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Common Causes of ED

What causes erectile dysfunction?

More than 90 percent of all ED can be traced to a physical (organic) cause. This cause is usually due to slow and steady decrease of blood flow to the penis, which eventually leads to inadequate and inefficient blood storage in the penis after it becomes erect. This is commonly referred as a venous leak. Most men with this condition will complain of an inability to maintain and erection. As the condition progresses, an erection will no longer be obtained as well and men may stop responding to medications such as Cialis, Levitra and Viagra.

Difficulty in getting or maintaining an erection is often a predictor of vascular problems elsewhere in the body, including heart disease. Other factors that can effect your erection include:

  • High cholesterol

  • Cigarette smoking (which constricts the blood vessels leading to the penis)

  • Excessive alcohol

  • Diabetes (as many as 60 percent of diabetic men have erection problems at some point)

  • Heart disease

  • Certain prescription drugs, particularly blood pressure and cardiovascular medications, as well as some tranquilizers and antidepressants

  • Radiation therapy to treat prostate or rectal cancer

  • Pelvic surgery (bladder, colon, rectal)

  • Spinal surgery

  • Radical prostate cancer surgery (60 percent of men, after all types of radical prostatectomy, have impotence)

  • Stroke or neurological disease, including Parkinson's, Alzheimer's, and multiple sclerosis

  • Trauma to the pelvic area from car or motorcycle accident

  • Hormone imbalance



Drug induced (medication)

Many prescription medications can cause problems with erections, but the ones that are the most commonly associated with this complaint are anti-hypertensive (blood pressure) medications, beta blockers, and anti-depressants. These cause ED by interfering with the nerve impulses or blood flow to the penis. Important: Medications should never be changed without your doctor's permission. Talk to your doctor about any concerns you have regarding the potential effects of medication on ED.


Alcoholism and Smoking

Alcoholism disrupts hormone levels and can lead to permanent nerve damage, causing impotence. Smoking may lead to vascular disease or other health problems, which may cause ED. Tobacco is a major cause of erectile dysfunction; in my practice, over 68% of all of my patients either smoke or have a history of tobacco smoking.


Peyronie's Disease (acquired penile curvature or bent penis)

Peyronie's disease is an inflammatory condition of unknown cause, and while typically affecting men in their 50's and 60's, is also seen in much younger men. Deformity or narrowing of the penile shaft is usually associated with this condition. In some circumstances, it can be subtle and will only be noted during an erection. Fibrosis/scarring of the penile tissue will cause erection problems by allowing blood to leak back into the circulation (venous leak).

Many patients report significant pain with an erection, which typically lasts for six to twelve months. Most treatments, including anti-inflammatory medication, Vitamin E, Verapamil, Colchicine, are unfortunately ineffective. For men also suffering from Erectile Dysfunction and Peyronie's Disease, insertion of the Internal Penile PumpTM is the best option. For most men, this should be considered early in order to prevent permanent penile shortening and deformity as well as to restore potency.


Physical or Nerve (neurologic) Trauma 

ED can result from physical or neurological trauma to the body. These include pelvic fracture, spinal cord injuries, brain injuries or tumors, stroke, birth defects or muscular diseases. Patients with neurological diseases such as those caused by diabetes, Parkinson's disease, Alzheimer's, brain tumors, lumbar disc herniation, multiple sclerosis can all have Erectile Dysfunction.


Psychological Problems

While most Erectile Dysfunction is physically caused, the psychological aspects are still present in many patients. It is normal for a man who suffers from erectile dysfunction to have a psychological reaction to a loss of a normal bodily function (erections). The primary problem, however, is physical, and for most men, restoring potency will do wonders for their psychological wellbeing.

Many men under stress may experience some performance anxiety and have unreliable erections on a temporary basis. If the condition persists, then the patient should be evaluated by an expert. Depression or anxiety disorders and the medications used to treat these conditions can also cause Erectile Dysfunction.


Priapism

If an erection lasts longer than four hours, it can cause tissue injury, which will result in ED. Causes of priapism include sickle cell anemia, injection therapy for ED that is improperly prescribed or used; illegal drug use or misuse of medications such as Viagra.


Effects of Aging

It is estimated that 65 percent of men over age 65 have some type of ED. Statistically, the number of men experiencing ED rises as their age increases. However, age alone does not cause ED. It is simply that older men are more likely to have the illnesses.


Hormonal Problems

This is a rare cause of erectile dysfunction. It is natural for a man's hormone level to decrease with age, and studies show that hormonal replacement is rarely successful. Certain diseases, such as kidney failure and liver disease can disrupt the balance of hormones, which control erections. Furthermore, hormonal replacement, more specifically testosterone, has a lot of side effects including stroke, sterility, prostate enlargement, and atrophy of the testicles. Low levels of testosterone can also be a factor.


Low Testosterone and Obesity

Testosterone is a hormone that is produced by the testes in males. It performs many physiological roles in the body, including maintenance of muscle strength and muscle mass, bone density, fat distribution, production of sperm, and regulating sex drive. Testosterone levels hit their highest level in adolescence and early adulthood, and most men have some decrease in their testosterone levels around age 40. For a majority of men, this middle-age drop does not cause any harmful effects. 

Obesity also plays a role metabolic syndrome in causing abnormalities in testosterone levels. Accumulation of fat around the waistline, also known as central obesity, ED, cardiovascular disease, diabetes and the metabolic syndrome share another feature in common: low male testosterone. As obesity increases, the levels of the active or free testosterone declines.