Introduction – What is Erectile Dysfunction?
Erectile dysfunction/impotence is known as men’s consistent or recurrent inability to attain and/or maintain an erection long and good enough to complete sexual performance.
It is known to affect more men as they age, especially those who suffer from coexisting medical conditions like cardiovascular disease, hypertension, smoking, inactivity, obesity, diabetes mellitus, drug use, etc.
Largely, ED happens to: some 1-9% of men at age of < 40 years; 20-30% in those of 40-50 years; 20-40%, of 60-69 years; 50-75%, of >70 years.
Common sense and experience tell us that any disease is always a process of lifelong making and the ED-affected men would not come to see the doctors until they accumulate enough amount of inconvenience and embarrassment.
Every disease always displays its symptoms on its unique pattern of full spectrum ranging from its initial almost non-perceivable mild stage to its final obvious stage. For ED, it emerges and progresses so slow that the affected men become puzzled at the beginning and even for many of years.
As time goes by, the symptoms of ED become more and more often and obvious. Finally, they become so annoyed saying enough, that is enough, and come to see and ask the doctors, preferably urologists, to help them restore erection.
Before starting the care for erectile dysfunction, one has to know what is its underlying causes.
Known to us, the first step to take care of any health condition or disease is to realize, understand, and accept its currently available truth and facts. Similarly, a systemic comprehensive evaluation would be the first step to define its potential causes as depicted in How to Handle Sickness.
How and why are the causes of erectile dysfunction categorized or classified?
Classifying a disease is not just to make clinical researchers possible to analyze but also to make it easy to understand for the patients and their family. Traditionally, the causes for ED are grouped into two categories:
- organic ED, and
- psychogenic ED.
Fundamentally, the bottom line mechanism for ED is not able to keep enough blood to engorge the blood chambers (or cylinders) of the penis so to maintain and sustain an erection to complete sexual intercourse at will, which results from some impairment of blood vessels and nerves to the penis.
This is possibly caused by diseases, trauma especially affecting spinal cord, surgery affecting local blood vessels and nerves to the penis, etc. But, in reality, the causes for ED in an individual are not so clear cut as it may seem. In fact, ED is always caused by multiple factors among which they may be interacting.
Since medical professionals have never really cured anything for anyone, but just help patients understand what the causes may be so to modify something to some degree for reasonable patients with/without medication and/or surgery at a reasonable time in a reasonable way at the time and location under the circumstance. That is all the doctors can do for their patients.
So, a comprehensive evaluation is required to reveal the causes for ED in an individual case, which may be as follows:
- Organic ED:
1) Vasculogenic: the problem from poor circulation.
a. arteriogenic – blood vessel hardening and narrowing by atherosclerosis, and
b. venogenic – due to venous leakage by incompetent venous valve.
2) Neurogenic: the problem from poor nerve regulation to the penis, may be caused by Alzheimer’s disease, injury to brain or spinal cord, trauma, or surgery,…
3) Endocrine disease: too high or too low thyroid function, disorders of adrenal glands like Cushing syndrome, poor testosterone production by testes, or poor central testosterone- stimulating hormone, or overproduction of prolactin by the brain, and diabetes mellitus.
2. Psychogenic: only accounts for 10% of ED; more common in men less than 35 years of age; may result in poor interest in partner, performance-related anxiety like fear for failure, negative mood, with life stress from personal, interpersonal, or environmental circumstances.
3. Mixed ED: In fact, this is probably most common because both vasculogenic and psychogenic issues may interact.
What are the Common Associated Medical Conditions with ED?
- Atherosclerosis – blood vessel hardening and narrowing;
- Diabetes mellitus
- Priapism – unwanted persistent erection, usually associated with drugs affecting central nerve system like antidepressants.
- Peyronie’s disease – local “scar” in the wall of penile cylinders.
- Prostate cancer and its treatments like hormonal use, radiation, surgery,…
- Drug use – any drugs affecting brain like opioid-related pills, sex hormone or steroid use.
What are the Commonly Mentioned Risk Factors for ED?
The following conditions increase the probability to develop ED:
- Diabetes mellitus: known at a 3-times higher risk to develop ED, which occurs at much earlier age and related with disease duration; associated with a 14 times higher risk of blood vessel related disease and death. Hence, proper diabetic control can not be over stressed.
- Cardiovascular disease – related with high blood fat (lipid), hypertension, peripheral vascular disease. Remember: Consider cardiovascular disease as a systemic disease.
- Lower urinary tract symptoms associated with BPH (benign prostate hyperplasia).
- Chronic severe kidney or liver diseases.
- Prior surgery and/or radiation or trauma to/in lower abdomen, pelvis, penis, testes.
- Hormonal disorders like hypogonadism (low testosterone) by problems in testes or in central nerve (pituitary gland) or adrenal glands (Cushing disease).
- Priapism (unwanted prolonged erection).
- Peyronie’s disease.
- Long-distance cycling.
- Depression / psychological disorders.
- Neurogenic disorders like Parkinson’s disease, Alzheimer’s disease/dementia, prior stroke.
- Anti-hypertensives like thiazide diuretics, beta-blockers, alpha-2 agonists.
- ACE (angitensin-converting enzyme) inhibitors, angiotensin receptor blockers, calcium-channel blockers may cause some ED (less) but also may improve erectile function in some.
- Psychotropics like monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRI), lithium.
- Antiandrogens like bicalutamide or
- Tobacco smoking.
- Others like digoxin, cimetidine, spirolactone, marijuana.
Does Genetic Factors Play a Role in Developing ED?
The up-to-date research suggests several gene polymorphism may be linked with ED. But in practice, this is not practically important since nothing can be done with genetic (hereditary) issues, and a detailed history taking can help identify what are potential causes for ED in individual patient.
What May Prevent the Occurrence of ED?
- Avoid smoking.
- Optimal medical care for commonly associated medical conditions.
- Increase exercise and weight control.
- Split bicycle seat for long-distance cycling.
Just like any disease, ED is, in most patients, caused by multiple factors and those factors can interact. That is why the care for ED has to be systemic, comprehensive, and holistic in approach.This way you will have the best possible treatment for erectile dysfunction in the world.
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Of course, if you have additional questions, please do not hesitate to reach me at 734-846-2699 or firstname.lastname@example.org. Further, if needing more help/support? You may set up a private personal counseling so to decide what would be most reasonable for you. Doing so will ease your unnecessary anxiety and fear. Don’t you like that? I am ready for you.
James Chin-Ti Lin, M.D.
Certified urologist, award-winning author, and founder of www.ForMeFirst.com and www.sick-ask.com