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Causes
Achieving an erection involves a complex interaction of sensory information, nerves, blood vessels, hormones, and emotions. Because of this complexity, erectile dysfunction can involve physical factors, psychological factors, or a combination of the two. Essentially, erectile dysfunction occurs when the body experiences a breakdown in the sequence of events leading to an erection. This disruption can occur in nerve impulses to and from the brain, spine, and penis; or in the muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa that respond to those impulses.
A number of diseases that affect the tissues near the penis cause most cases of erectile dysfunction. Vascular diseases, such as atherosclerosis (hardening of the arteries), hypertension, and high cholesterol, cause up to 70 percent of erectile dysfunction in men with physical causes. Atherosclerosis alone accounts for between 50 and 60 percent of erectile dysfunction cases in men over age 60.
Between 35 and 50 percent of men with diabetes experience erectile dysfunction because the disease can damage nerves and arteries, making an erection difficult. Kidney disease can affect hormones, circulation, nerve function, and energy level. These changes can lower libido (sex drive) or sexual ability. Drugs used to treat kidney disease can also cause erectile dysfunction.
Since the nervous system plays a vital part in achieving and maintaining an erection, it is common for men with diseases such as stroke, multiple sclerosis, Alzheimer's disease, Parkinson's disease, and spinal cord injuries to experience erectile dysfunction.
Surgery and injury can also cause ED. Though prostate and bladder cancer don't cause erectile dysfunction on their own, the surgery to remove the cancer can lead to erectile problems. To remove these cancers, doctors must also remove nerves and tissues around the affected areas. Some of these surgeries only result in temporary ED (lasting six to 18 months), but other procedures result in permanent damage to the nerves and tissue responsible for causing an erection. Injuries to the pelvis, bladder, spinal cord, and penis that require surgery also commonly cause ED. Injury or diseasecan also cause venous leak, a condition where the veins cannot prevent blood from leaving the penis, which can cause men difficulty in maintaining erections.
Though hormonal imbalances only account for 5 percent of all ED cases, problems with the pituitary gland, which regulates hormones such as prolactin and testosterone, can affect a man's response to sexual stimulation. Hormonal imbalances that affect erection can also result from kidney disease, liver disease, or a tumor on the pituitary gland.
Tobacco, alcohol, and drug use all can damage a person's blood vessels and restrict blood flow to the penis. Smoking, in particular, plays a large role in causing ED in people with arteriosclerosis.
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