Definition:
Erectile dysfunction (ED) is the difficulty in attaining or maintaining firm erection sufficient to permit satisfactory intimate relationship in more than 50% of the time. Sometimes referred to as impotence. [NHS policy]
The failure to get an erection in less than 20% of the time can occur for a variety of reasons, such as drinking too much alcohol, stress, relationship problems, or from being physically tired. This typically requires change in lifestyle.
Prevalence:
Studies showed about 15-72% of men under 40 suffer ED of organic aetiologies. About 50% of adult men are reported to suffer from erectile dysfunction and more common in men above the age of 40.
Erectile dysfunction is a highly personal problem that many men find it embarrassing or shameful to talk about and are reluctant to seek treatment.
Men with ED -if left untreated- may suffer from depression and low self-esteem, and put stress on relationships as men experience difficulties establishing and maintaining relationships (less sex than they used to).
Pathophysiology:
Erectile dysfunction (ED) is a neurovascular phenomenon modulated by hormonal, local biochemical & biomechanical/ structural factors of the penis.
Male organ is a cylindrical chamber which contain several blood vessels and tissues and one major artery in each chamber. During intercourse the brain sends chemical messages to the blood vessels in male organ to dilate the artery in each chamber allowing blood to flow inside to keep erection. If blood flow is insufficient or fail to stay inside chambers it will cause erectile dysfunction.
Causes:
Erectile dysfunction causes are classified into: aging, vasculogenic, neurogenic, endocrinological, drug-induced, psychogenic & other aetiologies e.g., Peyronie’s disease (PD), Degenerative skin conditions e.g. Lichen Sclerosis, or unhealthy lifestyle etc.
Any medical condition that affects the blood sinuses wellbeing, like:
-Diabetes Mellitus: (Type I & II) it was found that ED happens in 65% -75%
-Hypertension (15%), Atherosclerosis, Heart disease (39%), chronic kidney disease. ED is a strong predictor for coronary artery disease, and cardiovascular assessment of patients presenting with erectile dysfunction is now recommended.
-Vascular causes are commonly due to focal arterial occlusive disease.
Neurogenic causes:
Erectile dysfunction in young men can happen with Multiple Sclerosis, Epilepsy or by trauma in close proximity to the spinal cord are at increased risk of ED.
Psychological:
ED sometimes, has emotional or psychological causes. This is called psychogenic ED. It may happen when a man is feeling depressed or anxious, having problems with his relationship, or dealing with stress. Men who feel conflicted about sex because of religious or cultural beliefs may also experience reduced libido or arousal lag.
Medications/Substance abuse:
Erectile dysfunction can be induced by some medications-as a side effect, such as antidepressants, NSAIDs, finasteride (Propecia), antiepileptics and neuroleptics, chemotherapy etc.
Lifestyle
such as obesity, limited or an absence of physical exercise, excessive smoking or Substance or Alcohol abuse. Embarring STIs or prostatitis’ discharge or frequent lower urinary tract symptoms, have been linked to the development of erectile dysfunction
Peyronie’s disease (PD):
Erectile dysfunction can be associated with Peyronie’s disease. It is estimated that 8% of men with PD are under 40 years, with 21% of these individuals experiencing ED.
Degenerative skin diseases/ infections: causing pain-releated impotency e.g, Lichen Sclerosis, Lichen Planus, Herps Simplex, candidiasis, balanitis etc.
Post pelvic surgery:
ED happens due to blation of the pudendal nerve (e.g. to treat pelvic CA, e.g Radical Prostatectomy). The prostate gland is surrounded by nerves necessary for rigid erections. Surgeons may try to preserve as many of the nerves as possible, but erectile dysfunction (ED) is still a frequent result.
Endocrinological:
Are uncommon in the young population, however possible aetiologies include low Testosterone, DHT, DHEAS, PRL, PSA, Klinefelter’s syndrome, congenital or acquired hypogonadotropic hypogonadism.
Written by Dr. Nadia Yousri, OB&GY Surgeon & Regenerative Sexual Aesthetics Consultant, FRCOG, MRCOG, PhD, MSc & DFFP
YouTube: Dr. Nadia Yousri: https://youtu.be/PdTObUhTnyo
References
1-Aging and Erectile Dysfunction. Echeverri Tirado LC, Ferrer JE, Herrera AM. Sex Med Rev. 2016 Jan;4(1):63-73.
2-Endothelial dysfunction and erectile dysfunction in the aging man. Aversa A, Bruzziches R, Francomano D, Natali M, Gareri P, Spera G. Int J Urol. 2010 Jan;17(1):38-47.
3-Erectile dysfunction in the aging man. Aiser FE. Med Clin North Am. 1999 Sep;83(5):1267-78.
4-Exploring the relationship between depression and erectile dysfunction in aging men. Seidman SN. J Clin Psychiatry. 2002;63 Suppl 5:5-12; discussion 23-5.
5-Erectile dysfunction in aging male. Romanelli F, Sansone A, Lenzi A. Acta Biomed. 2010;81 Suppl 1:89-94.
6-Vasculogenic erectile dysfunction in teenagers: a 5-year multi-institutional experience. Tal R, Voelzke BB, Land S, Motarjem P, Munarriz R, Goldstein I, Mulhall JP. BJU Int. 2009 Mar;103(5):646-50.
7-Physiology of penile erection and pathophysiology of erectile dysfunction.
Dean RC, Lue TF. Urol Clin North Am. 2005 Nov;32(4):379-95, v.
8-Erectile dysfunction: anatomical parameters, aetiology, diagnosis, and therapy.
Hafez ES, Hafez SD. Arch Androl. 2005 Jan-Feb;51(1):15-31.
9-Relationship Between Cannabis Use and Erectile Dysfunction: A Systematic Review and Meta-Analysis.Pizzol D, Demurtas J, Stubbs B, Soysal P, Mason C, Isik AT, Solmi M, Smith L, Veronese N. Am J Mens Health. 2019 Nov-Dec;
10- Organic causes of erectile dysfunction in men under 40. Ludwig W, Phillips M. Urol Int. 2014;92(1):1-6.
11- Psychogenic erectile dysfunction. Classification and management.
Rosen RC. Urol Clin North Am. 2001 May;28(2):269-78.
External Link
“Shocking treatment to perk up a man’s flagging lovelife: Can erectile dysfunction really be cured with soundwaves?