What is Erectile Dysfunction?

Erectile Dysfunction is defined as the inability to achieve or maintain an erection that is adequate for sexual function. Though not often discussed, over 18 million adult men in the United States have erectile dysfunction.1 Many seek treatment for erectile dysfunction as this condition can affect not only one’s sexual health, but also one’s psychological health, relationships with partners, and overall quality of life. Fortunately, there are effective treatments for erectile dysfunction.

Causes of Erectile Dysfunction

Erectile Dysfunction and Diabetes

Half of men with diabetes will experience erectile dysfunction (ED) within 10 years of their diagnosis. High blood sugar levels can damage the nerves that control sexual stimulation. They can also damage blood vessels; these are necessary to provide adequate blood flow to the penis in order to achieve and maintain an erection.

While oral medications are a common first therapy, they tend to only work in about 50% of men with diabetes.

Men with diabetes are more likely to move on to other treatment options, such as the pump, penile injection therapy, and penile implants. The penile implant has the highest satisfaction rate of all treatment options.

Erectile Dysfunction and Cardiovascular Disease

Many men are uncomfortable speaking with their physician about erectile dysfunction symptoms; however, it is important to address this because erectile dysfunction can sometimes be a warning sign of current or future heart disease.

Erectile dysfunction precedes coronary artery disease in almost 70% of cases.

The arteries in the penis are very tiny compared to those in other parts of the body. If there is underlying coronary artery disease, these smaller arteries in the penis are affected by atherosclerosis (blocked blood vessels) sooner. Many times, we will refer patients to a cardiologist in order to determine if there is underlying cardiovascular disease.

You can reduce your risk of ED by improving your heart health. This includes increasing physical activity, quitting tobacco products, losing weight and following a healthy diet.

Erectile Dysfunction and Prostate Cancer

Erectile dysfunction is a potential complication following prostate cancer treatments. The nerves that control an erection lie very close to the prostate and may be injured during treatment. With nerve-sparing procedures, some men may regain their previous level of erectile function, although it may take up to a year. Unfortunately, some men may not recover their ability to have a natural erection. Radiation for prostate cancer can cause erectile dysfunction symptoms to appear gradually, usually within 2-3 years after treatment.

If you are experiencing ED after your prostate cancer treatment, you can still return to a healthy sex life. We can help you decide what treatment options are best for you.

Regardless of the cause of erectile dysfunction, it is likely to cause feelings of stress and frustration. It’s also very common for erection problems to cause tension in a relationship; particularly if one or both partners withdraws emotionally, and the problem is not discussed. It is important to keep in mind that even if you are dealing with ED, there are treatment options available to help you return to a satisfying sex life!

Erectile Dysfunction Causes in Detail

Decreased Arterial Blood Flow

  • Diabetes, atherosclerosis, vasculitis, tobacco use
  • Increased venous leakage
  • Altered erectile tissue
    • Fibrosis
    • Peyronie’s Disease

Neurogenic

  • Diabetes (peripheral)
  • CVA (Stroke)
  • Parkinson’s
  • Alzheimer’s
  • Spinal Cord Injuries

Endocrine

  • Hypogonadism (Low Testosterone)
  • Hyperprolactinemia (High Prolactin Levels)

Iatrogenic/Related to surgery and/or medications

  • Surgical
    • Radical Prostatectomy
    • Rectal Surgery
    • AAA (Aortic Aneurysm Repair)
  • Medications
    • Antihypertensives (Thiazide diuretics, beta-blockers, calcium channel
      blockers, angiotensin-converting enzyme (ACE) inhibitors)
    • Antidepressants (SSRIs), Tricyclic antidepressants
    • Antiarrhythmics (e.g., Digoxin)
    • Antiandrogens (Testosterone Blockers)
    • Leuprolide, Flutamide, Finasteride, Dutasteride
    • H2 receptor antagonists (e.g., Cimetidine)
  • Recreational/Abuse agents
  • Cigarette smoking
  • Cocaine & marijuana

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