desire is treated differently than an inability to have an erection. Depression is also associated with Ed and decreased libido. So your doctor may spend some time evaluating you for depression. Next a physical exam that includes the pulses in the Pelvic area and an examination of the penis and testicles should be done. If pulses are weak in the groin or in the feet, this may indicate an issue with circulation. And if the testicles are smaller than usual, a low testosterone may be the cause. You then may be sent for blood testing to evaluate for things like diabetes testosterone level, liver and kidney function, thyroid hormone and cholesterol levels. As I mentioned , if it's bad for your heart, it's bad for your penis. So the risk for cardiovascular disease, such as risks for heart attack or stroke, may be present as erectile dysfunction. So testing for things like diabetes and elevated lipids is important.

Your doctor may ask you about any chest pain, your ability to walk certain distances or if you've had increased fatigue and less ability to do your normal activities. If any of these things have occurred recently, your doctor may refer you to a cardiologist for further testing of your heart depending. On the results from this part of the evaluation, this will determine the next steps in management. Many patients will be given a trial of medication, but some others may need testosterone replacement or medication for depression or a referral to a counselor or cardiologist.


dr Sam Shah