What is it and what are the causes of erectile dysfunction?

Erectile dysfunction (ED) is most often defined asthe inability to obtain and maintain an erection sufficient for a satisfactory sexual intercourse. They are often accompanied by individual discomfort and difficulties in the relationship with the sexual partner.

Other names found in the literature on the subject are: erectile dysfunction, erectile dysfunction, male erectile dysfunction and currently considered inappropriate due to their ambiguity and falling out of use – potency disorders or impotence.

Depending on the adopted criterion, erectile dysfunction can be divided into:

The causal criterion:

• organic (somatic disease or damage, influence of drugs, stimulants),
• psychogenic,
• mixed (both groups of causes and factors play a role).

Beginning criterion:

• lifelong (primary),
• acquired (secondary).

Situational criterion:

• generalized (occur in all situations and circumstances),
• situational (specific places, circumstances, not with all partners, during intercourse with a partner / partner, but not during masturbation).

Degree of severity:

• mild,
• moderate
• deep.

Possible causes and factors that increase the likelihood of developing erectile dysfunction

Cardiovascular diseases:

• atherosclerosisand blood vessel diseases,
• arterial hypertension.

Metabolic and endocrine diseases:

• diabetes_
• hyperlipidemia (excess cholesterol in the blood),
• thyroid disease,
• hyperprolactinaemia (can be drug-induced or result from disorders of the pituitary gland),
• hypogonadism (testosterone deficiency),
• metabolic syndrome (coexistence of many disorders related to the metabolism of fats, sugar, obesity andarterial hypertension).

Mental diseases and disorders:

• depression_
• acute anxiety.

Neurological diseases:

• multiple sclerosis,
• a historyof stroke.

Other diseases:

• liver failure
• kidneyfailure
• chronic obstructive pulmonary disease,
• night apnea.

Penile Diseases:

• Peyronie’s disease,
• penile fracture.

Injuries:

• spinal cord,
• pelvicfractures .

Other sexual dysfunction:

• loss or weakening of sexual need (libido)
• ejaculation disorders (most oftenpremature ejaculation),
• dyspareunia (pain during sexual activity in women).

Side effects associated with the treatment of other diseases:

• surgical trauma of nerves (e.g. removal of the prostate, rectum),
• removal of both testicles,
• pelvicradiotherapy ,
• medications (below).

Medicines:
(the problem is discussed in detail in the chapter on somatic diseases and mental disorders and drugs for sexuality used in their therapy)

• psychotropic (antidepressant, antipsychotic, anxiolytic).
• antihypertensive and circulatory (anti-arrhythmic, ß-blockers, diuretics, calcium channel blockers),
• hormonal and metabolic (antiandrogens, luteinizing hormone analogues,estrogens, statins, anabolic steroids),
• others (H2-blockers, metoclopramide, ketoconazole).

Lifestyle:

• sedentary lifestyle,
• smoking tobacco,
• excessive alcohol consumption,
• drugs (opioids, marijuana, cocaine),
• obesity.

Independent factors:

• aging.

Psychogenic factors:

• situational and reactive:
  • lack of privacy and intimacy,
  • predicting failure in sexual interaction (especially after failure; operation of the “vicious circle” mechanism),
• overwork, fatigue, acute and chronic stress,
• factors related to personality and its development:
  • starting a sexual life (lack of experience), a tendency to react with disorders in difficult situations,
  • insecurity in the male role,
  • anxiety towards women, sex, sexual phobias,
  • religious rigor and hostile attitude towards sex,
  • complex of a small member, inferiority,
  • unconscious homosexual needs or homosexual orientation,
  • unaware or unfulfilled special preferences and needs regarding the type of sexual activity or stimulation,
• dysfunctional and misconceptions and myths about male sexuality (examples):
  • “A real man doesn’t deal with things like communication or feelings”,
  • “Every touch is sexual and should lead to sex”,
  • “A real man is always good at sex”,
  • “Bigger is better”,
  • “Women won’t like me if I don’t get an erection”,
  • “A real man has no sexual problems”,
  • “I should be sexually fit all night”,
  • “The obligation to satisfy a woman rests on a man”,
• factors related to the partnership relationship:
  • conflicts in a relationship,
  • stressful behavior of a partner / partner,
  • loss of attractiveness or lack of attractiveness of a partner / partner,
  • sexual dysfunction in a partner / partner,
  • mistakes in the art of love,
  • unconscious hostile feelings towards your partner.

How common is erectile dysfunction?

World and national data currently provide a great deal of research data on the prevalence of erectile dysfunction.

For example, research data from eight countries show the following prevalence in different age groups:

• 20-29 years old -8%,
• 30-39 years of age – 11%,
• 40–49 years – 15%,
• 50–59 years – 22%,
• 60–69 years – 30%,
• 70–75 years – 37%.

The main conclusions of these studies are:

• the problem concerns all age groups, including the youngest men,
• the prevalence of the problem increases with age,
• older age is not absolutely related to the occurrence of these disorders.

How do erectile dysfunction manifest?

Erectile dysfunction is now considered not so much as a separate disease, but as a symptom of other diseases, especially of the cardiovascular system, as most of the risk factors are the same. Symptoms of disorders may increase gradually (the involvement of organic factors is more often suspected then, e.g. increasing vascular damage due to hypertension and excess cholesterol) or appear suddenly in a person who has been sexually well-functioning so far (the involvement of psychological factors, e.g. stress related to a new partner, acute stress related to another area of ​​life or a direct influence of other factors, e.g. drinking a lot of alcohol).

What to do in the event of symptoms?

A single or multiple occurrence of symptoms in a situation that can be psychologically understood or attributed to some factor, e.g. alcohol consumption, does not require action, especially when the elimination of this situation causes the symptoms to subside. However, repeated or persistent erectile dysfunction, increasing during erectile dysfunction, requires medical consultation in order to make a proper diagnosis. This doctor may be a sexologist, urologist, psychiatrist or internist. It may also make sense to visit a cardiologist, because erectile dysfunction may precede other symptomsof coronary artery diseaseand the resultingheart attackby several years .

How does the doctor make a diagnosis?

Erectile dysfunction is not a separate disease. Rather, they are considered a symptom that requires recognition of the underlying cause. Currently, the prevailing view is that in nearly 80% of cases the primary cause concerns organic factors (most often related to the circulatory system), and in 20% psychogenic factors. Psychological factors as secondary, i.e. in response to an emerging problem, seem to play a significant role in the majority of men, regardless of the primary cause, and therefore need to be considered in the comprehensive diagnosis and treatment of erectile dysfunction. Since erectile dysfunction can be a symptom of many serious diseases or have the same risk factors, their proper diagnosis and treatment is very important not only for the quality of sexual life of a man and a couple, but also for a person’s overall health.

The diagnosis is made by a doctor on the basis of the following tests to identify the underlying causes of erectile dysfunction:

• a detailed interview from the patient and his partner / partner,
• research using questionnaire methods and scales,
• biochemical and hormonal tests performed on the collected blood,
• urological examination, sometimes also neurological and internal medicine,
• apparatus methods (ultrasound of the penis vessels, devices for measuring night erections).

The interview must take into account the aforementioned factors that are potential causes or increase the risk of disorders, as well as the presence of nocturnal and morning penile erections – their presence suggests the involvement of psychogenic factors.

The most commonly used questionnaires and scales are:

• questionnaire to assess the sexual life of a man (IIEF-5),
• member hardness scale.

Among the biochemical and hormonal tests are performed (the choice will depend on the doctor depending on the history, the presence of other symptoms, previous results):

• blood count,
• sugar andlipidconcentration (lipid profile),
• liver tests,
• ionogram,ureaandcreatinine,
• thyroid hormone levels (TSH, fT3, fT4),
• total and free testosterone levels,
• SHGB (steroid-binding globulin),
• LH, FSH,
• PRL (prolactin),
• prostate specific antigen (PSA).
• Medical examinations may include:
• blood pressure measurement,
• per rectal examination (through the anus),
• palpation of the penis and testicles,
• Ultrasound of the penis vessels, testicles, pelvis,
• examination of nervous reflexes,
• general examination (auscultation, palpation).

What are the treatments?

The methods listed are discussed in more detail in the sections devoted to pharmacological and psychological methods of treating sexual disorders.Among the pharmacological methods, the doctor may suggest:
Drug treatment – oral:
selective and reversible inhibitors of phosphodiesterase type 5 (PDE 5),

• sildenafil,
• vardenafil,
• tadalafil,

other oral medications selected depending on the assessment of the mechanisms of the development of disorders:

• trazodone,
• bupropion,
• apomorphine,
• testosterone,
• bromocriptine,
• yohimbine,

Pharmacological treatment – in the form of injections into the cavernous bodies of the penis (injections):

• alprostadil (prostaglandin E1),

Vacuum apparatuses.

Surgical treatment:

• prosthesis of a member,
• unblocking of the penis vessels.

Physiotherapy – pelvic floor muscle exercises.

Psychological methods:

What is it and what are the causes of erectile dysfunction?

Erectile dysfunction is most often defined asthe inability to obtain and maintain an erection sufficient for a satisfactory sexual intercourse. They are often accompanied by individual discomfort and difficulties in the relationship with the sexual partner.

Other names found in the literature on the subject are: erectile dysfunction, erectile dysfunction, male erectile dysfunction and currently considered inappropriate due to their ambiguity and falling out of use – potency disorders or impotence.

Depending on the adopted criterion, erectile dysfunction can be divided into:

The causal criterion:

• organic (somatic disease or damage, influence of drugs, stimulants),
• psychogenic,
• mixed (both groups of causes and factors play a role).

Beginning criterion:

• lifelong (primary),
• acquired (secondary).

Situational criterion:

• generalized (occur in all situations and circumstances),
• situational (specific places, circumstances, not with all partners, during intercourse with a partner / partner, but not during masturbation).

Degree of severity:

• mild,
• moderate
• deep.

Possible causes and factors that increase the likelihood of developing erectile dysfunction

Cardiovascular diseases:

• atherosclerosisand blood vessel diseases,
• arterial hypertension.

Metabolic and endocrine diseases:

• diabetes_
• hyperlipidemia (excess cholesterol in the blood),
• thyroid disease,
• hyperprolactinaemia (can be drug-induced or result from disorders of the pituitary gland),
• hypogonadism (testosterone deficiency),
• metabolic syndrome (coexistence of many disorders related to the metabolism of fats, sugar, obesity andarterial hypertension).

Mental diseases and disorders:

• depression_
• acute anxiety.

Neurological diseases:

• multiple sclerosis,
• a historyof stroke.

Other diseases:

• liver failure
• kidneyfailure
• chronic obstructive pulmonary disease,
• night apnea.

Penile Diseases:

• Peyronie’s disease,
• penile fracture.

Injuries:

• spinal cord,
• pelvicfractures .

Other sexual dysfunction:

• loss or weakening of sexual need (libido)
• ejaculation disorders (most oftenpremature ejaculation),
• dyspareunia (pain during sexual activity in women).

Side effects associated with the treatment of other diseases:

• surgical trauma of nerves (e.g. removal of the prostate, rectum),
• removal of both testicles,
• pelvicradiotherapy ,
• medications (below).

Medicines:
(the problem is discussed in detail in the chapter on somatic diseases and mental disorders and drugs for sexuality used in their therapy)

• psychotropic (antidepressant, antipsychotic, anxiolytic).
• antihypertensive and circulatory (anti-arrhythmic, ß-blockers, diuretics, calcium channel blockers),
• hormonal and metabolic (antiandrogens, luteinizing hormone analogues,estrogens, statins, anabolic steroids),
• others (H2-blockers, metoclopramide, ketoconazole).

Lifestyle:

• sedentary lifestyle,
• smoking tobacco,
• excessive alcohol consumption,
• drugs (opioids, marijuana, cocaine),
• obesity.

Independent factors:

• aging.

Psychogenic factors:

• situational and reactive:
  • lack of privacy and intimacy,
  • predicting failure in sexual interaction (especially after failure; operation of the “vicious circle” mechanism),
• overwork, fatigue, acute and chronic stress,
• factors related to personality and its development:
  • starting a sexual life (lack of experience), a tendency to react with disorders in difficult situations,
  • insecurity in the male role,
  • anxiety towards women, sex, sexual phobias,
  • religious rigor and hostile attitude towards sex,
  • complex of a small member, inferiority,
  • unconscious homosexual needs or homosexual orientation,
  • unaware or unfulfilled special preferences and needs regarding the type of sexual activity or stimulation,
• dysfunctional and misconceptions and myths about male sexuality (examples):
  • “A real man doesn’t deal with things like communication or feelings”,
  • “Every touch is sexual and should lead to sex”,
  • “A real man is always good at sex”,
  • “Bigger is better”,
  • “Women won’t like me if I don’t get an erection”,
  • “A real man has no sexual problems”,
  • “I should be sexually fit all night”,
  • “The obligation to satisfy a woman rests on a man”,
• factors related to the partnership relationship:
  • conflicts in a relationship,
  • stressful behavior of a partner / partner,
  • loss of attractiveness or lack of attractiveness of a partner / partner,
  • sexual dysfunction in a partner / partner,
  • mistakes in the art of love,
  • unconscious hostile feelings towards your partner.

How common is erectile dysfunction?

World and national data currently provide a great deal of research data on the prevalence of erectile dysfunction.

For example, research data from eight countries show the following prevalence in different age groups:

• 20-29 years old -8%,
• 30-39 years of age – 11%,
• 40–49 years – 15%,
• 50–59 years – 22%,
• 60–69 years – 30%,
• 70–75 years – 37%.

The main conclusions of these studies are:

• the problem concerns all age groups, including the youngest men,
• the prevalence of the problem increases with age,
• older age is not absolutely related to the occurrence of these disorders.

How do erectile dysfunction manifest?

Erectile dysfunction is now considered not so much as a separate disease, but as a symptom of other diseases, especially of the cardiovascular system, as most of the risk factors are the same. Symptoms of disorders may increase gradually (the involvement of organic factors is more often suspected then, e.g. increasing vascular damage due to hypertension and excess cholesterol) or appear suddenly in a person who has been sexually well-functioning so far (the involvement of psychological factors, e.g. stress related to a new partner, acute stress related to another area of ​​life or a direct influence of other factors, e.g. drinking a lot of alcohol).

What to do in the event of symptoms?

A single or multiple occurrence of symptoms in a situation that can be psychologically understood or attributed to some factor, e.g. alcohol consumption, does not require action, especially when the elimination of this situation causes the symptoms to subside. However, repeated or persistent erectile dysfunction, increasing during erectile dysfunction, requires medical consultation in order to make a proper diagnosis. This doctor may be a sexologist, urologist, psychiatrist or internist. It may also make sense to visit a cardiologist, because erectile dysfunction may precede other symptomsof coronary artery diseaseand the resultingheart attackby several years .

How does the doctor make a diagnosis?

Erectile dysfunction is not a separate disease. Rather, they are considered a symptom that requires recognition of the underlying cause. Currently, the prevailing view is that in nearly 80% of cases the primary cause concerns organic factors (most often related to the circulatory system), and in 20% psychogenic factors. Psychological factors as secondary, i.e. in response to an emerging problem, seem to play a significant role in the majority of men, regardless of the primary cause, and therefore need to be considered in the comprehensive diagnosis and treatment of erectile dysfunction. Since erectile dysfunction can be a symptom of many serious diseases or have the same risk factors, their proper diagnosis and treatment is very important not only for the quality of sexual life of a man and a couple, but also for a person’s overall health.

The diagnosis is made by a doctor on the basis of the following tests to identify the underlying causes of erectile dysfunction:

• a detailed interview from the patient and his partner / partner,
• research using questionnaire methods and scales,
• biochemical and hormonal tests performed on the collected blood,
• urological examination, sometimes also neurological and internal medicine,
• apparatus methods (ultrasound of the penis vessels, devices for measuring night erections).

The interview must take into account the aforementioned factors that are potential causes or increase the risk of disorders, as well as the presence of nocturnal and morning penile erections – their presence suggests the involvement of psychogenic factors.

The most commonly used questionnaires and scales are:

• questionnaire to assess the sexual life of a man (IIEF-5),
• member hardness scale.

Among the biochemical and hormonal tests are performed (the choice will depend on the doctor depending on the history, the presence of other symptoms, previous results):

• blood count,
• sugar andlipidconcentration (lipid profile),
• liver tests,
• ionogram,ureaandcreatinine,
• thyroid hormone levels (TSH, fT3, fT4),
• total and free testosterone levels,
• SHGB (steroid-binding globulin),
• LH, FSH,
• PRL (prolactin),
• prostate specific antigen (PSA).
• Medical examinations may include:
• blood pressure measurement,
• per rectal examination (through the anus),
• palpation of the penis and testicles,
• Ultrasound of the penis vessels, testicles, pelvis,
• examination of nervous reflexes,
• general examination (auscultation, palpation).

What are the treatments?

The methods listed are discussed in more detail in the sections devoted to pharmacological and psychological methods of treating sexual disorders.Among the pharmacological methods, the doctor may suggest:
Drug treatment – oral:
selective and reversible inhibitors of phosphodiesterase type 5 (PDE 5),

• sildenafil,
• vardenafil,
• tadalafil,

other oral medications selected depending on the assessment of the mechanisms of the development of disorders:

• trazodone,
• bupropion,
• apomorphine,
• testosterone,
• bromocriptine,
• yohimbine,

Pharmacological treatment – in the form of injections into the cavernous bodies of the penis (injections):

• alprostadil (prostaglandin E1),

Vacuum apparatuses.

Surgical treatment:

• prosthesis of a member,
• unblocking of the penis vessels.

Physiotherapy – pelvic floor muscle exercises.

Psychological methods:

• sex education and sexual counseling,
• behavioral and training methods:
  • focus on sensory experiences,
  • sexual skills training,
  • communication training,
  • systematic desensitization,
  • other.
  Individual psychotherapy:
  • diversified goals, based on different schools of therapy and different selection of interventions,
  • psychosexual therapy.
  Steam therapy:
  • partner / marriage psychotherapy,
  • sexual therapy.
  Is it possible to recover completely?The possibility of complete recovery depends on the cause. The effectiveness of oral medications for treating erectile dysfunction is very high. In patients with severe vascular damage, advanced diabetes, damage to the penile tissues, and in patients with testosterone insufficiency, the effectiveness of oral medications is lower. It may also be caused by improper intake of oral medications. Similarly, good results are achieved after the use of injections into the cavernous bodies of the penis or vacuum devices. These methods may be effective and indicated in some patients who do not respond to oral medications or are unable to use them. Psychotherapeutic and training methods show good effectiveness in cases where the problem occurs at some point in sexual functioning (not, for example, throughout life), the partners have a good bond, there is mutual desire and good general health. It is often appropriate to combine pharmacological and psychotherapeutic methods.What should I do after treatment is finished?After completion of the basic treatment (symptoms disappearance, their severity decreased), further management, e.g. continuation of pharmacotherapy and / or psychotherapy, is determined by the physician. The patient should take the preventive measures described below. If the underlying cause of the disorder (psychological or health) is not corrected, the problem may recur. Sometimes it is not possible to remove the cause, e.g. permanent vascular or nerve damage as a result of surgery, severe atherosclerosis or severe diabetes.What to do to avoid getting sick?Erectile dysfunction is not a disease of its own, but rather is considered a symptom of other underlying diseases or conditions. Therefore, disease prevention will consist in the prevention of the most common diseases that may cause them and the elimination of risk factors, mainly related to the lifestyle, on which we have the greatest influence. The way of eating will be important, preferably with the use of the so-called Mediterranean diet, with lots of vegetables, processed grains, fish, and little animal fats and red meat. Regular, preferably daily exercise in the fresh air, giving up excessive drinking of alcohol, complete elimination of smoking, no drugs and unnecessary pharmacological agents not prescribed by a doctor should be recommended.Periodic health checks will also be important, taking into account the most common problems: blood pressure control, bloodglucose(sugar) control, and cholesterol determination (the so-called lipid profile).

• sex education and sexual counseling,
• behavioral and training methods:
  • focus on sensory experiences,
  • sexual skills training,
  • communication training,
  • systematic desensitization,
  • other.Individual psychotherapy:
  • diversified goals, based on different schools of therapy and different selection of interventions,
  • psychosexual therapy.Steam therapy:
  • partner / marriage psychotherapy,
  • sexual therapy.Is it possible to recover completely?The possibility of complete recovery depends on the cause. The effectiveness of oral medications for treating erectile dysfunction is very high. In patients with severe vascular damage, advanced diabetes, damage to the penile tissues, and in patients with testosterone insufficiency, the effectiveness of oral medications is lower. It may also be caused by improper intake of oral medications. Similarly, good results are achieved after the use of injections into the cavernous bodies of the penis or vacuum devices. These methods may be effective and indicated in some patients who do not respond to oral medications or are unable to use them. Psychotherapeutic and training methods show good effectiveness in cases where the problem occurs at some point in sexual functioning (not, for example, throughout life), the partners have a good bond, there is mutual desire and good general health. It is often appropriate to combine pharmacological and psychotherapeutic methods.What should I do after treatment is finished?After completion of the basic treatment (symptoms disappearance, their severity decreased), further management, e.g. continuation of pharmacotherapy and / or psychotherapy, is determined by the physician. The patient should take the preventive measures described below. If the underlying cause of the disorder (psychological or health) is not corrected, the problem may recur. Sometimes it is not possible to remove the cause, e.g. permanent vascular or nerve damage as a result of surgery, severe atherosclerosis or severe diabetes.What to do to avoid getting sick?Erectile dysfunction is not a disease of its own, but rather is considered a symptom of other underlying diseases or conditions. Therefore, disease prevention will consist in the prevention of the most common diseases that may cause them and the elimination of risk factors, mainly related to the lifestyle, on which we have the greatest influence. The way of eating will be important, preferably with the use of the so-called Mediterranean diet, with lots of vegetables, processed grains, fish, and little animal fats and red meat. Regular, preferably daily exercise in the fresh air, giving up excessive drinking of alcohol, complete elimination of smoking, no drugs and unnecessary pharmacological agents not prescribed by a doctor should be recommended.Periodic health checks will also be important, taking into account the most common problems: blood pressure control, bloodglucose(sugar) control, and cholesterol determination (the so-called lipid profile).