Many males take getting an erection for granted. But for at least 10% of all men, getting an erection is a major challenge.
If you are one of these men, you may have erectile dysfunction (ED), often called impotence. Erectile dysfunction occurs when blood flow or nerve impulses to the penis are weakened or blocked.
Most ED has a physical cause. Heart disease, diabetes and Peyronie's disease can damage blood vessels and nerves. Treatment for prostate cancer can cause damage. In a few cases, ED has a psychological cause.
In addition to the major physical causes of ED there are other causes such as spinal cord injuries, smoking, alcohol, MS, vascular disease and more. Every man should know about them.
Every man should also know that doctors-specifically urologists - have a much better understanding of erectile dysfunction today than just a few years ago. The are successfully treating more men with ED than ever before.
If you think you have impotence, see your doctor as soon as possible. To help you decide if you should see a doctor, take a simple self-evaluation here.
And if you do have ED, remember that the chances are very good that you can get successful treatment.
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Peyronie's Disease
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A spinal cord injury can reduce or stop nerve impulses from the brain to the penis. These nerve impulses are necessary for the blood flow you need to get an erection.
Depending on the injury, spinal cord damage may cause ED ranging from partial to complete.
Groin and pelvic injuries may harm nerves and cause ED. For example, falling on the crossbar of a bicycle can damage blood vessels that supply the penis. Some studies have linked regular bicycling to ED. It is thought that the bicycle seat compresses the path of blood to and from the penis.
Other studies have also linked water sports, gymnastics, and horseback riding to pelvic injuries that can cause impotence.
Treatment for prostate cancer, especially radical prostatectomy, often damages or destroys the nerves that control erections.
Radiation therapy treats prostate cancer by destroying cancer cells. Alternatives for radiation treatment include cryotherapy, radioactive seed therapy, brachytherapy, and extended beam radiation therapy (EBRT).
Radiation therapy can cause impotence. It can damage arteries that carry blood to the penis. It can also cause scar tissue near the prostate that restricts blood to the penis.
Impotence caused by radiation therapy may not occur immediately as it often does with prostate surgery. The problem may occur months or even years after treatment.
About 10% of erectile dysfunction cases are psychological. The cause is in the mind and not the body.
Depression, guilt, worry, stress, and anxiety can come from job, marital, financial or other problems. They can cause a man to lose his sexual drive and suffer ED. This can produce even more anxiety. The result can be chronic sex problems-often called "performance anxiety."
Psychological impotence is highly treatable. A urologist may recommend treatment from a psychologist, psychiatrist, sex therapist, or marriage counselor.
Arteriosclerosis is the hardening and narrowing of the arteries. It reduces blood flow throughout the body. It also can slow blood flow to the penis, making it difficult to get or maintain an erection.
Hardening of the arteries accounts for 50%-60% of impotence in men over 60. Risk factors include:
Sometimes the veins that keep blood in the penis during an erection are damaged. The veins can't hold blood in the penis long enough for sexual intercourse.
Smoking can lead to any of the factors above. It may be the most significant risk factor for erectile dysfunction caused by hardening of the arteries.
Doctors specializing in erectile dysfunction say that smoking is a reason why many men become impotent when they are middle-aged and older.
Smoking can damage the arteries that carry blood to the penis. High blood pressure and a high-fat diet can make the problem worse by causing more damage to the arteries.
A male smoker with high blood pressure is seven times more likely to have ED than other men. Impotence related to smoking can also affect men as young as 30 who have smoked for a long time.
Over 200 prescription drugs may cause some degree of impotence as a side effect. The most common are diuretics and blood pressure drugs. Tranquilizers, antidepressants, sedatives, other psychiatric drugs, and many over-the-counter medicines can also cause ED.
(Never stop taking your medication or change dosage unless your doctor tells you to.)
Long-term use of alcohol, nicotine and illegal drugs such as marijuana and cocaine can also lead to impotence.
Multiple sclerosis is a disease of the central nervous system (CNS). In MS, the body's immune system attacks the outer nerve sheath. It causes scarring in random spots throughout the CNS. In the image to the left, notice the "demyelization" (lesions) in the brain.
The scarring interferes with nerve impulses. Impulses meant to cause erection may not reach the penis. This can cause impotence.
The primary male hormone is testosterone (molecule shown to the right.) After age 40, a man's testosterone level gradually declines. By age 70 the level normally has fallen by about 30%. While this level is "normal" for a man of 70, it would be low for a younger man. About 5% of men that doctors see for erectile dysfunction have low testosterone levels. In many of these cases, low testosterone causes lower sexual interest, not impotence.
Erectile dysfunction has many causes. But you don't have to live with it. Many treatments are available. Doctors are becoming better informed about ED and the wide range of treatment choices. Doctors (especially urologists) are using modern treatments more successfully.
Viagra is the best-known drug for treating ED. It is successful for millions of men. About 70% of men respond to Viagra or Cialis.
When Viagra fails, there are other treatments available, including penile implants, vacuum devices, drug injections, and urethral suppositories.