What are the causes behind erectile dysfunction?

Occasional potency problems are nothing to worry about. There are many reasons why the erection is temporarily absent. These include stress, an acute illness, or mental tension. However, if a man does not get a sufficient erection for a long time, experts speak of erectile dysfunction or erectile dysfunction (erectile impotence).

Impotence is not uncommon, especially in old age. It is estimated that more than half of all men between the ages of 60 and 70 suffer from it. But erectile dysfunction can also occur in your 20s, 30s, or 40s.

Symptoms of erectile dysfunction

Typical symptoms of erectile dysfunction: Although the man is sexually aroused,

•     Does the penis not get stiff enough and/or
•     the erection does not last long enough to have satisfying sex.

Sexual intercourse is then not or hardly possible.

Doctors only diagnose erectile dysfunction if the problems with potency last for at least six months.

Erectile dysfunction can significantly impair the quality of life – both that of the affected man and that of his or her partner.

What happens with an erection?

Inside the penis are two pairs of cavernous bodies, which consist of smooth muscle and spongy tissue. When a man is sexually aroused, the smooth muscle relaxes and arteries dilate, allowing more blood to enter the erectile tissue.

As the swelling increases, the surrounding veins that carry blood back to the heart are squeezed. The blood can no longer drain and accumulate. This leads to an erection: the penis becomes stiff and erect.

Causes of erectile dysfunction

An erection is a highly complex physical process involving hormones, nerves, and blood vessels, among other things. The process can easily be disturbed - for example by 비아그라 구매 hormonal changes, problems with vessels and nerves, changes in the erectile tissue, and last but not least by psychological factors. Erectile dysfunction can therefore have many different causes. Sometimes no specific cause can be found.

In most cases, erectile dysfunction has physical causes such as arteriosclerosis, diabetes, or high blood pressure. Especially from the age of 50, chronic diseases are often responsible for impotence. In young men, on the other hand, psychological problems are often behind it. In addition, it may be that both physical and psychological components are involved in the development.

Possible causes of erectile dysfunction include:

•     Circulatory disorders/vascular diseases, such as  arteriosclerosis
•     Nerve damage, for example, due to certain diseases, injuries, operations
•     hormonal imbalances, such as low testosterone
•     certain medications
•     psychological factors
•     Diseases/malformations of the penis/corpus cavernosum

Impotence due to circulatory disorders/disorders of the blood vessels

Especially in older men, erectile dysfunction is usually due to reduced blood flow or vascular changes.

If the blood flow in the arteries is reduced, not enough blood gets through the penile arteries into the erectile tissue. Arteries are the blood vessels that carry oxygen-rich blood from the heart to all areas of the body. It is also possible that the blood is draining away too quickly via the veins (venous-occlusive dysfunction). Veins are the blood vessels that carry deoxygenated blood back to the heart.

In both cases, the amount of blood in the penis is not sufficient to achieve or maintain an erection.

The most common causes or contributing factors to arterial circulatory disorders are:

•     Arteriosclerosis,
•     diabetes mellitus,
•     dyslipidemia and
•     High blood pressure.

Arteriosclerosis ( hardening of the arteries ) builds up deposits of fat and calcium in the arteries over the years, which are known as plaques. This causes the arteries to become narrower and more rigid so that the blood can no longer flow through them easily - and the erectile tissue may not be supplied with enough blood. Risk factors such as smoking or being overweight favor this process.

Damage to the small blood vessels that connect arteries and veins can disrupt blood flow to the cavernous bodies of the penis. Experts speak of microangiopathy. This disorder is often due to high blood pressure or diabetes mellitus.

Erectile dysfunction due to nerve disorders or injuries

During sexual arousal, the brain becomes active first: it transmits signals via nerve tracts to the nerve fibers of the penis. These then release certain messenger substances that set the erection in motion.

If the nerve fibers are damaged, this process can be disturbed. Then the man does not get an erection, although he is aroused. A possible cause of nerve damage is a so-called polyneuropathy in the context of diabetes mellitus. Neurological diseases such as multiple sclerosis, a stroke, or Parkinson's can also be a cause.

Injuries can cause erectile dysfunction if nerves in the penis area are damaged. This can happen, for example, after a pelvic fracture. In addition, erectile impotence can be the result of pelvic surgery. For example, if the prostate had to be removed due to prostate cancer. Erectile dysfunction can also occur after rectal surgery.

Hormonal causes of erectile dysfunction

Erectile dysfunction very rarely has hormonal causes. For example, a lack of the male sex hormone testosterone can impair potency. The reason: if there is too little testosterone, the man usually feels less sexually aroused - and as a result may not get an erection.

Elevated prolactin levels can also promote erectile dysfunction. Prolactin is a hormone that stimulates milk production in women after childbirth, enabling them to breastfeed. The male body normally produces only small amounts of prolactin. If the prolactin level is too high - for example, due to medication or certain diseases - potency problems can result.

Erectile dysfunction caused by medication

Certain active ingredients can have a negative effect on potency. These include, among other things

•     Beta-blockers, such as those used to treat high blood pressure or heart disease
•     certain antidepressants
•     Antiandrogens (inhibit the action of 비아그라 구입 male sex hormones)
•     water medication (diuretics)
•     cholesterol-lowering agent
•     Medicines for epilepsy (anticonvulsants)

Alcohol, nicotine, and other drugs such as cocaine or marijuana can also have a negative effect on potency.

Psychological causes of erectile dysfunction

Especially in young men, erectile dysfunction often has psychological causes, for example, due to

•     fear of failure
•     problems in the partnership
•     sexual fears/fear of intimacy
•     decreased sexual desire

Last but not least, physical and psychological causes can occur in combination. For example, a slight physical erectile dysfunction can lead to fear of failure, which intensifies the problem.

Make the right diagnosis

In order to be able to treat erectile dysfunction, it is first important to know the causes. Initial indications of the possible causes result from the conversation between the patient and the doctor.

Talking openly about sexuality is not easy for many of those affected. However, certain information is important in order to be able to get to the bottom of erectile dysfunction. It may be useful to include your partner in the conversation.

During the conversation, the doctor will ask about possible previous illnesses, the patient’s lifestyle, and whether they are taking medication. She or he will want to know when the erectile problems first became apparent and how exactly they manifest themselves. It is helpful to know whether the patient has a spontaneous erection at night or in the morning - this could be an indication that the erectile dysfunction has a psychological cause.

The first point of contact for erectile dysfunction can be a urologist, but also the family doctor's practice. Depending on the suspected cause, doctors from other disciplines, such as neurologists, may be called in.

Does erectile dysfunction have physical causes?

In order to find out whether the erectile dysfunction has physical causes - for example, diabetes or arteriosclerosis - thorough physical and neurological examinations are necessary.

The physical examination includes an assessment of the anal area, testicles, and prostate. The doctor scans these regions and checks whether there are any changes. She or he can also determine how well the reflexes are functioning in this area.

In addition, the doctor will look for possible signs of circulatory, nervous, or endocrine disorders. To find out whether there is a circulatory disorder, he or she can measure blood pressure and pulse in the arms and legs, for example.