Erectile dysfunction: causes and symptoms. Premature ejaculation

Causes of erectile dysfunction

Erectile dysfunction can the result of organic causes associated with blood vessels, nerves and hormones or psychological factors. Current statistics shows that about 80% of all problems with erection are of organic origin.

Erection usually occurs when imagination or senses (vision, hearing, smell, taste, touch) receive stimulation and a man gets excited. Central nervous systems sends nerve impulses to the penis increasing blood flow. Blood fills in the chambers of the penis and makes it bigger and rigid.

The following four factors are required for the erection to occur:

  • Adequately functioning nervous system which sends certain signals to the penis.
  • Undamaged blood vessels (cardiovascular system) that allows blood enter and leave the vessels unobstructed.
  • Healthy penile smooth muscles which should be relaxed to allow blood fill the penis and make it bigger.
  • Ability to retain blood in the penis to maintain its rigidness.

Organic causes of erectile dysfunction include long-lasting (chronic) or short-lasting (acute) post-operative damages and complications associated with nerve impulses or penile blood supply.

Men after 50 typically face erection problems due to physical causes.

  • Problems with blood vessels (cardiovascular system) may prevent penile blood supply or keeping blood inside the penis to maintain erection. For example, chronic hypertension can damage blood vessels and lead to erectile dysfunction.
  • Problems with nerves (neurological problems) can prevent the signals that produce bodily arousal from the brain and spinal cord to the penis. Such neurodegenerative diseases as Parkinson’s, Alzheimer’s, multiple sclerosis and angina pectoris can have a negative impact on a man’s ability to get and maintain erection and may decrease sexual desire. Nerve damages caused by diabetes, post-operative complications and spinal cord damages can also lead to erectile dysfunction.
  • Erectile dysfunction can be caused by structure of the penis or surrounding tissues.
  • Hormonal problems such as low testosterone can also cause erectile dysfunction.
  • Drug side effects (for example, medications for hypertension or depression) can include erectile dysfunction. In some cases, it is enough to change the dosing regime or replace the drug to resolve the problem.
  • Smoking, alcohol and illegal drugs can lead to erectile dysfunction. To resolve or improve the problem, it is enough to overcome these addictions.

Some types of activities can obstruct penile blood supply causing erectile dysfunction. Some doctors noticed that men who regularly riding bikes long distances have more incidences of erectile dysfunction than men who ride a bike from time to time, especially if the seats are small and hard. However, the possible link between riding a bike and erectile dysfunction has not been proved yet.

It is highly unlikely that vasectomy will directly cause a man to have erectile dysfunction. However, post-operative pain can have a negative effect on sexual life. Besides, if a man is uncomfortable about vasectomy, it can have a negative impact on his psychological condition.

Psychological causes of erectile dysfunction include depression (which also has an organic side), anxiety, stress, grief or problems in current or past relations. All these have a negative effect on erection as man can not concentrate on things that aroused him before. Erectile dysfunction in men younger 40 who have no organic risk factors is more likely to be caused by psychological and not physical factors.

  • Problems in relations can lead to erectile dysfunction. It can occur when a man becomes a widower or when he loses a sexual interest to his partner.
  • Some men develop erectile dysfunction when they are thinking about marriage.
  • Some men may have difficulties with sex after their first baby is born.

Blood vessels and erectile dysfunction

As erection is the result of increased blood flow into your penis, problems with blood vessels  can lead to erectile dysfunction. Problems with vessels are the following:

  • Hardening of the arteries (arteriosclerosis) in the penis can block blood supply to the penis and arteries.
  • Side effects by drugs having a negative impact on vessels (some diuretics or other medications to treat hypertension).
  • Drainage of cavernous bodies can lead to incomplete erection.

Erectile dysfunction and hormonal factors

Hormonal factors can play a significant role in the development of erectile dysfunction. Men with low testosterone production (this condition is known as hypogenitalism) may have a low sexual desire. If this condition is suspected, doctors typically ask patients to have a testosterone level test. Only a few men with erectile dysfunction have a low level of testosterone.

Abnormally high levels of prolactin in blood (hyperprolactinemia) can also be a cause of erectile dysfunction. High levels of prolactin impairs testosterone production leading to hypogenitalism.

There are special medications to treat low testosterone and high levels of prolactin.

Prescription drugs and erectile dysfunction

Some drugs can cause erectile dysfunction. Inform your doctor about the drugs you are taking. If you have problems with erection, these drugs may aggravate the problem. Your doctor can change the dosing regime or recommend alternative treatment.

The drugs that can potentially cause erectile dysfunction are:

  • Clomipramine hydrochloride (Anafranil) to treat obsessive-compulsive disorder.
  • Flutamide to treat prostate cancer.
  • Leuprolide acetate (Eligard, Lupron) to treat alcohol addiction.
  • Naltrexone hydrochloride (Revia) to treat alcohol addiction.

Other drugs that can provoke erectile dysfunction.

Drugs that can cause or aggravate erectile dysfunction
Medical drugs Examples
Drugs to treat hypertension ·         Amlodipinum (Norvasc)

·         Atenolol (Tenormin)

·         Clonidine (Catapres)

·         Methyldopa

·         Metoprolol (Lopressor, Toprol XL)

·         Nifedipine (Adalat, Procardia)

Diuretics ·         Acetazolamide (Diamox)

·         Chlorotiazide (Diuril)

·         Chlortalidon (Taliton)

·         Hydralazine

·         Hydrochlortiazide

·         Hydrochlorthiazide and metoprolol (Lopressor)

·         Spironolactone (Aldactone)

·         Triamterene (Dyrenium)

Antidepressants ·         Amitriptyline

·         Citalopram (Celexa)

·         Escitalopram oxalate (Lexapro)

·         Fluoxetine (Prozac, Sarafem)

·         Fluvoxamine

·         Imipramine (Tofranil)

·         Izocarboxazid (Marplan)

·         Nortriptyline hydrochloride (Pamelor)

·         Paroxetine (Paxil)

·         Fenelzine (Nardil)

·         Sertraline (Zoloft)

·         Tranycylpromine (Parnat)

Neuroleptic agents ·         Chlorpromazine

·         Fluphenazine

·         Haloperidole (Haldol)

·         Perphenazine

·         Risperidone (Risperidal)

·         Thioridazine

·         Tiotixene (Navan)

Hormones ·         Estrogens

·         Alternatives of luteinizing hormone-releasing hormone (Zoladex, Lupron)

Anticonvulsant ·         Carbamazepine (Carbatrol, Epitol, Tegretol)

·         Phenobarbital (Solfoton)

·         Phenytoin (Dilantin)

Cardiovascular drugs ·         Digoxin (Lanoxicaps, Lanoxin)
Drugs to treat ulcers and heartburn ·         Cimetidine (Tagamet)

·         Famotidine (Mylanta, Pepcid)

·         Nizatidine (Axid)

·         Ranitidine (Zantac)

Drugs to treat benign prostatic hyperplasia ·         Dutasteride (Avodart)

·         Finasteride (Proscar)

Among other drugs that have a negative effect on erectile function are the drugs to treat:

  • Parkinson’s disease, for example Levodopa (Sinemet)
  • Nausea and vomiting, for example prochlorperazine (Compro) and promethazine (Promethegan).

Erectile dysfunction – symptoms

Symptoms of erectile dysfunction include the inability to:

  • Get erection at any time during masturbation or together with a sexual partner.
  • Maintain erection long enough to have a sexual intercourse.
  • Maintain erection sufficient to end a sexual intercourse.

While a man can have erectile dysfunction, he still may have a sexual desire and be able to have an orgasm with ejaculation.

Erectile dysfunction – Mechanism

A lot of men may experience erectile dysfunction from time to time. However, when it happens regularly, it can have a negative impact on a man’s sexual life, his relationships with partner and his self-confidence. A man suffering from erectile dysfunction often has fear of failure that only aggravates the problem. If you can not maintain erection sufficient to have sex or you have an orgasm before or right after the intromission (premature ejaculation), you may feel dissatisfaction and think that you do not satisfy your partner.

Fortunately, many organic and psychological factors leading to erectile dysfunction are treatable.

Premature ejaculation

Premature ejaculation is an uncontrolled urge to ejaculate before or right after the intercourse. Ejaculation occurs earlier than a man wants is and with minimal sexual stimulation.

Premature ejaculation is the most common form of male sexual dysfunction. Its cause is often unclear but can be associated with the lack of sexual experience or psychological factors such as fear or depression. In some cases, health problems or drug side effects are responsible for this condition.

Premature ejaculation treatment depends on its cause and may include consultation, behavioral therapy or special drugs to delay orgasm.

Who are in a risk group

Risk for developing erectile dysfunction is increased in elderly men.

  • Nearly half of men from 40 to 70 years old complain about erection problems.
  • More than 15 men out of 100 at the age of 40 report about problems with erection from time to time. 2 times more men at the age of 70 (30 men out of 100) report about serious problems with erection.

Diseases, physical or psychological problems and some types of physical activity can also increase the risk.

The diseases damaging blood vessels are:

  • Diabetes. Nearly half of men with diabetes suffer erectile dysfunction.
  • Hypertension and other vessel diseases.
  • High cholesterol and low level of HDL cholesterol.

Diseases or procedures affecting the nervous system are:

  • Diabetes.
  • Multiple sclerosis.
  • Angina pectoris.
  • Parkinson’s disease.
  • Prostate, bladder, rectum or urethra surgery. These procedures can damage nerve endings which are important for getting and maintaining erection.

Among other disorders increasing the risk of erectile dysfunction are:

  • Thyroid disorders.
  • Low levels of hormones which are important for adequate development and functional activity of reproductive organs (hypogonadism) that can lead to low testosterone.

Traumas and treatments that increase the risk of erectile dysfunction are:

  • Penile or pelvic trauma.
  • Spinal cord or penile nerve endings trauma.
  • Pelvic surgery.
  • Pelvic radiation exposure.

Drugs and other substances that increase the risk of erectile dysfunction are:

  • Some drugs to treat hypertension or depression.
  • Chronic alcoholism.
  • Drug addiction.
  • Smoking.

Psychological factors are:

  • Depression.
  • Anxiety and stress.
  • Recent important changes in life such as birth of a baby, retirement, new job, break in relationships or death of the partner, divorce or marriage).

Such types of physical activities as riding a bicycle on a small and hard seat can increase the risk of erectile dysfunction as it restricts penile blood supply. However, this is still disputable and not all experts agree with this.

It is highly unlikely that vasectomy will directly cause a man to have erectile dysfunction. However, post-operative pain can have a negative effect on sexual life. Besides, if a man is uncomfortable about vasectomy, it can have a negative impact on his psychological condition.