What causes erectile dysfunction (ED)?

Updated: Aug 08, 2018
  • Author: Edward David Kim, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

ED usually has a multifactorial etiology. Organic, physiologic, endocrine, and psychogenic factors are involved in the ability to obtain and maintain erections. In general, ED is divided into 2 broad categories, organic and psychogenic. Although most ED was once attributed to psychological factors, pure psychogenic ED is in fact uncommon; however, many men with organic etiologies may also have an associated psychogenic component.

Conditions that may be associated with ED include diabetes, [25, 26, 27] hypertension, [28] , and CAD, as well as neurologic disorders, endocrinopathies, benign prostatic hyperplasia, [29] , sleep apnea [30] , COPD, [31] and depression (see Table 1 below). [32, 33, 34, 35] In fact, almost any disease may affect erectile function by altering the nervous, vascular, or hormonal systems. Various diseases may produce changes in the smooth muscle tissue of the corpora cavernosa or influence the patient’s psychological mood and behavior.

Table 1. Diseases and Conditions Associated With Erectile Dysfunction (Open Table in a new window)

Vascular causes

Atherosclerosis

Peripheral vascular disease

Myocardial infarction

Arterial hypertension

Vascular injury from radiation therapy

Vascular injury from prostate cancer treatment

Blood vessel and nerve trauma (eg, from long-distance bicycle riding)

Medications for treatment of vascular disease

Systemic diseases

Diabetes mellitus

Scleroderma

Renal failure

Liver cirrhosis

Idiopathic hemochromatosis

Cancer and cancer treatment

Dyslipidemia

Hypertension

Neurologic causes

Epilepsy

Stroke

Multiple sclerosis

Guillain-Barré syndrome

Alzheimer disease

Trauma

Respiratory disease

Chronic obstructive pulmonary disease

Sleep apnea

Endocrine conditions

Hyperthyroidism

Hypothyroidism

Hypogonadism

Diabetes

Penile conditions

Peyronie disease

Epispadias

Priapism

Psychiatric conditions

Depression

Widower syndrome

Performance anxiety

Posttraumatic stress disorder

Nutritional states

Malnutrition

Zinc deficiency

Hematologic diseases

Sickle cell anemia

Leukemias

Surgical procedures

Brain and spinal cord procedures

Retroperitoneal or pelvic lymph node dissection

Aortoiliac or aortofemoral bypass

Abdominal perineal resection

Proctocolectomy

Transurethral resection of the prostate

Radical prostatectomy

Cryosurgery of the prostate

Cystectomy

Medications

Antihypertensives

Antidepressants

Antipsychotics

Antiulcer agents (eg, cimetidine)

5-Alpha reductase inhibitors (eg, finasteride and dutasteride)

Cholesterol-lowering agents

Methadone

Conditions associated with reduced nerve and endothelium function (eg, aging, hypertension, smoking, hypercholesterolemia, and diabetes) alter the balance between contraction and relaxation factors (see Pathophysiology). These conditions cause circulatory and structural changes in penile tissues, resulting in arterial insufficiency and defective smooth muscle relaxation. In some patients, sexual dysfunction may be the presenting symptom of these disorders.

Given the multiplicity of possible etiologic factors, it may be difficult to determine how much any given factor is contributing to the problem. A thorough evaluation is necessary for correct identification of the specific cause or causes in any given individual.


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