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There are many underlying physical and psychological
causes of erectile dysfunction. Reduced blood flow to the penis
and nerve damage are the most common physical causes. Underlying
conditions associated with erectile dysfunction include the
following:
Vascular Disease
- Arteriosclerosis, the hardening and narrowing of the
arteries, causes a reduction in blood flow throughout the
body and can lead to impotence. It is associated with age
and accounts for 50% to 60% of impotence in men over 60.
Risk factors for arteriosclerosis include:
Diabetes mellitus
- High blood pressure
- High cholesterol
- Smoking, which can lead to any of the above risk
factors, is perhaps the most significant risk factor for
impotence related to arteriosclerosis. Diabetes Mellitus
Chronic high levels of blood sugar associated with
diabetes mellitus often damage small blood vessels and
nerves throughout the body, which can impair nerve
impulses and blood flow necessary for erection. About 60%
of men with diabetes experience impotence.
Drugs
- Over 200 commonly prescribed drugs are known to
cause or contribute to impotence, including drugs for
high blood pressure, heart medications, antidepressants,
tranquilizers, and sedatives. A number of
over-the-counter medications also can lead to impotence.
Long-term use of alcohol and illicit drugs may affect
the vascular and nervous systems and are associated with
erectile dysfunction.
Hormone Disorders
- Hormone disorders account for fewer than 5% of
cases of impotence. Testosterone deficiency, which
occurs rarely, can result in a loss of libido (sexual
desire) and loss of erection. Among other conditions,
an excess of the hormone prolactin, caused by
pituitary gland tumor, reduces levels of testosterone.
Hormone imbalances can also result from kidney or
liver disease.
Neurologic Conditions
- Spinal cord and brain injuries (e.g.,
paraplegia, stroke) can cause impotence when they
interrupt the transfer of nerve impulses from the
brain to the penis. Other nerve disorders, such as
multiple sclerosis, Parkinson's disease, and
Alzheimer's disease, may also result in impotence.
Pelvic Trauma, Surgery, Radiation Therapy
- Trauma to the pelvic region or spinal cord can
damage veins and nerves needed for erection.
Surgery of the colon, prostate, bladder, or rectum
may damage the nerves and blood vessels involved
in erection. Prostate and bladder cancer surgery
often require removing tissue and nerves
surrounding a tumor, which increases the risk for
impotence.
- New nerve-sparing techniques aimed at lowering
the incidence of impotence to 40% to 60% are now
being developed and used in these surgeries.
Temporary impotence is also associated with these
procedures, even those in which nerve-sparing
techniques were used. It can take as long as 6 to
18 months for full erections to return.
- Radical cystectomy (for bladder cancer) and
prostatectomy (for prostate cancer) require
cutting or removing nerves that control penile
blood flow. These nerves do not control sensation
in the penis and are not responsible for orgasms;
only erection is affected by these procedures.
- Radiation therapy for prostate or bladder
cancer also can permanently damage these nerves.
Peyronie's Disease
- Peyronie's disease is a rare inflammatory
condition that causes scarring of erectile
tissue. Scarring produces curvature of the penis
that can interfere with sexual function and
cause painful erections.
Venous Leak
- If the veins in the penis cannot prevent
blood from leaving the penis during erection,
erection cannot be maintained. Venous leak can
be a result of injury, disease, or damage to
the veins in the penis.
Psychological Conditions
- Depression, guilt, worry, stress, and
anxiety all contribute to loss of libido and
erectile dysfunction. If a man experiences
loss of erection, he may worry that it will
happen again. This can produce anxiety
associated with performance and may lead to
chronic problems during sex. If the cycle is
inescapable, it can result in impotence.
Psychological factors in impotence are often
secondary to physical causes, and they
magnify their significance.
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