Erectile Dysfunction (ED, Impotence) (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Erectile dysfunction (impotence) facts
- What is erectile dysfunction (ED)?
- What is normal penis anatomy?
- How common is erectile dysfunction?
- How does erection occur?
- How is erection sustained?
- What causes erectile dysfunction?
- What are erectile dysfunction risk factors?
- What are erectile dysfunction symptoms and signs?
- How do health-care professionals diagnose erectile dysfunction?
- What drugs treat erectile dysfunction?
- What is the treatment for erectile dysfunction?
- What are erectile dysfunction treatments for men with cardiovascular disease?
- Oral phosphodiesterase type 5 (PDE5) inhibitors
- Sildenafil (Viagra)
- Vardenafil (Levitra)
- Tadalafil (Cialis)
- Avanafil (Stendra)
- What are intracavernosal injections?
- What are intraurethral suppositories?
- What is the role of testosterone therapy in the treatment of erectile dysfunction?
- Can a penis pump (vacuum device) help erectile dysfunction?
- What about psychological therapy for erectile dysfunction?
- Surgery for erectile dysfunction
- Can over-the-counter (OTC) and/or natural or home remedies treat erectile dysfunction?
- Is it possible to prevent erectile dysfunction?
- What is the prognosis for erectile dysfunction?
- What research is being done for erectile dysfunction?
- Impotence (Erectile Dysfunction, ED) FAQs
- Find a local Urologist in your town
What causes erectile dysfunction?
The ability to achieve and sustain erections requires the following:
- A healthy nervous system that conducts nerve impulses in the brain, spinal column, and penis
- Healthy arteries in and near the corpora cavernosa that when stimulated can bring increased blood flow into the penis
- Healthy muscles and fibrous tissues within the corpora cavernosa, which can distend to allow the penis to fill with blood
- Adequate levels of nitric oxide in the penis
- Normal-functioning tunica albuginea that allows for compression of the veins
- Appropriate psychosocial interactions
Erectile dysfunction can occur if one or more of these requirements are not met. The following are causes of erectile dysfunction, and many men have more than one potential cause:
- Aging: There are two reasons why older men are more likely to experience erectile dysfunction than younger men. First, older men are more likely to develop diseases (such as heart attacks, angina, cardiovascular disease, strokes, diabetes mellitus, and high blood pressure) that are associated with erectile dysfunction. Second, the aging process alone can cause erectile dysfunction in some men by causing changes in the muscle and tissue within the penis.
- Diabetes mellitus: Erectile dysfunction tends to develop 10 to 15 years earlier in diabetic men than among nondiabetic men. The increased risk of erectile dysfunction among men with diabetes mellitus may be due to the earlier onset and greater severity of atherosclerosis (hardening of the arteries) that narrows the arteries and thereby reduces the delivery of blood to the penis. Atherosclerosis can affect the arteries in the penis. Diabetes mellitus also causes erectile dysfunction by damaging nerves that go to the penis, much like the effect of diabetes on nerves in other areas of the body (diabetic neuropathy). Diabetes can also affect the muscles in the penis, leading to troubles with erections. Smoking cigarettes, obesity, poor control of blood glucose levels, and having diabetes mellitus for a long time further increase the risk of erectile dysfunction in people with diabetes.
- Hypertension (high blood pressure): Men with high blood pressure have an increased risk of developing erectile dysfunction. Hypertension can cause troubles with erections related to atherosclerosis or from low levels of nitric oxide being made from the arteries in the penis.
- Cardiovascular diseases: The most common cause of cardiovascular diseases in the United States is atherosclerosis, the narrowing and hardening of arteries that reduces blood flow. Atherosclerosis (a type of vascular disease) typically affects arteries throughout the body and is aggravated by hypertension, high blood cholesterol levels, cigarette smoking, and diabetes mellitus. Hardening of the arteries to the penis and pelvic organs, atherosclerosis, causes insufficient blood flow into the penis. There is a close correlation between the severity of atherosclerosis in the coronary arteries and erectile dysfunction. For example, men with more severe coronary artery atherosclerosis (hardening of the arteries in the heart) also tend to have more erectile dysfunction than men with mild or no coronary artery atherosclerosis. Some doctors suggest that men with new onset erectile dysfunction should be evaluated for silent coronary artery diseases (advanced coronary artery atherosclerosis that has not yet caused angina or heart attacks).
- Cigarette smoking: Cigarette smoking aggravates atherosclerosis and can cause vasospasm (spasms of the arteries) and thereby increases the risk for erectile dysfunction.
- Nerve or spinal cord damage: Damage to the spinal cord and nerves in the pelvis can cause erectile dysfunction. Nerve damage can be due to disease, trauma, or surgical procedures. Examples include injury to the spinal cord from automobile accidents, injury to the pelvic nerves from prostate surgery for cancer (prostatectomy), and some surgeries for colorectal cancer, radiation to the prostate, surgery for benign prostatic enlargement, multiple sclerosis (a neurological disease with the potential to cause widespread damage to nerves), and long-term diabetes mellitus.
- Substance abuse: Marijuana, heroin, cocaine, methamphetamines, crystal meth, and narcotic and alcohol abuse contribute to erectile dysfunction. Alcoholism, in addition to causing nerve damage, can lead to atrophy (shrinking) of the testicles and lower testosterone levels.
- Low testosterone levels: Testosterone (the primary sex hormone in men) is not only necessary for sex drive (libido) but also is necessary to maintain nitric oxide levels in the penis. Therefore, men with hypogonadism (low testosterone with symptoms) can have low sex drive and erectile dysfunction.
- Medications: Many common medicines produce erectile dysfunction as a side effect. Medicines that can cause erectile dysfunction include many used to treat high blood pressure, antihistamines, antidepressants, tranquilizers, and appetite suppressants. Examples of common medicines that can cause erectile dysfunction include propranolol (Inderal) or other beta-blockers, hydrochlorothiazide, digoxin (Lanoxin), amitriptyline (Elavil), famotidine (Pepcid), cimetidine (Tagamet), metoclopramide (Reglan), indomethacin (Indocin), lithium (Eskalith, Lithobid), verapamil (Calan, Verelan, Isoptin), phenytoin (Dilantin), gemfibrozil (Lopid), amphetamine/dextroamphetamine (Adderall), and phentermine.
- Depression and anxiety: Psychological factors may be responsible for erectile dysfunction. These factors include stress, anxiety, guilt, depression, widower syndrome, low self-esteem, posttraumatic stress disorder, and fear of sexual failure (performance anxiety). It is also worth noting that many medications used for treatment of depression and other psychiatric disorders may cause erectile dysfunction or ejaculatory problems.
Learn more about: Eskalith
What are erectile dysfunction risk factors?
The common risk factors for ED include the following:
- Advanced age
- Cardiovascular disease
- Diabetes mellitus
- High cholesterol
- Cigarette smoking
- Recreational drug use
- Depression or other psychiatric disorders
- Pelvic surgery, including radical prostatectomy and colorectal surgery
- Pelvic radiation, such as for prostate cancer and some colorectal cancers
- Trauma to the pelvis (pelvic fracture), penis (penile fracture), and perineum
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