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Physical Causes of Erectile Dysfunction

The origins of erectile dysfunction are twofold: physical and psychological.

 Up to thirty years ago, psychological factors were thought to be most important. Sex therapists Masters and Johnson went so far as to claim that nine out of ten men with erectile dysfunction had a psychological problem.

For example, men with depression are very often impotent. But nowadays, we know that even though the psychological aspect is very important, a lot of men with erectile dysfunction have physical problems.

Of course, it isn't necessarily as simple as you might think to separate the two, because erectile dysfunction causes changes in a a man's emotional state: all of us who have found ourselves impotent on occasion will know the anxiety and depression this can produce.

 One can therefore legitimately ask whether stress, anxiety and depression cause erectile dysfunction or whether they are a result of it.

But in all cases, we should keep in mind the way in which erections develop so we can see how these basic principles may be affected by physical or psychological factors.

First, the erectile tissue may not fully fill with blood because arterial blood flow to the penis is partially impeded. This means a man will not get an erection.

On the other hand, when a man loses his erection before orgasm and ejaculation, he most likely has some problem in his venous occlusive mechanism: this is the system that keeps blood in the penis and thus holds his erection firm. A failure in either of these areas can cause erectile dysfunction.

Blood vessel abnormalities as a cause of erectile dysfunction

As we said above, if the arteries which carry blood to the penis are blocked or damaged, or if the veins which drain blood from the penis are damaged, a good erection may fail to develop, or be maintained, respectively.

Most often, a blockage of the arteries which carry blood to the penis is responsible: as little as fifteen percent blockage (occlusion) of these very small blood vessels can cause a problem with erectile dysfunction.

This blockage is often caused by risk factors like smoking cigarettes, high blood pressure, diabetes, and elevation of blood cholesterol levels. Injury caused by pelvic trauma or pelvic radiation therapy may also be responsible.

Most men with erectile dysfunction caused by a reduction in arterial blood flow will show other cardiovascular problems in the body. For even if they have not had a heart attack, impotent men often have a history of coronary artery disease, and some men with erectile dysfunction have poor blood circulation to their feet and legs, again as a result of arterial occlusive disease.

A past pelvic fracture which has blocked one of the arteries carrying blood to the penis may also cause erection problems: this is sometimes seen in young patients, in their twenties, who have undergone pelvic trauma or fracture.

And as is fairly well known, diabetic men may show erectile dysfunction as an effect of damage to the nerve and vascular supply to the penis.

Diabetic men, and some older men, have large amounts of scarring, or fibrosis, on the inside of the walls of the arteries which supply the blood to the penis. Scarring, caused by arterial plaque buildup, can reduce the internal diameter of the arteries.

Patients with high lipid levels in their bloodstream are definitely at increased risk of arteriosclerosis, because the excess lipid builds up in the internal walls of the arteries and eventually leads to a blockage.

Hypertension - high blood pressure - is yet another risk factor. It's no surprise, therefore, that almost half of one series of impotent men who were the subject of a research study had hypertension. But it's not the increase in circulating blood pressure itself that is the cause of erectile dysfunction; in fact, it's the arterial stenosis found in men with high blood pressure that is most likely to be the origin of their erectile dysfunction.

As we said above, failure of the mechanism that closes the veins that allow blood to drain from the penis is one of the more common causes of vasculogenic erectile dysfunction. In some men, the the veins are never fully clamped as the arterial blood flows into the penis early in the erection - though this is mostly a problem for older men, it may be seen in relatively young men who have had erection problems through their entire life.

These men tend to report that a normal erection begins to develop, but after seconds of sexual activity (at most, a minute or so), they will lose their erection. Surgery may be one answer for this kind of problem.

Peyronie's disease is characterized by non-elastic scar tissue forming on the inner surfaces of the tunica albuginea, which in turn prevents adequate compression of the veins under the tunical surface. This means the arterial blood is not held within the penis in the normal way.

In an anxious man, the trabecular smooth muscle of the penis and the vascular spaces of the penis may not relax sufficiently to allow adequate sinusoidal expansion, in which case the subtunical veins will not become compressed sufficiently to maintain an erection. This may happen when a man is overanxious.

In effect, his adrenalin impairs relaxation of the smooth muscle of his penis in response to the stimulation of nitric oxide. (This is explained in more detail here.)

Interestingly, smoking cigarettes, apart from causing widespread arterial blockage, may also prevent the cavernous smooth muscle from dilating enough. Once more, there is not enough clamping of the penile veins to permit the increase in intracavernous arterial pressure which is required for an erection.

Checklist to determine the causes of erectile dysfunction

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Other pages on this website about the causes of erectile dysfunction and impotence

Home ] Introduction to ED ] Beliefs which cause erection problems ] Background information on ED ] Background information on erectile dysfunction ED ] [ Physical causes of ED ] Personality and relationship issues as a cause of erectile dysfunction (ED) ] Endocrinological causes of ED ] Vascular disease and ED ] What's causing your erection problems? ] Emotional & psychological problems in ED ] More on causes of ED ] Sleep apnea and erectile dysfunction ] How to control the risk of ED ] Lack of arousal and ED ]

Other sections on erectile dysfunction

Home ] Diagnosis of Erectile Dysfunction ] The Causes of Erectile Dysfunction ] Effects of Erectile Dysfunction On Men and Their Partners ] Treatment for Erectile Dysfunction ]