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Erectile Dysfunction: Causes and Treatments

Learn about erectile dysfunction, its causes, and how you can treat it.

Manly Minute: Episode 1: What is Erectile Dysfunction & Causes?

It’s not uncommon for men to experience difficulties with erections from time to time. However, if these problems persist, it may be a sign of erectile dysfunction (ED). ED is defined as the inability to get or keep an erection firm enough for sexual intercourse. While it can occur at any age, ED is more common in older men. There are many potential causes of ED, and often more than one contributing factor. In general, ED may be caused by:
  • Diseases or conditions that affect blood flow or nerve function involved in erections
  • Injuries that affect the nervous system or the blood vessels that supply blood to the penis
  • Psychological conditions, such as anxiety or depression
  • Certain medications
  • Substance abuse

Diseases or conditions that affect blood flow or nerve function involved in erections

A variety of diseases and conditions can lead to ED by affecting blood flow or nerve function involved in erections. These include:
  • Atherosclerosis – This is a type of arteriosclerosis, or hardening of the arteries. It occurs when plaque builds up on the walls of the arteries, narrowing the arteries and reducing blood flow to the penis.
  • Diabetes – This condition can damage nerves and blood vessels involved in erections. High blood sugar levels can also affect sexual function.
  • Heart disease – This can reduce blood flow to the penis.
  • High blood pressure – This can damage blood vessels and reduce blood flow to the penis.
  • Multiple sclerosis – This disease can damage the nerves involved in erections.
  • Parkinson’s disease – This disease can damage the nerves involved in erections.

Injuries that affect the nervous system or the blood vessels that supply blood to the penis

Injuries to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by affecting the nerves or blood vessels that are involved in erections. These injuries can include:
  • Pelvic surgery – This can damage the nerves or blood vessels involved in erections.
  • Prostate surgery – This can damage the nerves or blood vessels involved in erections.
  • Radiation therapy – This can damage the nerves or blood vessels involved in erections.
  • Spinal cord injury – This can damage the nerves involved in erections.

Psychological conditions, such as anxiety or depression

Anxiety and depression can both lead to ED by affecting the way the brain transmits messages between the nervous system and the penis. These conditions can also affect a man’s motivation to have sex, and can lead to performance anxiety.

Certain medications

A variety of medications can lead to ED by affecting blood flow or nerve function involved in erections. These include:
  • Anti-androgens – These are used to treat prostate cancer and can reduce libido.
  • Antidepressants – These can affect sexual desire and interfere with erections.
  • Anti-anxiety medications – These can interfere with erections by affecting sexual desire.</
Taylor Smith, PA-C

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Video transcription:

Hey guys, this is the man the minute with taylor. Today we want to focus on a really important concept and kind of talk all about what is erectile dysfunction. I think it’s really important for us to first understand kind of what that is and what that means before we can kind of talk about how how to fix it and how we can treat that, and so today, we’re going to focus on that topic. So, let’s dive in so this is a very common condition. Even here in the united states, it’s a very, very prevalent condition. That is something that we just want to be able to address with our patients, and so it affects approximately 50 percent of men over the age of 40, which is a very alarming statistic, and I think sometimes as guys we’re just maybe a little bit embarrassed or we don’t want to talk about it, but it does impact your life and your confidence both personally and in your in your relationships, and so we do want to be very open to discussion about this and and help where we can. So we want to kind of do an image to discuss kind of how erections work and and what the mechanisms are physiologically. What what happens when, when there is an erection, and so we’re going to kind of go over a brief, drawing and kind of step by step, explain how this physiology works all right so to understand the anatomy of the of the penis. I do want to kind of just refer to this, drawing or this graphic here, so the penis is basically a structure that contains three chambers, so in these upper two chambers, these are what are called the corpora cavernosa. So this is what fills with blood the sponge-like tissue will fill with blood as an erection is occurring which is coming from. The blood flow is coming from these penile arteries, so we have a penile artery in each of these chambers and then, of course, on each side. You’ll have that sponge-like tissue that will fill up with blood during an erection. This bottom tube is where your urethra is so. Basically, this is where your urine would come out from the penis as we’re urinating. So again, the the physiology- it’s all about the physiology here, so the penile arteries are gonna, fill with that blood. It’s gonna fill this sponge-like tissue and that’s what causes both girth and length of the penis to occur during an erection and make that something that’s able to be firm enough for sexual intercourse. So now that we know a little bit about how erectile function works, we kind of want to talk about the different types of erectile dysfunction that exist. So the first cause of reptiles function is when the chambers within the penile tissues, are not expanding or not that the blood flow is not getting into that area which does not allow that tissue to to reach that firmness. That is needed for for an erection, and so just like that picture demonstrated it’s all about those chambers that fill with that blood. That is going to provide adequate blood flow for a sustainable erection. So this would be noticed in men who are unable to maintain an erection at all. This would be kind of the pathophysiology behind that is. If a man cannot attain an erection, we know that something is not working within those chambers. The second cause of ed is when that blood will fill those chambers, but then it’s not staying there, so it’s escaping through other vessels in that area that are taking that blood away from that space, which allows a man not to be able to maintain an erection, so this type of ed would be for those men who can get an erection but have difficulty maintaining that erection during intercourse. So as we can see, it really truly is all about blood flow. That is where the the main source of ed comes from, and so whether or not there’s not adequate blood getting there or whether the blood is not staying there is, is the source of that ed. A super, interesting fact is that the arteries in the penis are actually some of the smallest in the body. So, unlike the coronary vessels that are maybe a little bit larger in diameter and in the brain where our arteries are larger, the penile arteries will be one of the first to start to experience any kind of blockages or signs of maybe there’s something going on with the vessels. And so, if you are experiencing erectile dysfunction, we definitely want to be making sure that your overall health is also better and in a good spot, checking your cholesterol levels and rolling out your chances for heart disease or your risk factors for heart disease, and so that can definitely be a sign that there may be something else coming in your future that if we can get on top of that now, your long-term health will improve. So, unlike many of our other arteries that have these backup flows, kind of different orders, that branch out from the main artery, the penile arteries actually do not have that, and so it’s just kind of one main artery that goes into those chambers. And so, if that one artery is, is blocked or not feeling. Well, then, that is there’s no backup for other vessels to be filling the the penile tissue, and so that’s another reason why erectile dysfunction is such a big deal, because it really you’re limited in how many arteries are going into that area, and so what we try to do with any kind of treatment is just allow more blood to be in those areas open up those arteries and get that blood where it needs to be. So that’s why we want the blood flow to get there in order to attain and maintain an erection. So as we age, it is a very natural process that our vessels do start to acquire some of these plaque buildups and some scarring, which is also called medically atherosclerosis, and so the penile arteries are, as we mentioned, one of the first ones that may start to notice these changes and what happens is as that scarring is building up there, even though there may be adequate sexual stimulation. The the functionality is not there, because that blood flow cannot reach those areas. There are many factors that can affect this high blood pressure, diabetes. Of course, environmental exposures, and then it is part of the natural aging process as well. So as as we’re treating your ed concerns, we also can kind of pay attention to your overall health, and we just want to make sure that we’re all inclusive in the things that we’re treating regarding men’s health so as mentioned before the other type of ed, would be where the the blood flow is getting there. But it’s not staying there. So we refer to this as venus leak, so the vessels around that area are actually taking that blood away and return it to other parts of the body. This results in inadequate firmness or intimacy. If you notice that you’re still able to attain an erection but not maintain the erection, then that would be the type of ed that we would be considering in this case, in another episode, we’ll kind of dive into some of the treatment options for both of these types of vertical dysfunction, so stay tuned. For that there’s definitely some things naturally, and also some really awesome interventions that we have available here now that we can help treat both of those sources of ed. There are, of course, some other causes of ed as well that we want to mention so the first one would be medication side effects. This can be from antidepressants. This can be from beta blockers, so we want to be really thorough in your work up. If there’s any medications that may be contributing to that. Seeing if there’s other medications we can switch to or or weed from to kind of help restore that that functionality, another one, would be pelvic surgery. So if you’ve had prostate surgery or bladder surgery for any reason, sometimes the nerves can be damaged during those procedures, and that can definitely be a contributory factor in aed kind of along those same lines, neurological damage, so spinal injuries or again, any kind of nerve injury that can impact erections is something that can also occur. Another big one is hormone deficiencies so testosterone. If your testosterone levels are a little bit lower or on the lower end of normal, we can optimize those levels and many times men will find that libido and qualit y of erections will return as we restore those to optimal levels and then, of course, the last one can be psychological, there’s, definitely a big psychological component to intimacy and if there’s anything that we can help with reducing anxieties or depression, any of those kinds of things. Of course we want to be able to address those with you as well. So the last topic I want to cover in this manly minute today is why treat early for ed. Some studies suggest that untreated ed can actually lead to penile shrinkage. The fact that that tissue becomes hypoxic or lacking oxygen actually contributes to the contractility of the penile tissues, and it affects the the weight that it can actually expand as that blood flow gets into those spaces. So if we catch ed early, your outcomes are going to be likely much more positive and be able to restore that oxygen and those that blood flow to those areas. Much sooner that will have long-term effects, both on quality of erections and potentially size of venous tissue. So if you have any questions or concerns about anything that you’ve heard during our manly minute today, if you can send those in to as a question to us or make a consult appointment with us, we’d be happy to discuss these with you and really just identify where we can improve your your health goals and how we can help you best. You.

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