Many men mistakenly think that erectile dysfunction (or ‘impotence’) is solely a physical or mechanical issue, but the reality is far more complicated. There are a great many causes for such a complex disorder including hormonal, drug-related, and most commonly in men under the age of 40; psychological.
There is no question that erectile dysfunction (ED) can be both distressing and embarrassing to many men, but addressing the underlying cause can be the most important and yet neglected solution. Too many men treat the physical symptoms only, thinking that this is sufficient. Very often the real cause is a combination of various factors which requires an equally complex solution.
The Four Causes of ED
It is important to note that ED can be caused by a number of different factors, and in order to get to the root of the problem it often needs a full diagnosis from a qualified medical professional. A doctor can take a look at your overall health and try to establish any physical, medicinal or emotional warning flags, they may also be able to refer you to a psychotherapist who may be able to deal with any potential psychological issues. Essentially they will be monitoring four types of causal factors:
Physical causes of ED include issues such as the narrowing of the arteries that supply a flow of blood to the penis. These issues are often caused, in turn, by other long-term medical conditions such as diabetes or heart disease.
Certain surgical procedures can also lead to erectile dysfunction, in particular surgery within the pelvic area might lead to injury of nerves or arteries which connect to the penis. It is also possible that surgery on the spine or the brain might cause ED. Some procedures which have been known to result in ED are Brachytherapy, Radiation Therapy (in particular for bladder, prostate, colon and rectal cancers), prostatectomy, abdominal perineal resection, aorto-iliac or aortofemoral bypass, cystectomy and cryosurgery of the prostate.
Hormonal & Drug-Relates Causes
Certain hormonal issues can result in erectile dysfunction, for instance men who have low levels of testosterone may have a reduced libido and diminished sexual arousal. Treatments often include injections of synthetic testosterone.
Some prescribed medicines or substances can have an effect on blood flow to the penis as well as libido and sexual arousal. One very common example would be alcohol, which reduces blood flow to the penis and can decrease the level of arousal a man feels before and during sex. Another common example would be antidepressants, which can alter the functioning of a person’s neurochemistry during sexual arousal.
Psychological issues can also play a significant part in the onset of erectile dysfunction. These issues include anxiety, fear, depression, a current relationship problem, or bad past experiences that have left psychological scars.
When a doctor is taking a diagnostic approach to resolving an ED problem, they will often seek to separate the physical and psychological causes of ED. It often comes to light that there is not just one single issue causing the problem, but a combination of physical and psychological causes which overlap and create a cyclical spiral.
Difficulties gaining or maintaining an erection can cause serious emotional and psychological reactions for the majority of men. In some instances a single case of ED can become self-sustaining as the anxiety and stress caused by the occasion brings on “performance anxiety” which then leads to further instances of ED. This is also known as “inorganic” ED.
In other cases simply growing older can cause ED in some men, possibly due to a lack of confidence in themselves or a failure of self-image. Therapy and communication with their partner can help resolve this significantly.
There are drugs available to tackle the symptoms of impotence and most men will be aware of the potential benefits that drugs like Viagra have to offer, but lifestyle and ED are often inextricably linked and a review of the man’s overall lifestyle can often lead to a potential resolution of their erection difficulties.
Common lifestyle factors that are common contributory causes of ED include: stress, being overworked, being overweight, and excessive consumption of alcohol. Sexual function can be heavily influenced by a person’s overall physical and mental wellbeing and ED can be considered to be a warning sign that they are not currently maintaining a healthy enough lifestyle to have an active and un-troubled sex life.
Even the most effective ED treatments available will struggle to make a significant impact against constant fatigue and not enough sleep, all of which may also potentially start to have an impact on the relationship as well.
A realistic and honest appraisal of your current lifestyle and some changes made as result of this can have a significant impact on your physical and mental wellbeing, and ultimately your sex life. Plenty of restful sleep, combined with a reasonable level of exercise, quitting smoking and reducing alcohol, will all combine to bring a number of health benefits and a likely improvement in your sex life.
When you look at the profile of men who are experiencing ED, you will often find that depression and anxiety are a common feature. It is often the case with most forms of psychological illness that the person experiencing these problems will possibly be reluctant to face up to the fact that they have an issue that needs addressing. This reluctance to accept the issue is heightened by the perceived stigma attached to forms of mental illness and to erectile dysfunction.
It is fairly common knowledge throughout the medical profession and in general, that men are more likely to try and ignore or suppress depression than women, but it is quite difficult to ignore when the problem manifests itself through ED by becoming a physical condition. The vast percentage of men who have been diagnosed as suffering from severe depression will also have ED, and they will need to receive appropriate treatment for their depression before any medical measures to tackle ED are likely to succeed.
Tackling the problem together
The physical aspects that lead to ED are often the first thing diagnosed but the psychological aspects are equally as important, especially if the man is in a relationship. It is often a successful way to treat ED by treating the couple rather than the individual, so communication with a partner and talking about the problem affecting their love life and how to resolve it, will be a crucial aspect in returning things to normal in the future.
When tackling the causes of ED it is always important to take into account the psychological as well as the physical problems that are often combining to create a problem.
Dr Tom Brett trained St Thomas’ Hospital Medical School in London and graduated in 1992, a year later he immigrated to Australia where he began post-graduate General Practitioner training. In 1998 he gained fellowship of the Royal Australian College of General practitioners and later, in 2000, was awarded a certificate in Sexual Health and HIV prescribing. In 2007 he returned to live and work in London and is now Medical Director for the Lloydspharmacy Online Doctor service.