Erectile Dysfunction

Sexual health and function are important determinants of quality of life. Disorders such as erectile dysfunction (ED) and female sexual dysfunction are becoming increasingly more important as a result of the aging population and newer therapies. Because this subject is discussed widely in the media, men and women of all ages are seeking guidance in an effort to improve their relationships and experience satisfying sexual lives.

Erections occur in response to tactile, olfactory, and visual stimuli. The hypothalamic and limbic pathways play an important role in the integration and control of reproductive and sexual functions.

Sexual behavior involves the participation of autonomic and somatic nerves and the integration of numerous spinal and supraspinal sites in the CNS. The penile portion of the process that leads to erections represents only a single component. The ability to achieve and maintain a full erection also depends on the status of the peripheral nerves, integrity of the vascular supply, and biochemical events within the corpora.

CAUSES

The causes of ED is usually multifactorial. Organic, physiologic, endocrine, and psychogenic factors are involved in the ability to obtain and maintain erections. In general, ED is divided into organic and psychogenic impotence, but most men with organic etiologies usually have an associated psychogenic component. Almost any disease may affect erectile function by altering the nervous, vascular, or hormonal systems. Various diseases may produce changes in the smooth muscle tissue of the corpora cavernosa or influence the patient’s psychologic mood and behavior.

Diabetes is a well-recognized risk factor, with approximately 50% of diabetic men experiencing ED. The etiology of ED in diabetic men probably involves both vascular and neurogenic mechanisms. Evidence indicates that establishing good glycemic control can minimize this risk.

Cigarette smoking has been shown to be an independent risk factor.

Mental health disorders, particularly depression, are likely to affect sexual performance.

A sedentary lifestyle is a contributing factor to ED.

Vascular diseases account for nearly half of all cases of ED in men older than 50 years. Vascular diseases include atherosclerosis, peripheral vascular disease, myocardial infarction, and arterial hypertension.

Prostatic surgery for benign prostatic hyperplasia has been documented to be associated with ED in 10-20% of men. Radical prostatectomy for the treatment of prostate cancer poses a significant risk of ED.

Some medications can leads to ED. Eg. 

  • Antidepressants
  • Antipsychotics
  • Antihypertensives
  • Antiulcer agents, such as cimetidine and finasteride
  • 5-Alpha reductase inhibitors
  • Cholesterol-lowering agents