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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 leads 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.
In some cases, the breakdown or damage in the
sequence of events affects the arteries, muscles and surrounding tissues of the
penis. 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 that affect hormones, circulation, nerve
function and energy level. These changes can lower libido (sex drive) or
sexual ability. Drugs used to treat kidney disease may also cause ED.
- Neurological (nerve and brain)
diseases: The nervous system plays a vital part in achieving and
maintaining an erection. It is common for men with conditions 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, restrict blood flow to the heart, the brain and--in the case
of ED-- to 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. Some of these surgeries result in only temporary problems
(lasting 6-18 months), while others result in permanent damage to nerves
and tissue.
- 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 cases of 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.
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