Erectile dysfunction is a persistent inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance.
For most men, erectile dysfunction is caused by physical problems, usually related to the blood supply of the penis.
Types and Causes of ED
The following are some of the different types and possible causes of erectile dysfunction:
Organic Erectile Dysfunction
Organic ED involves abnormalities in the penile arteries, veins, or both and is the most common cause of ED, especially in older men. When the problem is arterial, it is usually caused by arteriosclerosis, or hardening of the arteries, although trauma to the arteries may be the cause.
The controllable risk factors for arteriosclerosis–being overweight, lack of exercise, high cholesterol, high blood pressure, and cigarette smoking–can cause erectile failure often before progressing to affect the heart.
Many experts believe that atrophy, a partial or complete wasting away of tissue, and fibrosis, the growth of excess tissue, of the smooth muscle tissue in the body of the penis (cavernous smooth muscle) triggers problems with being able to maintain a firm erection.
Poor ability to maintain an erection is often an early symptom of erectile dysfunction. Although the condition is called venous leak, the real problem is not with the veins but the malfunction of the smooth muscle that surrounds the veins.
The end result is difficulty with maintaining a firm erection (losing an erection too quickly) that is now believed to be an early manifestation of atherosclerosis and vascular disease.
Erectile Dysfunction is common in people with diabetes. The process involves premature and unusually severe hardening of the arteries. Peripheral neuropathy, with the involvement of the nerves controlling erections, is commonly seen in people with diabetes.
Depression is another cause of ED and is closely related to erectile dysfunction. Because there is a triad relationship between depression, ED, and cardiovascular disease, men with depression should be fully evaluated for medical illness as well as psychological factors. Some antidepressant medications cause erectile failure.
There are many neurological (nerve problems) causes of ED. Diabetes, chronic alcoholism, multiple sclerosis, heavy metal poisoning, spinal cord, and nerve injuries, and nerve damage from pelvic operations can cause erectile dysfunction.
A great variety of prescription drugs, such as blood pressure medications, antianxiety and antidepressant medications, glaucoma eye drops, and cancer chemotherapy agents are just some of the many medications associated with ED.
Hormonal abnormalities, such as increased prolactin (a hormone produced by the anterior pituitary gland), steroid abuse by bodybuilders, too much or too little thyroid hormone, and hormones administered for prostate cancer may cause ED. Low testosterone can contribute to ED but is rarely the sole factor responsible for ED.
ED Risk Factors
Erectile dysfunction is also a symptom that accompanies many disorders and diseases.
Direct risk factors for erectile dysfunction may include the following:
- prostate problems;
- type 2 diabetes;
- hypogonadism in association with a number of endocrinologic conditions;
- hypertension (high blood pressure);
- vascular disease and vascular surgery;
- high levels of blood cholesterol;
- low levels of HDL (high-density lipoprotein);
- chronic sleep disorders (obstructive sleep apnea, insomnia);
- neurogenic disorders;
- Peyronie’s disease (distortion or curvature of the penis);
- priapism (inflammation of the penis);
- alcohol use;
- lack of sexual knowledge;
- poor sexual techniques;
- inadequate interpersonal relationships;
- many chronic diseases, especially renal failure and dialysis;
- smoking, which exacerbates the effects of other risk factors, such as vascular disease or hypertension.
Age appears to be a strong indirect risk factor in that it is associated with an increased likelihood of direct risk factors, some of which are listed above.
Accurate risk factor identification and characterization are essential for the prevention or treatment of erectile dysfunction.
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