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Causes
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Erectile dysfunction has organic and psychological
causes. Numerous risk factors such as age, smoking,
diabetes, hypertension, chronic consumption of alcohol
and drugs, high cholesterol and obesity have been
described.
Occasionally erectile dysfunction is primary (the man
has never been able to achieve or sustain erections),
which is almost always due to psychological factors and
less frequently due to biological factors (usually
associated with low testosterone levels). The secondary
erectile dysfunction occurs when a man who previously
could achieve and maintain erections, is no longer able
to do so. Over 90% of these cases is of organic nature
but always associated with a psychological component.
Psychogenic causes
They are usually caused by depression, sense of guilt,
worry, fear of intimacy, situations of anxiety or stress or
environmental influences, such as the fear of inducing a
pregnancy or contracting diseases. They are able to
inhibit the erectile response and libido (sexual desire).
One case is the so-called "performance anxiety" which
determines an inhibitory effect on erections and is
common in young people first sexual experiences or
after the first failure in sexual relations.
Vascular causes
They can be both arterial and venous (better defined as
veno-occlusive disease). In the first case there is a
reduced blood flow to the penis, while in the latter it
causes a condition of venous insufficiency (penile
venous valves are not able to retain the blood within the
penis). Arteriosclerosis, cardiovascular disease and
diabetes are undoubtedly the most frequent causes.
Among the most common cardiovascular diseases there
are hypertension (20%), myocardial infarction (45%) and
stroke (85%).
Drug causes
About 25% of ED are caused by drug therapy, either
directly or indirectly. Psychiatric drugs, sedatives and
hormones and especially antihypertensives and drugs
for cardiovascular diseases are the main drug classes
associated with ED.
Endocrine causes
Hormonal causes are infrequent (less than 5%).
Iperprolattina, hypogonadism, hypothyroidism and
hyperthyroidism, Cushing's syndrome can cause erectile
dysfunction. Although hypogonadism (low testosterone
and low bioavailability of testosterone) is associated with
a decrease in libido, the link between testosterone and
erectile capacity is unclear.
Neurogenic causes
The lesions of the spinal cord and brain injuries, because
of the interruption of the control circuits and the
sensory stimuli of the erection, are responsible of
erectile dysfunction. It frequently happens in Parkinson's
disease or in Alzheimer's disease, in spinal trauma or in
some cases of peripheral neuropathy.
Surgery and radiotherapy
Surgery and radiation therapy to the pelvis area may be
associated with ED for the damage to nervous and
vascular structures of the penis. Colon surgery,
particularly to the rectosigmoid, prostate, bladder can
cause injuries to the neuro vascular network pelvic with
the consequence of erectile dysfunction; the damage can
give temporary defect erection for about 2 years
regressing totally or partially also in less time.
Diabetes
In diabetes the DE has a prevalence 3 times higher than
that of the general population and many factors of
vascular, nervous and anatomical contribute to
determine it and in many study the prevalence varies
from 48% to 59%.
Peyronie's disease
It is an uncommon and not clear inflammatory condition
(repetitive microtrauma, reactions car / dysimmune,
metabolic local) that produces scar retrattive repairs that
make the affected area of the corpora cavernosa rigid
and prevent erectile expansion; when it is present in a
small area it leads to curvature on the side of the lesion;
when it is larger it causes a defect in the expansion of
the corpora cavernosa and related erectile dysfunction.