Erection is a complex neuro-vascular process in which, under the influence of various stimuli (visual, olfactory, mechanical – touch, pressure), vasodilatation of the vessels in the penis occurs, meanwhile blocking the outflow of blood from the cavernous bodies and spongy body. They are filled with blood and repeatedly increase the size of the penis. The presence of a stop in one of the mechanisms – for example, the transmission of nerve impulses or blockage of blood flow leads to the impossibility of an erection.
Erectile dysfunction is the inability to initiate and maintain an erection, which makes sexual intercourse impossible. This is a problem that often worsens a man’s self-esteem and results in conflicts and tension in the relationship with the sexual partner. According to some statistics, about 5% of men over the age of 40 suffer from erectile dysfunction. For men over 70 years of age, this percentage rises to 15%. Mild to moderate erectile dysfunction affects 10% of men per decade – i.e. 20% of 20-year-olds; 50% of 50 year olds etc. Worldwide, around 52% of men are affected by the condition. The presence of accompanying cardiovascular diseases, diabetes, and the use of certain medications increase the risk of erectile dysfunction.
The risk factors that are associated with an increased risk of erectile dysfunction are stress, obesity, smoking, alcohol, diabetes, hypertension atherosclerosis, etc.
The causes of erectile dysfunction can be classified into several groups – psychogenic, organic, and iatrogenic (drug-mediated).
Psychogenic factors are considered the most common cause of erectile dysfunction. The presence of emotional stress, low self-esteem, psychological trauma, restlessness, etc. cause an increased secretion of catecholamines (epinephrine, norepinephrine), which prevent the relaxation of the penile smooth muscles and, accordingly, blood filling of the corpora cavernosa. A single episode of erectile dysfunction can promote further emotional stress and provoke a prolongation of the problem. A combination of drug treatment and psychotherapy is suitable for psychogenic erectile dysfunction, and sometimes even just releasing emotional stress can solve the problem.
If there are doubts about the presence of an organic cause for erectile dysfunction, look for vasculopathy or neuropathy – a problem in the arteries, veins, or nerves to the penis, low testosterone levels, prostate cancer, diabetes, etc. Undergoing surgery involving innervation or vascularization may also be a potential cause. Spinal, craniocerebral, or genital trauma can be the cause of erectile dysfunction. Other conditions such as sleep apnea, COPD, cirrhosis, scleroderma, hypertension, and atherosclerosis also cause erectile dysfunction. Diseases that cause neuropathy are related to erectile dysfunction – for example, epilepsy, stroke, Alzheimer’s, Parkinson’s, brain tumor, etc.
Impairments in blocking venous compression and outflow are another cause of erectile dysfunction. Such a disorder is observed in Peyronie’s disease, in which scarification tissue is formed in the tunica albuginea. This leads to penile deformity, painful erection, and erectile dysfunction.
Endocrinological disorders – decreased testosterone levels, hyperthyroidism, hyperprolactinemia, etc. can also cause erectile dysfunction.
Iatrogenic erectile dysfunction is associated with the use of certain medications – antihypertensive medications (beta-blockers, alpha-blockers, diuretics, etc.), antidepressants, anxiolytics, antipsychotics, antiepileptics, 5-alpha-reductase inhibitors, nasal decongestants, etc.
Alcohol and drug use can also cause erectile dysfunction.
An interesting fact is that prolonged cycling may be a factor in the genesis of erectile dysfunction. Newer and modern bicycles have cushioned seats with a modified design so as to reduce pressure in the perineal area.
Among the most used medications for the treatment of erectile dysfunction are phosphodiesterase 5 inhibitors ( Sildenafil, Vardenafil, Tadalafil, etc.). There are also prostaglandin analogs for intraurethral and intracavernous injection use, but these days they are used less and less.
The causes of erectile dysfunction can be psychogenic or organic, but in most cases, it is a combination of both. Organic is associated with vascular disease or neuropathy. Another type of erectile dysfunction is iatrogenic, associated with the use of various drugs.
