In a process as complex as penile erection, problems can occur for many reasons. Very often an erectile problem will have more than one cause. The causes may be psychological or physical or a combination of both. Distinguishing between psychological and physical causes is helpful, because
treatments may differ depending on the cause. This Patient's Guide focuses on treating erectile problems that have mainly physical causes.
Psychological causes of erectile dysfunction include stress and anxiety due to marital, financial or other external problems. For example, a sexual active man may suddenly find himself unable to have an erection shortly after losing his job. It is possible for the man's stress and anxiety to interfere with nerve impulses from his brain when he attempts sexual intercourse. "Performance anxiety" is a also a common cause of erectile dysfunction. Because of anxiety about his ability to "perform," a man finds he cannot perform - which causes more anxiety, thus completing a vicious cycle. Psychiatric illnesses such as depression can also cause erectile dysfunction.
The most frequent physical causes of erectile dysfunction are vascular (blood vessel) diseases. Vascular diseases may cause problems involving blood flow into the penis to make it erect. They can also cause problems of holding the blood in the penis to maintain the erection. Thus, hardening of the arteries and other diseases that affect the vascular system are risk factors for erectile dysfunction.
Diseases that affect the nervous system, such as multiple sclerosis and alcoholism, can also cause erectile dysfunction. Some diseases associated with erectile dysfunction can affect both the vascular and the nervous systems. Diabetes is an example.
As pointed out previously, erectile dysfunction often has multiple causes. A man with diabetes, for instances, may be a heavy smoker and a heavy drinker. He may have high blood pressure and a high level of blood cholesterol. Each of these conditions can damage the vascular system and/or nervous system. Each is a risk factor for erectile dysfunction. When any of these conditions occur together, the risk increases.
Erectile dysfunction can result from pelvic fractures or crush injuries experienced in an automobile, motorcycle or other accident. The accident victim may be left with injured nerves and/or penile arteries that cannot supply enough extra blood to the penis for an erection. Spinal cord injuries that destroy nerve fibers are another cause of erectile dysfunction. Some types of surgery and radiation therapy, such as for treating prostate, bladder or rectal cancer, carry a risk of erectile dysfunction. In addition, certain medications might contribute to erectile dysfunction. The patient should review with his doctor all medications taken recently.
The effect of low levels of the male sex hormone testosterone on erectile function is not clear. Studies have shown that low testosterone levels do not necessarily prevent a man from having an erection. Low testosterone levels, however, can decrease sexual desire.
The effects of aging on erectile function have also been studied. Although the rate of erectile dysfunction in the male population increases with age, aging itself does not appear to be the cause. The causes are illness, such as vascular diseases and diabetes, that may develop as a man ages, with possible contributing effects from medications taken to treat such illnesses. There may be contributing effects as well from years of smoking or alcohol abuse.
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