90 percent of all erectile dysfunction is organic

Many fairy tales circulate around the causes of erectile dysfunction. The most famous one: Erectile dysfunction would usually have psychological causes. The truth is: Studies demonstrate that up to 90 percent of all erectile dysfunction can be explained by organic causes. These causes, however, may be very diverse.

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Study:  Erectile dysfunction as early warning signs for arteriosclerosis (PDF)
Advanced training:  Erectile dysfunction as a marker for arteriosclerosis (PDF)

Current study: Erectile dysfunction as an early warning sign

Erectile dysfunction is often an early warning sign of diseases of the blood vessels. This has also been shown by a recent study (December 2019) of the Institute for Erectile Dysfunction. In 4 out of 10 cases Prof. Dr. Nicolas Diehm and colleagues discovered by means of computed tomographic angiography (CTA) for the diagnosis of erectile dysfunction previously undiagnosed findings that required further clarification or treatment. In 37.5 percent of the cases (85 out of 200 men) this was arterial calcification (arteriosclerosis). In 8 men (4.25 percent) bulgings of the abdominal artery (aorto-iliac aneurysms) were detected, in one case vascular occlusion (embolism). Fatty liver (hepatic steatosis), intestinal bulgings (intestinal diverticulosis) and prostate hyperplasia were further incidental findings.

For the study published in Swiss Medical Weekly in December 2019, experts analyzed the data of 200 men who had undergone a CTA to clarify erectile dysfunction.  The average age of the men was a good 60 years (+/- 12 years). In 90 percent of the men (181 out of 200) circulatory disorders of the erectile arteries could be diagnosed as the cause of erectile dysfunction.  

Study as PDF:  Incidental findings during computed tomographic angiography diagnostic work-up in patients with arteriogenic erectile dysfunction

Erectile dysfunction as sentinel disease

Another work also assesses erectile dysfunction as an important early marker for previously undetected diseases. Dr. Vignes Mohan (Max Grundig Klinik Brühl) and Prof. Dr. Nicolas Diehm designate erectile dysfunction as sentinel-disease in CARDIOVASC 2019/19. This is what medical practitioners call diseases that indicate possible further diseases. For example, 70 percent of all men with proven coronary heart disease (CHD) report that they also experienced erectile dysfunction long before the diagnosis.

Furthermore, erectile dysfunction is anything but a lifestyle disease, write Mohan and Diehm. Rather, it is a medically highly relevant problem in middle-aged men that often shows relevant comorbidities and can serve as a very important marker symptom for arteriosclerosis.

PDF download:  Erectile dysfunction as a marker for arteriosclerosis

Circulatory disorders as the most common cause for erectile dysfunction

A harden penis is a penis full of blood. This being the case, it is easy to understand that the majority of all erectile dysfunctions are the result of circulatory disorders. In almost half of the cases, it is arterial obstruction caused by arteriosclerosis (arterial calcification). If the arteries supplying the penis are constricted by plaques, not enough blood reaches the cavernous bodies - and the erection is not or only insufficiently achieved.

Diabetes damages blood vessels and nerves

Another 30 percent of erectile problems are a result of diabetes. There are two main reasons for this. Firstly, high blood glucose levels damage the blood vessels in the long term and thus impair blood flow. Secondly, poorly treated diabetes is accompanied by a progressive loss of fine nerve fibers. Thus the smooth muscles in the blood vessels are less headed for and the sensitivity of the penis is reduced. Medical practitioners speak of diabetic neuropathy.


Causes of erectile dysfunction

Erectile dysfunction due to medication

Medication can also cause erectile dysfunction. This holds especially true for psychologically effective drugs. Loss of libido and erectile problems are frequent side effects of most antidepressants or neuroleptics. This also applies to some antiepileptics such as carbamazepine and phenytoin as well as antiandrogens such as Androcur and Finasteride. Strong analgesics such as morphine or fentanyl as well as drugs against prostate hyperplasia or bladder weakness also interfere with erectility. Overall, drug-induced erectile dysfunction accounts for about 15 percent of all cases.

Antihypertensive drugs and erection

Not all antihypertensive drugs such beta blockers, diuretics or ACE inhibitors have a negative effect on erection. The side effects on the penis and cavernous bodies vary from active ingredient to active ingredient. For example, the beta blocker bisoprolol is less suitable for erectile dysfunction. Nebivolol, on the other hand, even had positive effects on erectility. Likewise the ACE inhibitor Ramipril is said to promote the erectile function. Therefore, the choice of these drugs should always be made individually. Nevertheless, hypertension is one of the most important risk factors for erectile dysfunction. Because persistently high blood pressure damages the blood vessels.


Impotence as a result of disease or surgery

The erection process is mainly controlled by the brain and nerves. Therefore, diseases or injuries of the brain and nerves are another major cause for erectile dysfunction. These include, for example, many paraplegia or other injuries to the nerve tracts in the spinal cord, including by herniated disks.

Injuries to the brain (craniocerebral trauma), brain tumors or strokes are another cause. In addition, diseases affecting the brain such as dementia, epilepsy or Parkinson's disease. The pathological degradation of the nerve tracts in multiple sclerosis also often leads to erectile problems. However, not only diseases of the brain and nerves are possible organic causes of erectile dysfunction. Thyroid dysfunction or overproduction of the hormone prolactin can also be the reason for an erectile dysfunction.

Serious diseases

Cancer (in particular with chemotherapy or/and radiation) and heart attack as well as an impaired function of kidneys or liver are further possible cause of impotence. In case of serious diseases, however, it is not always possible to precisely separate whether the disease itself or, for example, the drug therapy induced the erectile problems.

Surgeries and injuries

Erectile dysfunctions are also typical side effects or consequences of surgeries in the area of the pelvis or prostate gland. During these interventions, for example, nerve tracts are occasionally damaged that are indispensable for an erection.


Testosterone deficiency (hypogonadism)

There is no doubt that the male sex hormone testosterone has an influence on erection. However, the exact effect on erectile dysfunction has not been conclusively clarified. Experts have long assumed that a reduced testosterone level hardly matters. However, recent studies suggest that testosterone deficiency could play a significantly greater role in the hormonal dysfunction called hypogonadism. Testosterone deficiency with men under 50 arises from pathologically disturbed hormone production in the germ cells (primary hypogonadism) or more rarely in the pituitary gland (secondary hypogonadism). Men over the age of 50 go through climacteric sooner or later. With them, testosterone production decreases due to aging. One then speaks of the partial androgen deficiency of the older man (PADAM). In these cases, a therapy with testogel / nebido (testosterone substitution) can be taken into consideration.


Impotence and psyche

There is no doubt that male potency is also a question of the psyche. Stress, quarrels, crises or traumatic experiences are occasionally expressed through no desire or temporary impotence. If the strain persists, it can develop a momentum of its own. Therefore, a small part of the erectile dysfunction requiring treatment can be traced back to psychological causes.


Behavioral causes

Finally, it is also the behavior that can cause an erectile dysfunction. Smoking (drugs/smoking pot), lack of exercise and a high-fat diet are particularly harmful to the cardiovascular system. Among other things, they promote hypertension and arteriosclerosis - and hence two of the most significant risk factors of circulatory disorders. In addition, alcoholics as well as men with high alcohol consumption suffer above average from erectile dysfunction.


It all depends on the diagnosis

You can see: There are many causes for erectile dysfunction. And even the causes listed here are not complete. For the best possible treatment the diagnosis is of decisive importance. Only if the cause is correctly identified, the respective therapy can be initiated. At the institute for erectile dysfunction you are in the best hands from the very beginning - for a reliable diagnosis with the best possible chances of success in treatment.

Your partner for the therapy of erectile dysfunction

Six questions for Dr. Diehm:

Prof. Dr. Diehm answers eight frequently asked questions about erectile dysfunction (German)

Do you have any questions?

At the Institute for Erectile Dysfunction you find qualified dialog partners for all questions on erectile dysfunction. If you have any questions or would like to make a consultation appointment: Call us:
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