What causes erectile dysfunction (impotence)?
Impotence (erectile dysfunction) is not a disease, but a secondary condition brought on by other, primary causes. It is a side effect, a symptom of something else. Thirty years ago, when men went to their doctors asking for help for erectile problems, they were told that there was no treatment because it was caused by aging, or it was all in their heads (psychological). A generation of research has been conducted in the intervening years.
Since an erection requires a sequence of events, impotence can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area of the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.
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Damage to arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of erectile dysfunction. Diseases--including diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, and vascular disease--account for about 70 percent of cases of impotence. Between 35 and 50 percent of men with diabetes experience impotence.
Surgery (for example, prostate surgery) can injure nerves and arteries near the penis, causing impotence. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to impotence by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa. Also, many common medicines produce impotence as a side effect. These include high blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug). Experts believe that psychological factors cause 10 to 20 percent of cases of impotence. These factors include stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure. Such factors are broadly associated with more than 80 percent of cases of impotence, usually as secondary reactions to underlying physical causes.
Other possible causes of impotence (erectile dysfunction) are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as insufficient testosterone.
The four main causes of impotence include:
Physical illness - there are many diseases that interfere with functioning of the penis by either reducing blood flow or affecting the nerves. Some of these diseases include heart and blood vessel diseases, diabetes, multiple sclerosis and alcoholism. When the impotence is caused by a physical illness it usually develops slowly. Most causes of impotence are physical. Some prescription drugs, like narcotics, sedatives and blood pressure medication can give you impotence as a side effect.
Psychological factors - a man's sexual drive or performance can be affected by stress, such as problems at work, relationship difficulties or financial worries. Psychiatric conditions and feeling depressed or anxious about poor sexual performance can also result in a failed erection. Only one in ten cases of impotence are caused by psychological factors.
A combination of physical illness and psychological factors - physical problems with maintaining an erection may cause the man to feel anxious about lovemaking, which makes the problem worse.
Unknown - in a few cases, neither physical nor psychological causes can explain the loss of sexual functioning.
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