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Erectile dysfunction

Erectile dysfunction

Erectile dysfunction (ED) is a medical term that describes the inability to achieve and or maintain an erect penis. It is estimated that between 15 and 30 million American men suffer from ED. Most men have difficulty with erections from time to time, yet for some men, it is a regular and more severe problem.  It can cause low self-esteem, performance anxiety, depression, and stress.  ED may affect the quality of a marriage or intimate relationships.  There are, however, many safe and effective ED Treatments available.

What happens under normal conditions?

Achieving a normal erection is a complex process involving psychological impulses from the brain, adequate levels of the male sex hormone testosterone, a functioning nervous system, and adequate blood flow to the penis. During sexual arousal, nerve signals release chemicals that increase blood flow to the penis.  The blood flows into two erection chambers made of spongy tissue (the corpus cavernosum) in the penis.  The “smooth muscle” in the erection chambers relaxes, allowing blood to enter and engorge the two erection chambers.  The pressure of the blood in the chambers makes the penis firm, producing an erection.  After a man has an orgasm, the smooth muscle in the penis tightens forcing the blood to flow out of the chambers and the erection subsides.

What are the risk factors for ED?

The most common risk factors for ED are:

  • Older age
  • diabetes
  • high blood pressure
  • high cholesterol
  • smoking
  • cardiovascular disease

These diseases over a period of time, can lead to a deterioration of the penile blood vessels, causing reduced blood flow to the penis and subsequent erectile tissue damage. When this tissue is damaged, the blood escapes from the erection chambers into the veins and the erection is unable to be maintained.  Smoking, drug, and alcohol abuse - particularly over long periods of time - will compromise the blood vessels of the penis. Lack of exercise and a sedentary lifestyle can also contribute to the development of ED. Modifying these risk factors may 

contribute to overall health and in some individuals can correct ED. Patients undergoing surgery or radiation therapy for cancer of the prostate, bladder, colon, or rectum are at high risk for the development of ED. Further, drugs used to treat these risk factors listed above may also lead to or worsen ED.  ED can be caused by peripheral neuropathy in which the nerves leading to the penis fail to send coordinated signals to the penis. Peripheral neuropathy can be caused by diabetes, HIV infection, certain medications and other less common conditions.

What causes ED?

ED can result from medical, physical, or psychological factors.  ED can also occur as a side effect of medicine, alcohol, or drugs.  The physical and medical causes of ED include three basic problems:

Not enough blood flows into the penis.  Many conditions can reduce blood flow into the penis, examples include heart disease, diabetes, and smoking. When blood cannot fill the penis, achieving a satisfactory erection is difficult. 

The penis cannot store blood during an erection.  A man with this problem, called venous leak or cavernosal dysfunction, cannot maintain an erection because blood does not remain trapped in the penis.  This condition can occur to any man regardless of age.

Nerve signals from the brain or spinal cord do not reach the penis.  Certain diseases, injury, or surgery in the pelvic area such as prostatectomy or cystectomy can damage nerves in the penis making it difficult for the man to achieve an erection. For information about erectile preservation or penile rehabiliation protocol, please click here

Sexual activity requires the mind and body to work together.  Psychological, emotional, or relational problems can cause or worsen ED; and include but are not limited to:

  • Depression
  • Relationship conflicts
  • Stress at home or work
  • Anxiety about sexual performance

Many prescription and over-the-counter medications may have sides effect often causing erection difficulties.  Drugs such as marijuana, heroin, cocaine, and alcohol can lead to sexual problems. 

If your ED is due to a hormonal problem, such as low testosterone or diabetes, you may be referred to an endocrinologist.  Your healthcare provider may also refer you to a mental health professional.  These specialists treat psychological or emotional causes of ED.  Even if your ED is not caused by these factors, it may contribute to them and it may be helpful to get counseling, alone or with your partner, in addition to getting medical therapy for ED.

Who gets ED?

Studies show about one-half of American men over age 40 have some degree of ED.  Recent studies show most men with ED have an organic cause.  While ED becomes more common as men age, growing old is not the cause of the problem.  Though sexual function may decrease with age, many men enjoy sexual activity well into their senior years.

ED can also be an early warning sign of a more serious illness, such as heart disease, or diabetes mellitus.  Diagnosing and treating the condition that causes ED can improve your overall well-being, as well as help restore your sexual and overall health.

For more information on ED, please see common questions answered by Dr. Ramasamy 

For more information, please visit Dr. Ramasamy's YouTube channel.

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