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.
Erectile dysfunction can be an early warning sign for serious diseases - from diabetes to lipid metabolic disorder to arteriosclerosis and circulatory disorder. Diagnosis and therapy of erectile problems are therefore not lifestyle medicine, but a useful medical service for health care.
Causes of 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Prof. Dr. Diehm answers eight frequently asked questions about erectile dysfunction (German)
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