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Erectile Dysfunction
Physical Causes of Erectile Dysfunction
The process
of achieving an erection is complex and problems may occur
for a variety of reasons. These problems can be psychological,
physical, or a combination of the two.
Physical
causes of ED are related to a breakdown or damage to the sequence
of events that lead to an erection. This sequence involves
nerve impulses in the brain, spine, and penis as well as the
subsequent response in the muscles, fibrous tissues, veins
and arteries in and near the corpora cavernosa.
Often
times the breakdown or damage in the sequence affects the
arteries, muscles, and surrounding tissues of the penis, and
this breakdown is most commonly the result of a disease. Diseases
that commonly cause ED include:
Diabetes:
Diabetes can cause nerve and artery damage that can make achieving
an erection difficult. Between 35% and 50% of men with diabetes
experience ED.
Kidney disease: Kidney disease can cause chemical changes
to occur in your body that affect hormones, circulation, nerve
function, and energy level. Often times these changes will
lower a person's libido (sex drive) or sexual ability. Drugs
used to treat kidney disease may also cause ED.
Neurological (nerve and brain) diseases: The nervous
system (the body's system of nerves) plays a vital part in
achieving and maintaining an erection and it is common for
men with diseases such as stroke, multiple sclerosis (MS),
Alzheimer's disease, Parkinson's disease and spinal cord injuries
to experience ED. This is due to an interruption in the transmission
of nerve impulses between the brain and the penis.
Vascular disease: Vascular diseases are those that
affect the blood vessels. These diseases include atherosclerosis
(hardening of the arteries), hypertension, and high cholesterol.
These diseases, which account for 70% of physical-related
causes of ED, all restrict blood flow to the heart, the brain
and, in the case of ED, the penis. Atherosclerosis alone accounts
for 50%-60% of ED cases in men over age 60.
Prostate cancer: Prostate cancer doesn't cause ED on
its own, but surgery to remove the cancer can lead to erectile
problems.
The physical causes of ED are not only disease-related. There
are many other potential causes, including:
Surgery:
Surgery performed to treat diseases such as prostate cancer
and bladder cancer often require the removal of nerves and
tissues around the affected area which can lead to ED. Some
of these surgeries result in only temporary problems (lasting
6-18 months) while others result in permanent damage to the
nerves and tissue around the penis and require treatment in
order for an erection to be achieved.
Injury: Injuries to the pelvis, bladder, spinal cord, and
penis that require surgery also commonly cause ED.
Hormonal imbalances: Hormonal causes of ED account
for only 5% of all people diagnosed with ED. Imbalances of
hormones, such as thyroid, prolactin and testosterone, can
affect a man's response to sexual stimulation. These imbalances
can be the result of a tumor on the pituitary gland, kidney
disease, or liver disease.
Venous leak: If the veins in the penis cannot prevent blood
from leaving the penis during an erection, an erection cannot
be maintained. This is known as a venous leak, and can be
a result of injury or disease.
Tobacco, alcohol or drug use: All three of these substance
can damage a person's blood vessels and/or restrict blood
flow to the penis, causing ED. Smoking in particular plays
a large role in causing ED in people with arteriosclerosis.
Prescription drugs: There are over 200 types of prescription
drugs that may cause ED.
Reviewed
by the doctors at the Glickman Urological Institute at The
Cleveland Clinic.
Edited
by Charlotte Grayson, MD, WebMD, May 2004
Portions of this page © The Cleveland Clinic 2000-2004
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