Causes of erectile dysfunction

Synonyms

Potency disorder, impotence, medical: Erectile Dysfunction (ED)The causes of erectile dysfunction lie in the various systems that contribute to a man’s erectile function. For example, there is a psychological, vascular (vascular), nervous system (neurogenic), hormonal or small muscle (myogenic) erectile dysfunction. In many men, however, the disease is composed of several of these factors.

Drugs can also cause erectile dysfunction. Just as appropriate stimulation of the psyche, for example by images or thoughts, can cause an erection, another mental stimulus can also block or interrupt it. Thus, psychogenic erectile dysfunction is to be considered a symptom of a deeper, psychological problem.

This is where the therapy must start.

  • Causes: Especially feelings such as fear, whether of failing in relation to a woman, or triggered by early childhood experiences, upbringing or trauma, can severely limit or completely prevent a man’s erectile function.
  • Epidemiology: About 40% of erectile dysfunction is psychological.
  • Symptoms: The more or less subconscious fears described here lead to a so-called primary disorder, which lasts for a long time, while problems within the respective situation or partnership trigger a mostly acute, secondary disorder, which only refers to the current situation. This is often accompanied by other sexual disorders, such as loss of libido (loss of sexual desire) or ejaculation disorder (disorder of ejaculation).

Here the blood vessels of the penis are affected.

If they cannot fulfill their function more or less well, erectile dysfunction occurs. A venous erectile dysfunction is characterized by the symptoms of a rapidly occurring erection, which, however, subsides after a few minutes, i.e. cannot be maintained. If there are additional veins in the penis, this is usually the case since birth.

This potency disorder does not develop slowly, but is present from the beginning and is usually discovered by the man during puberty. If there is a mixed problem, i.e. if both arteries and veins are affected in some way, in moderate cases a slowed erection occurs, which only lasts a short time and/or does not develop completely.

  • Causes: Basically, a distinction is made between arterial (affecting the blood flow) and venous (affecting the blood outflow) disorders.

    An arterial disorder can be caused by the following factors: Fat metabolism disorders, smoking, high blood pressure or diabetes mellitus. These are the classic risk factors for arteriosclerosis, which can also affect the fine vessels of the penis and its erectile tissue. If these are calcified, less blood can flow through them into the erectile tissue.

    Their diameter can also expand less easily, resulting in erectile dysfunction. Other causes of restricted arterial function can also be injuries to the arteries caused by surgery or accidents. Venous outflow disorders can also have several causes.

    One of them is the congenital existence of additional (ectopic) veins in the erectile tissue. If there are more veins, more blood flows out and there may not be enough of them in the erectile tissue to allow an erection. If the structure of the muscles of the cavernous body is changed, for example by the incorporation of connective tissue, it loses its ability to relax, which is an essential prerequisite for filling the cavernous body and compressing the veins.

    This is usually caused by a preceding arterial disorder, as the muscle cells are no longer sufficiently nourished and are no longer able to convert into connective tissue. However, the muscles of the cavernous body may not only be altered in their structure (morphologically) but also functionally. In this case, the signal transmission process is disturbed, which leads to slackening.

    However, the consequences are the same as just described. Another factor that leads to a venous outflow disorder is a pathological connection of the erectile tissue nerves with those of the surrounding penile tissue or the glans. If this is the case, excessive blood flows out of the erectile tissue in this way, resulting in erectile dysfunction.If the connective tissue sheath (fascia) that surrounds the erectile tissue, the so-called tunica albuginea, is damaged, this also leads to a venous erectile dysfunction, since the erectile tissue cannot fill sufficiently to prevent the flow through the veins.

  • Epidemiology: Arterial vascular restrictions account for about 50 – 80% of all organically caused erectile dysfunction.

    Here it is worth mentioning that studies show that there is a strong correlation between the rate of erectile dysfunction and the number of sclerosed coronary arteries. Concerning multi-vascular diseases of the cardiovascular system, 2/3 of the patients here were affected by erectile dysfunction; in 70% of them the potency disorder even preceded the symptoms of coronary heart disease.

  • Symptoms: Typical of vascular erectile dysfunction affecting the arteries is a delayed and/or slowed erection, which can be either weak or complete. This erectile dysfunction is of course independent of the partner.

    Furthermore, the disorder does not start suddenly, but develops slowly and increases in severity.

Endocrine-induced erectile dysfunction is often also associated with a loss of libido (loss of sexual desire) and reduced sperm production.

  • Causes: The influence of male hormones (androgens) on the erection mechanism is not yet fully understood. However, the male sex hormone testosterone seems to play a role in this.

    It has been found that men with too low testosterone levels can develop erectile dysfunction. This can be the case with so-called hypogonadism (underfunction of the gonads), but testosterone levels also drop with age. Potency disorders are also less frequently observed in cases of hyperthyroidism or hypothyroidism.

  • Symptoms: A testosterone deficiency is mainly associated with reduced nocturnal erections.

    However, it can still be triggered by visual stimulation with images. For sexual intercourse, however, the extent of the erection is not sufficient.

Our nervous system is responsible for the absorption of stimuli, whether through the eyes in the form of images or through the skin by touch, as well as for their processing, interconnection and transmission. In order to trigger an erection, functioning nerve fibers are therefore indispensable.

  • Causes: One cause of neurogenic erectile dysfunction can be damage to the spinal cord. This is where the nerve tracts that communicate between the brain and the sexual organs run. Paraplegia, a tumor or even vascular damage can be responsible for this.

    A common cause of neurogenic erectile dysfunction is damage to the pudendal nerve, which is difficult to avoid in prostate cancer when the prostate is removed radically. Besides bleeding, impotence is the biggest risk in such an operation. Furthermore, there are numerous diseases that cause damage to the central or peripheral nervous system.

    Examples are polyneuropathy, Parkinson’s disease, multiple sclerosis or Alzheimer’s disease. A tumor or bleeding in the brain can also paralyze the areas that must be intact for erectile function.

  • Symptoms: They differ according to the location of the nerve damage. If a man is paralyzed from the area of the thoracic or lumbar vertebrae downwards, the psychogenic erection no longer functions, but the reflective erectile function remains.

    It is exactly the opposite case when the lesion in the spinal cord is located below the second cruciate vertebra (S2). Then the potency that can be triggered by thoughts is retained, but the reflex path for the reflex erection is interrupted and thus paralyzed. In neurodegenerative diseases as well as in tumors or bleeding, the symptoms depend on the localization and the degree of nerve damage.

Taking various drugs can cause impotence as a side effect. The most important ones are listed below:

  • Cardiovascular drugs: Antihypertensives (blood pressure reducers), diuretics (drainage drugs)
  • Hormone therapeutics: Antiandrogens (drugs that lower testosterone levels)
  • Psychotropic drugs: antidepressants, neuroleptics (drugs against psychoses), sedatives (tranquilizers), hypnotics (sleeping pills), antiepileptics