Causes of ED
ED is a complex condition with multiple causes. The pathophysiology of ED involves a complex interplay of physiologic, psychological, and lifestyle factors that can interfere with the normal physiologic processes that result in an erection. Physiologically, an erection occurs when the spongy tissue in the penis fills with blood, causing it to become stiff and erect. This process is controlled by the nervous system and involves the release of nitric oxide, a chemical that relaxes the blood vessels in the penis and allows blood to flow into the penis.4,19–21
The most common causes of ED include vascular problems, such as atherosclerosis or hypertension; neurologic problems, such as nerve damage from diabetes or spinal cord injuries; hormonal imbalances, such as low testosterone levels; and psychological problems, such as stress or anxiety.4,19–21 Vascular issues can lead to ED by causing a decrease in blood flow to the penis, making it difficult to achieve or maintain an erection. Neurologic problems can cause ED by disrupting the nerve signals necessary for an erection. Hormonal imbalances can also cause ED by disrupting the balance of hormones essential for sexual function. Psychological problems can cause ED by causing anxiety disorders or stress, making it difficult to relax and become sexually aroused.
In most cases, ED is caused by a combination of factors. The underlying pathophysiology of ED involves the inability of the penile vessels to dilate and fill with blood to achieve and maintain an erection. This can be due to structural changes in the vessels, dysfunction of the smooth muscle cells, or a combination of both. Diagnosis of ED typically begins with a thorough history and physical examination and may include further testing such as blood tests, psychological evaluation, nocturnal tumescence, and rigidity testing.3,7,21–23
Often ED is accompanied by concomitant sexual disorders. Healthcare providers must be aware of these disorders and evaluate them with ED. Some of the most common sexual conditions that accompany ED include4,19–21
● Premature ejaculation: This is a condition in which a man ejaculates earlier than he or his partner would like. It can be a separate disorder or happen in conjunction with ED.
● Delayed ejaculation: This is a condition in which a man takes a longer time to ejaculate than he or his partner would like. It can be a separate disorder or happen in conjunction with ED.
● Low libido: Also known as hypoactive sexual desire disorder, a condition in which a man has reduced interest in sexual activity.
● Anorgasmia: This is the inability to achieve orgasm; it can be a separate disorder or happen in conjunction with ED.
● Peyronie’s disease: This is a condition in which scar tissue forms inside the penis, causing it to bend or curve during an erection.
● Male hypogonadism: This is a condition in which the body does not produce enough testosterone, which can lead to a decreased sex drive and ED.
Awareness by the health care provider of these potential underlying and concomitant health conditions contributing to or causing ED is essential in ensuring that the individual’s care is maximized through a holistic approach to their condition.
