Causes of Erectile Dysfunction
What are the common ED causes?
There are many factors that go into a functioning and working erection. The first factor that typically we talk about is a vascular factor, that is, bringing blood to the penis. This consists of the arteries, not only the large arteries like the aorta and the iliac arteries that are bringing blood from the heart, but often it’s the smaller arteries we call the helicine arteries of the penis that are bringing that blood into that organ that are damaged and can result in decreased blood flow through a variety of factors which we can talk about.
The Nervous System and Erections
There’s also a neurologic component. There is a complex interplay of our two different nervous systems. This is not the somatic nervous system like, hey, I’m moving my hand. This is the autonomic nervous system. This is the nervous system that passively controls how our body works without us thinking.
The passive nervous system that’s involved in getting an erection is the parasympathetic nervous system. What this basically does is these parasympathetic nerves, when it’s time, an appropriate time to obtain an erection, they sort of shut out—they shut off the efflux, or the outflow of blood from the penis. So you have a relative inflow with a decreased outflow. Simple hydraulics—you got a woody.
Anxiety and Erectile Dysfunction
Some other factors that are involved in this are a lot more complex—higher cortical things that can affect how your erection functions. For instance, anything that activates anxiety where you’re nervous. A higher cortical function or sensation can create activation of the sympathetic nervous system. This is the opposite of the parasympathetic nervous system. This is that fight or flight reaction where blood is brought back to the core of the body which means away from peripheral organs like the penis.
Medications and ED
This can also be affected by a lot of medications, and along all of this, all the spectrum, both vascular, neurologic, and psychogenic can be in a play of one’s medications.
Cardiovascular Fitness and ED
Lastly, related to all of it is general health status, cardiovascular fitness. Can you walk up a flight of stairs? Are you healthy enough for the rigor of sexual activity? So all this is kind of interplaying, and it’s often complex and multifactorial, and rarely is one the sole cause of decreased erectile function.
So it can be an overlap of a lot of issues. So you address what you can, and your ultimate goal is usually satisfaction of yourself and your partner. And usually it seems like all of the factors are interconnected. So if you fix one, then it can be a domino effect. Often just fixing one can be all you need to tip you over to a satisfied end-point, where you’ll be thinking “This erection is working for me, it’s working for my partner. I’m pleased.” And sometimes it requires some substantial tweaking. Particularly, there are certain medications which we can talk about later that are pure erectile-killers.
Regardless of where you are, there’s a lot of pathways to improvement of ED for men, whether you’re young with mild ED, middle-aged with severe ED, or young with severe ED. There’s a lot of ways we can mitigate those ED factors, make those lifestyle modifications, change those medications, and work on getting, again, an erection that’s satisfying for you and for your partner.
Achieving An Erection Versus Maintaining An Erection
A lot of times, for patients that have a physiologic problem like decreased blood inflow, diabetes, hardening of the arteries, hypertension, it’s an obtaining problem. They can’t physiologically obtain the erection. There’s not enough blood flow going in or too much outflow going out. In my experience, the patients that have trouble maintaining it typically have some other factors. These can be medications, psychological issues, anxiety. And so these factors—again, it blends over. There’s no one that has exactly one versus exactly the other. But in my experience the obtaining of an erection still tends to be very psychological. But it tends to be more related to physiologic issues, and the maintaining tends to be more related perhaps to psychological or psychiatric or medication factors.
ED Symptoms and Sexual Expectations
Erectile dysfunction is a medical condition to a point. But so much about sex is psychological. We’re dealing with so many variables when you’re dealing with the sexual experience, from how society has constructed what we are supposed to do in the bedroom to having a larger issue within the relationship, the lack of communication, the lack of trust in the bedroom, expectations you put on yourself.
So once you build up an expectation around how you’re supposed to perform sexually, or even what the relationship is supposed to be like as a couple, often erectile dysfunction can bleed into the bedroom as all subconscious, and something that’s actually something much deeper. That’s why, when you work on erectile dysfunction, you really have to work on the whole relationship. Actually, take the penis sometimes completely out of the equation.
Can Erectile Dysfunction Mean Something More Serious?
Yes, anyone with ED symptoms should consider the possibility of a larger medical issue, just to be safe. It never hurts to check in on your heart health, your fitness levels, what your day to day nutrition quality is. These factors can all improve your ED and many other health conditions. If you have ED, be safe and rule out any other more serious medical conditions that ED could be signaling.
Also, you won’t get very far with addressing the psychological aspects of ED if there is a physical/medical issue that’s really causing the ED. That can be anything from blood pressure issues to side effects of medications to use or overuse of substances, non-prescribed substances. So all those things need to be assessed.
Ratio of Physical ED to Mental ED
What’s the ratio of actual medical reasons for ED as opposed to purely psychological reasons? I think that, surprisingly, few instances are medical versus psychological.
I think a lot of times people sort of assume there’s something medical happening. That’s why they go to their doctor originally, but a great proportion is more psychological in nature. And then some are kind of a combination.
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