What are the causes of Erectile Dysfunction?
Erectile dysfunction can be due to psychogenic or organic causes, but more often to their combination, thus creating a vicious circle
Organic causes are:
Arterial hypertension, smoking atherosclerosis of the vessels, diabetic vasculopathy, post-traumatic damage to the vessels supplying the penis and cardiac problems. It is even considered that erectile dysfunction is a precursor symptom - that is, it appears earlier - of coronary heart disease and myocardial infarction. Erection is the barometer of heart health. The erection. should not only be treated as a quality of life problem for patients, but also as a risk factor for cardiovascular disease
Penile function is controlled by the autonomic nervous system. Any cause, disease or medication that compromises the functioning of this system is likely to lead to erectile dysfunction. Such causes can be multiple sclerosis, Parkinson's disease, Alzheimer's, diabetic neuropathy, spinal injuries e.g. from traffic accidents and the use of neuroleptic drugs – anxiolytics, tranquilizers, hypnotics.
The entire sexual cycle - desire, arousal, erection, ejaculation, orgasm - are under the absolute control of sex hormones. Testosterone and prolactin, directly and indirectly thyroid hormones, play an important role in erectile function. Whether they are due to a malfunction of the corresponding organs, i.e. the testicles and the thyroid gland, or to a central disturbance in their production - at the level of the pituitary gland - or to the gradual decrease in testosterone levels with increasing age (andropause), the decrease in testosterone is very likely to lead to disorders of erection, desire (libido), ejaculation, orgasm, fertility and systemic metabolic disorders.
This specific systemic disorder of the body is characterized by disorders of cholesterol, lipids and glucose metabolism (diabetes mellitus, hypertension and abdominal obesity). The metabolic syndrome is one of the most important risk factors for the occurrence of erectile dysfunction in the modern man, as it is disease of the western lifestyle e.g. sedentary life and lack of exercise. Studies prove that a central role in the development of metabolic syndrome is played by the lack of testosterone.
• Antihypertensives (thiazide diuretics, β-blockers, etc.)
• Antiandrogens (GnRH agonists and antagonists)
• Drugs (alcohol, heroin, cocaine, marijuana, methadone)
• Anabolic steroids
Many surgeries - several of them are very common - are likely to lead to erectile dysfunction, often irreversible, without taking even preventative therapeutic protocols. Radical prostatectomy – the removal of the prostate for cancer – pelvic surgeries – for colon cancer – have a strong chance of erectile dysfunction.
Special mention should be made of the relationship between erectile dysfunction and diabetes mellitus. It should be clear, however, that it is not necessary for a man with diabetes to also experience erectile dysfunction. This depends on the level of diabetes control, the presence of other health problems, the type of drugs he uses and the presence of sexual desire. It is true that diabetes mellitus can potentially cause damage to the vessels and nerves of the penis, testosterone disorders, disorders in the anatomy of the penis (peyronie's disease) but also intense psychological burden due to chronic illness.
Psychogenic causes are more common in young men and are due to performance anxiety, a romantic disappointment or the loss of a loved one, but also as a secondary consequence of organic erectile dysfunction at older ages. There are many psychological mechanisms that worsen erectile function, such as the reduction of sexual desire, stress (work, social, failure in the sexual act), phobias, obsessions or even specific psychiatric diseases, such as depression and personality disorders.
How is the cause diagnosed?
The causal relationship of erectile dysfunction with the early diagnosis of diseases such as coronary heart disease and diabetes, as well as the multitude of factors to which it may be due, makes a diagnostic test necessary to clearly identify the cause and the severity of erectile dysfunction.
Basic diagnostic testing includes:
- General medical and sexual history. Timing of the onset of the problem, exact determination of the extent, psychosocial history, presence of morning erections.
- Clinical examination especially of external genitalia, breasts and prostate and gross neurological examination.
- Laboratory tests: The basic laboratory test consists of a general blood test and biochemical tests that measure sugar and lipids (cholesterol, triglycerides), as well as a hormonal test that measures testosterone (in a morning sample).
- Pressure measurement
- Cardiological examination, heart echo
- Special endocrinological testing based on indications
What are the current treatments?
The treatment of erectile dysfunction is a matter for the specialist. And when we refer to the term treatment, we mean the improvement of his erection as much as possible with proper information about the treatment and respect for the man's expectations and wishes. There are many therapeutic solutions and the choice should always be made in collaboration with the andrologist and the man, so that he knows what to expect from each treatment and no additional stress is added in relation to the result.