Sexual satisfaction is among the most important ingredients that maintain happiness in a couple and fulfill a relationship.
However, many men seem to face throughout their lives the failure to obtain an acceptable erection to initiate a sexual act. Although most cases of erectile dysfunction occur after the age of 40, these problems do not bypass teenagers or young men.
Causes of Erectile Dysfunction
About erectile dysfunction
Erectile dysfunction means the constant or repeated inability to obtain and/or maintain the erection necessary to allow sexual intercourse. Statistics show that 1 in 3 men over the age of 40 face this problem and one in 10 adult men will suffer from long-term erectile dysfunction.
Any man can occasionally face erectile dysfunction that can occur for several reasons, such as high alcohol consumption, stress, relationship problems or extreme fatigue. But when these are constantly repeated and last more than 3 months, it may be erectile dysfunction.
Specifically, failure to achieve an erection in less than 20% of your sexual encounters is not unusual and usually does not require treatment. However, the failure to achieve an erection in more than 50% of the attempts to maintain a sexual act implies the existence of an associated medical problem that requires treatment.
Contrary to popular belief, erectile dysfunction is not an inevitable attribute of aging. It may be true that some older men may need more stimulation, but they can get an erection and enjoy intercourse. Erectile dysfunction, considered by many as the end of sexual life or equated with impotence, is no longer an insurmountable and definitive problem for doctors.
About erection
The mechanism of erection is not only related to desire, but mainly to sexual stimuli and the general state of health of the man, more precisely to the functioning of the nervous system (which transmits the signals of excitement) and circulatory system (ensures vascularization at the level of the penis), but also to other factors.
The penis consists of two sponge-like formations of erectile tissue, spread over the entire length of the organ, called corpora cavernosa, which contain a labyrinth of blood vessels in the form of cavernous spaces (like a sponge). These arterial spaces will accumulate the largest amount of blood from the penis during erection.
The urethra is a common channel for urine and spermatozoa, it passes along the posterior part of the corpora cavernosa. It is surrounded by an erectile tissue, called the corpus spongiosum, which contains two main arteries, vessels and nerves and has the role of protecting the urethra during erection.
An erection begins with sensory and mental stimulation. During sexual arousal, nerve messages cause stimulation of the penis and relaxation of the muscles of the corpora cavernosa, allowing blood to fill the open arterial spaces, which will create pressure in these cavernous structures, the penis enlarges, and an erection is caused. The tunica albuginea (membrane that surrounds the corpora cavernosa), helps these formations capture blood, supporting the erection. The erection is reversed when the muscles of the penis contract, stopping the flow of blood and opening the exit channels.
Causes of Erectile Dysfunction
Male sexual arousal is a complex process, involving hormones, brain, emotions, nerves, muscles and blood vessels. Any problem at their level can be related to the appearance of sexual dysfunctions and impotence.
At the origin of sexual dysfunctions can be found physiological, and psychological problems or it can be a combination of them.
The major organic causes are physiological (organic):
- Vascular disorders
- Neurological disorders
- Other causes (endocrine, traumatic, anatomical, surgical, oncological, iatrogenic)
- Erectile dysfunctions are most frequently determined by atherosclerosis or diabetes
Atherosclerosis of the cavernous arteries of the penis is often caused by smoking, hypercholesterolemia, hypertension, endothelial dysfunction, and diabetes. Atherosclerosis and aging decrease the dilation capacity of arterial blood vessels, limiting the amount of blood that can enter the penis.
Arterial hypertension contributes to the occurrence of ED, even in the absence of atherosclerosis. In patients with a high level of cholesterol, greater than 240 mg/ml, there is an increased risk of developing ED, 80% more frequently, than in healthy ones.
Endothelial dysfunction is damage to the inner lining that covers the small arterioles. The disorder reduces the capacity for vasodilation when needed to increase blood flow and is mediated by reduced levels of nitric oxide. Smoking, diabetes, and/or low testosterone levels are associated with endothelial dysfunction.
Veno-occlusive dysfunction allows venous leakage, which decreases the amount of blood in the corpora cavernosa and leads to the inability to maintain an erection.
Priapism, usually associated with trazodone consumption, cocaine abuse and sickle cell anemia, can cause penile fibrosis and lead to ED because it causes fibrosis of the corpora cavernosa and, therefore, impairment of penile blood flow necessary for erection.
Neurological causes include:
- stroke
- complex seizures
- multiple sclerosis, Parkinson’s disease
- peripheral neuropathies (diabetic neuropathy, especially frequent) and autonomic
- spinal cord injuries
- Complications of pelvic surgery (eg, radical prostatectomy, radical cystectomy, rectal cancer surgery) are other common causes
Traumatic causes: Prolonged perineal pressure (as happens while riding a bicycle) or pelvic or perineal trauma can cause ED.
Other causes include hormonal disorders, ingestion of certain medications, pelvic radiation, and structural disorders of the penis (eg, Peyronie’s disease).
Testosterone deficiency (hypogonadism) can decrease libido and cause erectile dysfunction.
The consumption of certain substances or certain medications causes erectile dysfunction
Alcohol and cocaine can cause temporary erectile dysfunction.
Antihypertensives: Beta-blockers, clonidine, spironolactone, thiazide diuretics.
Medicines for the central nervous system: anxiolytics, monoamine oxidase inhibitors, opioids, selective serotonin reuptake inhibitors, tricyclic antidepressants.
Other drugs that decrease erection: Amphetamines, 5-alpha-reductase inhibitors, antiandrogens, chemotherapy for cancer, anticholinergics, cimetidine, estrogens, agonists and antagonists of the luteinizing hormone.
Psychological factors, whether primary or reactive, must be considered in every case of ED. Psychological causes can include guilt, fear of intimacy, depression, stress or anxiety. Psychogenic erectile dysfunction can be situational, involving a certain place, time or partner.
Risk factors:
- Age over 50 years
- High blood sugar
- Hypertension
- High cholesterol
- Excessive smoking
- Drug or alcohol user
- Obesity
- Lack of exercise
- Relational conflicts
- Stress at home or at work
- Stress due to social, cultural or religious conflicts
- Worries about sexual performance
Types of erectile dysfunction
Types of erectile dysfunction can be primary, appearing at the beginning of sexual life and secondary, appearing after a period of sexual activity without problems.
Erectile dysfunction can occur in adult men, in principle at any age, regardless of social status, sexual experience or marital status. However, there are significant differences between the erectile dysfunction of young adults and those of an advanced age.
Psychogenic erectile dysfunction usually occurs in young people and is conditioned by the presence of anxiety and phobias. In elderly men, erectile dysfunction occurs against the background of organic, cardiovascular, endocrine, and urological diseases and can be both a complication and an early manifestation of them. If erectile dysfunction is not treated in time and correctly, one clinical form will be associated with another and mixed erectile dysfunction will appear, often much more difficult to treat.
Situational erectile dysfunction, dependent on the current psycho-emotional state of the man or the couple or other exogenous factors, does not constitute a medical condition and does not require treatment.
Prevention
A healthy lifestyle and treatment of health problems are the main preventive measures of sexual dysfunctions. In this sense, it is recommended:
- Treatment of chronic diseases
- Routine medical checks
- Quitting smoking, limiting alcohol consumption
- Frequent physical activity
- Stress reduction
- Specialized help in case of disorders such as anxiety or depression
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