Erectile Dysfunction: Information on Causes, Diagnosis & Treatments
- Obtaining Physical Erections
- Causes of Erectile Dysfunction
- Diagnosing ED
- Treating Erectile Dysfunction
Obtaining Physical Erections
The simplest way to understand what causes a man to experience erectile dysfunction is to understand how the body creates a physical erection. The muscles and arterial walls of the penis must become relaxed to allow blood flow into erection chambers. The cylinder-shaped spongy tissue becomes filled with blood which increases tissue pressure causing an erection. Venous loss of pressure where blood is lost by flowing backward is prevented by valves in the veins of the penis which creates hardness that will persist until ejaculation or manual/mental stimulation stops.
The process of filling the chambers with blood flow is produced by triggering hormones in the nervous system that become activated when the mind is stimulated through external touch or thoughts (brain signals). However, the process can stop or never start if the man's mind suppresses thoughts by his anxiety or stress levels.
Maintaining normal erectile function can be compromised by a variety of psychological factors required to create an erection. These include problems with hormones, nervous supply, and blood flow. These neurological and vascular problems could be the underlying cause of ED as could some associated diseases including diabetes or atherosclerosis.
Diabetic men with atherosclerosis who smoke often experience temporary or permanent erectile dysfunction because the arteries in the penis become clogged or narrowed. Many diabetics have extensive nerve damage (neuropathy) which affects the ability to obtain an erection. Other medical conditions associated with erectile dysfunction include multiple sclerosis, partial complex seizures (epilepsy), stroke, spinal cord injury, and non-diabetic neuropathy. Reducing any one of these risk factors could improve sexual function and orgasm completion.
Many men self-diagnose their erectile dysfunction condition when they are unable to obtain or maintain an erection. These men typically experience diminished sexual drive, failure of normal sexual function, difficulty in acquiring an erection, soft erections, or high levels of anxiety.
Causes of Erectile Dysfunction
The root cause of erectile dysfunction can be complicated and involve either psychosocial or medical problems, or both. The condition may be the result of problems occurring in social relationships including the inability to perform sexual intercourse. Medical conditions could directly affect the man's psychological well-being in that his sexual impotence causes increased anxiety and stress in an already stressful situation.Physical Causes
Any one of the medical conditions listed below could be the direct cause of erectile dysfunction. Addressing the underlying medical problems often results in sexual function difficulties. These physical causes include:
- Heart disease
- Blood vessel narrowing
- High blood pressure
- Parkinson's disease
- High cholesterol levels
- Multiple sclerosis
- Testosterone deficiency (hypogonadism)
- Thyroid conditions and other hormone disorders
- Spinal cord injuries
- Pelvic area injuries
- Surgical complications that might involve rectal cancer surgery, prostate surgical procedures including transurethral resection, cystectomy, and radical prostatectomy.
- Pelvic area radiation therapy
Primary erectile dysfunction is a condition that is almost always caused by psychological issues that could include:
- Severe anxiety
- Fear of intimacy
However, erectile dysfunction is not always a primary condition. Many secondary factors could cause significant problems when attempting to maintain an erection for sexual activity. Some of the major psychological causes that produce erectile dysfunction include:
- Miscommunicating with sexual partners
- Stress caused by emotional, financial, or work-related problems
- Anger and fear
- Anxiety and stress
- Performance anxiety
- Depression that leads to lower libido (minimal sexual drive)
- Mental health disorder
- Relationship issues
Determining whether a failure to perform a sexual activity is the result of erectile dysfunction typically requires a physical examination by a doctor and answers to multiple questions. The position may determine an underlying problem might be causing ED or some chronic health condition that requires consulting a specialist or further testing. The doctor will likely perform:
- A physical examination including examining the penis and testicles and performing nerve sensation tests.
- Blood tests – The doctor will likely take a blood sample to be analyzed under a microscope in a laboratory setting to look for indicators of low testosterone, diabetes, heart disease or other condition.
- Urinalysis (urine tests) – Examining a sample of urine in a laboratory setting can help determine if the patient is suffering from some underlying health condition including diabetes.
- Ultrasound – A specialist using a transducer (wand device) over veins supplying blood to the penis can help determine if the patient is suffering from blood flow problems.
- Psychological examination – The doctor will typically ask the patient questions to determine if psychological problems or depression is causing erectile dysfunction.
To determine if any psychological or medical problem is causing the erectile dysfunction, the doctor will ask a series of questions that could include:
- How long have you been experiencing the symptoms?
- Did your symptoms occur suddenly or gradually?
- Are you still experiencing early morning erections or late evening erections?
- Would you say that your erections are firm or soft?
- Is penetration during sexual intercourse difficult to achieve?
- Does the problem seem to be consistent, somewhat consistent, or all of the time?
- Do you experience erectile dysfunction when sexually active with different partners, during masturbation or oral stimulation?
- Do you have a problem with orgasms (climaxing), ejaculation, arousal, or libido (sexual desire)?
- Is your erectile dysfunction causing serious problems in your sexual confidence, sexual satisfaction, or sexual relationships?
- Do you have any underlying medical conditions?
- Are you currently taking medications, and if so, what are they?
- Do you take over-the-counter drugs, drink, or smoke?
- To determine if you have Peyronie's disease when the penis is erect, is it bent, curve, or painful?
- Do you have a medical history involving spinal cord, genital or pelvic trauma?
- Do you have any urinary issues?
- Have there been any recent changes in your relationship with your partner?
- Are you experiencing any recent changes in your sex life?
- Are any difficulties at work, with your relationships or home life causing stress in your life?
- Would you consider yourself depressed or are you suffering from a mental illness?
Depending on what is causing the patient's erectile dysfunction, doctors have numerous options for treating the condition. Providing the right treatment will ensure a healthy successful outcome to resolve erectile dysfunction. The physician typically explains the benefits versus the risks of every treatment and asks what preferences the patient has before recommending the best treatment. Some of these oral medication options include:
- Sildenafil (Viagra, Revatio)
- Avanafil (Stendra)
- Vardenafil (Staxyn, Levitra)
- Tadakafuk (Adcirca, Cialis)
These medications are effective because they maximize the benefits of nitric oxide, the body's natural chemical that relaxes muscles in the penis to help create an erection. In addition, to increase levels of nitric oxide, the body also responds by increasing blood flow when the man is sexually stimulated.