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Erectile Dysfunction Overview

Causes of Erectile Dysfunction

There are two fundamental reasons for not being able to achieve or sustain an erection: medical problems and psychological problems. The two often are intertwined. It's natural to develop emotional problems as a result of coping with a physical problem, and ED is no exception. But we'll talk about the physical reasons for ED first.

Medical Problems
Since the arteries and veins are so critical to achieving and maintaining an erection, any disease or disorder that damages them or impairs blood flow through them can cause ED. It makes sense, then, that most of the disorders associated with erectile dysfunction affect the arterial system. Diabetes is probably the single greatest cause of erectile dysfunction, with 35 to 50 percent of diabetic men affected. That's because diabetes causes vascular disease (disease affecting the blood vessels, including veins and arteries) and nerve damage, both of which directly impact the ability to achieve an erection. Many men with diabetes develop erectile dysfunction during their young- and middle-adult years, although their physicians frequently fail to make them aware of this complication. And many men experiencing ED who seek treatment for it often discover that their underlying problem is undetected diabetes or atherosclerosis (hardening of the arteries)--a good reason, if you need one, to seek help.

Any disease or disorder that damages them or impairs blood flow through them can cause ED.
©2006 Publications International, Ltd.
Any condition that impedes blood flow can cause ED.

In addition to diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, and vascular disease account for about 70 percent of all cases of ED. Other risk factors for erectile dysfunction include hypertension (high blood pressure); hyperlipidemia (excess fat or lipids in the blood); hypogonadism (decreased activity of the reproductive glands); endocrine disorders; smoking; anemia; trauma or injury to the pelvis or spine; coronary artery disease; Peyronie disease (a painful curvature of the penis, making penetration impossible); disease of the erectile tissue of the penis; vascular, colon, or prostate surgery; and depression. If you have any of these conditions, your primary care physician should ask you, during your routine medical exam, if you are experiencing any sexual dysfunctions. Primary care physicians can and should be the first line of diagnosis and treatment for men with ED. However, if your physician doesn't ask, bring up the topic yourself. Many primary care providers simply are not sensitive to problems of sexual dysfunction and do not actively look for symptoms, although that is beginning to change now.

Medication: ED is also a side effect of many common drugs, including prescription and over-the-counter medications and illegal drugs. It's estimated that 25 percent of all cases of ED have medication as their underlying cause.

Drugs taken for any of the following conditions may hamper your sexual functioning: high blood pressure, angina, ulcer, irritable bowel syndrome, anxiety, depression, psychosis, obesity, heroin addiction, alcoholism, tuberculosis, insomnia, prostate cancer, and glaucoma. If you are taking medication for any of those conditions and suspect it may be responsible for your ED, see your doctor right away; don't stop taking the medication on your own! Although your medication may be causing problems, the condition it was prescribed to treat can just as easily be the problem.Your doctor should be the one to decide whether the drugs are responsible for your ED problems and, if so, what to do about it. In many cases, stopping or switching the medication restores erectile functioning.

The following detailed list of prescription drugs has been reported to cause problems with erections, desire, potency, or ejaculation. Brand names are listed first, followed by generic names in parentheses:

  • High blood pressure and antianginal medications:

    • alpha adrenergic blockers, including Cardura (doxazosin), Dibenzyline (phenoxybenzamine), Esimil (hydrochlorothiazide and guanethidine), Flomax (tamsulosin), Ismelin (guanethidine), Hylorel (guanadrel), Hytrin (terazosin), Minipress (prazosin), Minizide (polythiazide and prazosin), and Uroxatral (alfuzosin)

    • a medication that contains methyldopa, such as Aldoclor, Aldomet, and Aldoril

    • andrenergic stimulants, such as Catapres (clonidine), Combipres (clonidine and chlorthalidone), Tenex (guanfacine), and Wytensin (guanabenz)

    • angiotensin converting enzyme (ACE) inhibitors, such as Lotensin (benazepril), Capoten (captopril), and Vasotec (enalapril)

    • beta blockers, such as Corgard (nadolol), Inderal (propranolol), Levatol (penbutolol), Lopressor (metoprolol), Sectral, (acebutolol), Tenormin (atenolol), Toprol (metoprolol), and Visken (pindolol)

    • calcium channel blockers, such as Adalat or Procardia (nifedipine), Calan or Isoptin or Verelan (verapamil), Cardene (nicardipine), Cardizem or Dilacor (diltiazem), Dynacirc (isradipine), Norvasc (amlodipine), Plendil (felodipine), and Vascor (bepridil)

    • diuretics, such as Aldactone (spironolactone), Bumex (bumetanide), Lozol (indapamide), Midamor (amiloride), and Mykrox or Zaroxolyn (metolazone)

    • combination drugs containing reserpine, such as Diurpres, Hydropres, and Ser-Ap-Es;drugs for enlarged prostate conditions (BPH), such as Avodart (dutasteride) and Proscar (finasteride)

  • Ulcer and irritable bowel syndrome medications that might cause ED include Donnatal and Kinesed (belladonna alkaloids and phenobarbital), Levsin (hyoscyamine), Pro-Banthine (propantheline), Quarzan (clidinium), Robinul (glycopyrrolate), and Tagamet (cimetidine).
    Antianxiety drugs that might cause ED include BuSpar (buspirone), Centrax (prazepam), Limbitrol (chlordiazepoxide and amitriptyline), Valium (diazepam), and Xanax (alprazolam)

  • Many antidepressants can cause erectile problems; these include monoamine-oxidase (MAO) inhibitors such as Marplan (isocarboxazid), Nardil (phenelzine), and Parnate (tranylcypromine); serotonin-reuptake inhibitors, such as Prozac (fluoxetine) and Zoloft (sertraline); and tricyclic antidepressants, such as Ludiomil (maprotiline), Anafranil (clomipramine), Asendin (amoxapine), Elavil or Endep (amitriptyline), Etrafon or Triavil (perphenazine and amitriptyline), Norpramin (desipramine), Pemlor (nortriptyline), Sinequan or Triadapin (doxepin), Surmontil (trimipramine), Tofranil (imipramine), Vivactil (protriptyline), Desyrel (trazodone), and Wellbutrin (bupropion)

  • Many antipsychotics affect potency, including Clozaril (clozapine); Compazine (prochlorperazine); Haldol (haloperidol); Eskalith, Lithane, Lithium, Lithobid, Lithonate, Lithotabs, or Cibalith-S (lithium); Mellaril (thioridazine); Navane (thiothixene); Prolixin (fluphenazine); Serentil (mesoridazine); Stelazine (trifluoperazine); Taractan (chlorprothixene); Thorazine (chlorpromazine); and Trilafon (perphenazine)

  • Amphetamines such as Desoxyn (methamphetamine) are prescribed for weight loss and can cause ED

  • Treatments for various diseases and addictions have been reported to cause impotence or erectile dysfunction. These include Methadone for heroin addiction, Antabuse for alcoholism, Trecator for tuberculosis, Doral for insomnia, glaucoma medications, and any estrogen- or progesterone-containing drugs used to treat prostate cancer.

Alcohol and nicotine: Many people seem to think that a good, stiff drink heightens the sexual experience. Actually, nothing could be further from the truth. Alcohol is a depressant, and, when consumed in more than small amounts, it really reduces the ability to have an erection. And it's well known that alcohol can have harmful effects on the body that can cause many long-term health problems, including physical problems with having and maintaining erections. Cutting back on or giving up alcohol altogether can have many healthy benefits, including eliminating a major cause of ED.

Nicotine has both an immediate and a long-term effect on erections. Nicotine directly interferes with the nerve pathways that produce and maintain an erection, and tobacco smoke causes heart disease and circulatory problems that reduce the supply of blood to the penis and destroy the flexibility of tissues. There really are no good reasons to smoke, but who would have thought that a better sex life might be a reason to quit? It's true, but it's wise not to expect miracles, either. Cutting back on alcohol and quitting smoking won't restore full potency overnight, and you may never restore the vigor you once had. But smokers and drinkers who clean up their acts see improvement in their sex lives and their overall health.

Nicotine has both an immediate and a long-term effect on erections.
©2006 Publications International, Ltd.
Smoking has both an immediate and a long-term effect on erections.

ED is often assumed to be a natural result of the aging process, to be tolerated along with other conditions associated with advancing age, such as hearing loss and vision impairments. But that's just another common misconception. ED does increase progressively with age -- it strikes 5 percent of men who are 40 years old, but that number rises to 15 to 25 percent for those age 65 and older -- but it's important to understand that it is not an inevitable consequence of aging. That bears repeating: Erectile dysfunction is not an inevitable consequence of aging.

The reason that the incidence of ED increases with age has to do with other age-related conditions. The older you are, the more likely you are to have developed diabetes, vascular disease, hypertension, or other diseases that increase the risk for erectile dysfunction. ED can also be a consequence of medical treatments for other specific illnesses. Routine surgery, such as prostate surgery, can injure nerves and arteries near the penis, causing ED. Injury to the penis, prostate, or bladder can be contributing causes of erectile problems by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa. Medication, as mentioned earlier, is a common cause. And years of cigarette smoking or alcohol or drug abuse begin to take a heavier toll on the body as we get older. These, too, can interfere with the ability to have an erection.

Psychological Factors
Until recently, it was mistakenly believed that ED was primarily a psychological problem. Men were made to feel their inability to achieve an erection was mostly "their fault." Many health care professionals believed erectile dysfunction was caused by mental or emotional problems, and patients were told, in effect, "It's all in your head."

But today, experts believe that most cases of ED are caused by physical problems related to the circulatory and/or nervous systems. Psychological factors are thought to be the primary cause of only 10 to 20 percent of the cases of ED. Depression, for instance, is a major psychological cause of erectile dysfunction.

That's not to say that there isn't a psychological aspect to ED, even when depression or some other psychological problem is not the direct cause. There is a psychological element in virtually all cases of ED. Psychological factors include stress and anxiety from work or home; worry about poor sexual performance; marital problems; unresolved sexual orientation; depression; and fear or anxiety about contracting sexually transmitted diseases, including HIV/AIDS. And performance anxiety (fear of failure) is self-fulfilling, as anxiety produces adrenaline, which constricts the penile tissue and prevents an erection. All of these issues reduce erotic focus or awareness of sensory stimulation that normally would be arousing. These factors are broadly associated with more than 80 percent of cases of impotence, usually as secondary reactions to underlying physical causes.

Whether a man's erectile problem is caused by physical or psychological factors, or a combination of the two, it is likely to become a source of mental, emotional, and physical stress. Erectile problems frequently have a profound effect on self-esteem and self-confidence. The ability to function sexually helps men define their role and shapes their identity. Loss of erectile function can be devastating.

Many men suffer in silence, convinced that they have no one to confide in, no one who will understand. Even if they don't blame themselves, they believe that others will. And they think that "real men" don't talk about their problems anyway.

Men experiencing ED have many other worries, too, which only compound their problem. They worry that they are failures as men and wonder if their partners will leave them. Because of the emotional pain associated with ED, it's common for men to make excuses to avoid sex with their partners. This can make a partner feel inadequate or unattractive, leading to rejection, loneliness, or depression. Women sometimes wonder if their partner is having an affair. The common failure of the man to communicate his condition only makes matters worse.

Seeking help for erectile dysfunction can also be a source of stress for the patient. Though doctors are well versed in the causes and reasons for the conditions, apprehension can stop some men from seeking medical advice. The truth is, treatment for ED is similar to the treatment of any other medical condition. In the next few sections, we will show you what you can expect when you seek a doctor's help for erectile dysfunction. We'll get started in the next section with diagnosis.

­This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider. ­