Erectile Dysfunction is one of the most common conditions in men above 40. Approximately 100 million men worldwide suffer from ED.

Male sexual dysfunction can present in different ways—the most common manifestations are as follows:

  • erectile impotence: inability to sustain an erection;
  • inhibited male orgasm (ejaculatory impotence): inability to achieve orgasm inside the woman’s vagina, although he may achieve orgasm via other methods;
  • premature ejaculation: ejaculation occurs before or immediately after entering the vagina.

Usually, erectile dysfunction (ED) is defined as a persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance that often lasts for more than 6 months.

It’s important to note that even if a man can achieve an erection in private, he can still not use it for satisfactory sexual activity that is defined as ED. Many men may be able to get an erection without a partner present, but if a man cannot use the erection for a sexual activity he is defined as having ED.

A man must not be able to achieve an erection rigid enough for sexual activity on several accounts (defined as long as 6 months by the NIH), not just one time, in order to have the definition of ED.

The ability to treat a patient for ED revolves around a man’s inability to have enjoyable and satisfactory (per his account) sexual activity. The principles of ED treatment are:

  • restoring sexual enjoyment;
  • enhancing sexual function;
  • optimizing Quality of Life for both a man and his partner;
  • improving personal relationships.

What are the causes of ED?

The most common causes of erectile dysfunction are:

  • hypertension;
  • cardiovascular disease;
  • dyslipidemia;
  • diabetes mellitus;
  • lifestyle factors (lack of exercise, poor nutrition, etc.);
  • alcohol use;
  • obesity;
  • physical inactivity;
  • smoking;
  • low-testosterone levels.

What are the different types of ED?

While there are a variety of conditions that cause ED, each condition affects the body differently (pathophysiology). It is important not only to define the cause of ED but also to identify the underlying pathophysiology.

There are several underlying mechanisms that cause ED. They are:

  • psychogenic ED;
  • neurogenic ED;
  • vasculogenic ED;
  • Iatrogenic ED.

Endocrine Causes:

  • low-T;
  • elevated Estrogen levels;
  • elevated SHBG.

Psychogenic ED

Psychogenic ED is a non-organic mechanism that makes it difficult to achieve an erection. Psychogenic ED is a type of performance anxiety, adrenaline mediated response.

A man can get overly nervous, anxious, or frightened during sex and not perform well during sexual activity. The surge of noradrenaline (a sympathetic hormone) activates the “fight or flight” response and arousal can be lost.

Medical conditions such as anxiety, depression, and stress accompany psychogenic ED. Treatment revolves around reducing performance anxiety.

Neurogenic ED

Neurogenic erectile dysfunction is caused by a condition that affects nerve signaling to the corpora cavernosa. This can be secondary to spinal trauma, diabetes, lumbar disc disease, brain injury, radical pelvic surgery (radical prostatectomy). Typically, sacral lesions or neurologic insults in this area of the spinal cord result in ED.

Nerve injury or reduced nerve function results in reduced Nitric Oxide (NO) release available to the smooth muscle of the penis. Lack of (NO) causes reduction and loss of smooth muscle cells in the penis and increased fibrosis in the penis causing venous leak resulting in ED.

Treatments revolve around penile rehab and daily PDE5 inhibitors to improve penile blood flow. Patients with neurogenic ED can be ultra-sensitive to oral ED meds such as Viagra or Cialis or penile injections like Trimix.

Vasculogenic ED

An erection is a vascular phenomenon. In order for a man to achieve an erection, blood vessels and penile corpora cavernosa muscle must dilate to accommodate increased blood flow. Vasculogenic erectile dysfunction is a direct result of arterial insufficiency and/or arterial stenosis.

Medical conditions such as obesity, hypertension, high cholesterol, diabetes can cause atherosclerosis, narrowing blood vessels, and causing decreased blood vessel wall elasticity. In combination, these vascular changes reduce the ability of the penis to fill with blood during arousal lending to decreased rigidity, length, and ultimately ED.

Endocrine Causes

It is well known that androgens, primarily testosterone, play a major role in penile development, physiology, and health. Men with low testosterone levels can have erectile dysfunction.

Androgen receptors in the corpora cavernosa (penile tissue) play an integral role in the erectile pathway. Androgens also are key to arousal and sexual desire which are integral to the erectile response to erotic stimuli.

Several clinical studies have shown that castration in animals reduces androgen and testosterone levels, decreasing intracavernosal pressures. This low-pressure profile within the penile tissue is a direct result of reduced arterial inflow and altered venous occlusion necessary for an erection to occur.

Hormone replacement therapy is provided by our clinic as a part of erectile dysfunction treatment among other available procedures. If you need to learn more, please contact us today by filling out this contact form.