By Sheldon Marks, M.D.
Dr. Marks is a prominent Tucson-based urologist, surgeon and colleague of Dr. Weil and a DrWeil.com Expert.
Erectile dysfunction (ED) is the ultimate whole-body health problem facing men. Normal erections require a complex and delicate balance of many bodily functions, all finely tuned and working together - psychological, hormonal, neurological, vascular and general health factors. Any disruption or imbalance of one or more can compromise erection quality.
Normal sexual intimacy is important for many couples to maintain a satisfying quality of life. This is especially true today, as our population ages and concerns over ED become more openly discussed in the media and at home. Men and women accept that sexual problems are more common and can be readily corrected.
This article will review the most common health problems that can lead to ED. The key is that you must take this information and talk to your doctor. It is important to know that often ED is a first warning sign for many serious and potentially dangerous health problems. If you have any questions, talk to your doctor.
Emotional/psychological health - Depression and other mental health problems are a common cause of ED. Not only can depression itself cause problems obtaining and maintaining an erection, depressed men often complain of a lack of interest in sex (libido). To make matters worse, many of the medications that treat depression can worsen erections or decrease libido even more. Some of the newer anti-depression medications have fewer sexual side effects, so be sure to tell your doctor that sexual function is a concern for you. Stress at work or home can block normal erections. In fact, simply worrying about your erections (performance anxiety) is enough to lead to problems.
Arteries and veins - A healthy blood supply to the penis is necessary for erections. The small arteries that bring blood to the penis are often damaged by years of high blood pressure, high cholesterol, or diabetes. Abdominal or pelvic artery problems such as an abdominal aortic aneurysm or its surgical repair can also lead to difficulties obtaining an erection. Problems with the veins that drain from the penis can cause ED as well. Often the onset of ED is a warning sign of potentially dangerous blockage of the coronary arteries that can lead to heart attacks. Unfortunately, many of the medications that treat high blood pressure can also cause erectile dysfunction as well.
Nervous system - An intact and functioning nervous system is important for normal erections. The nervous system includes the deep brain as well as the nerves that travel throughout the body, especially to the penis. Injury to these nerves, such as after a stroke, surgery, injury, from a tumor or neurologic disorder such as MS, can interfere with erections. Structures deep within the brain control the body's nerves and hormones that are necessary for normal sexual drive and function.
Hormones - A finely-tuned balance of hormones is required for normal erections. This balance includes having normal levels of testosterone, low levels of estrogen (yes, men have some estrogen in their system), as well as normal thyroid levels. Small non-cancerous pituitary gland growths can secrete high levels of prolactin, a hormone that causes ED and often breast enlargement. Obesity can play a role in ED as well. The extra fat cells in the abdomen of men convert testosterone to estrogen, interfering with the normal testosterone/estrogen balance.
Social habits can seriously compromise erection quality. Excess alcohol can cause liver damage and change the balance of hormones. Tobacco smoking over years is known to damage the blood supply to the penis. Distance bike-riding with old style narrow bike seats can cause ED from compression and damage of the delicate nerves and blood vessels which feed blood to the penis.
Pelvic surgery or radiation, including treatments for prostate, bladder or colo-rectal cancer and the repair of abdominal and pelvic artery problems are also known to cause ED.
Many prescription medications have ED as a common side effect. If you think that a medication you have been prescribed may be the culprit, talk to your doctor. The good news is that there are many alternative medications that may have fewer ED side effects.
Your general health is crucial to normal sexual function. Men with long-standing illnesses like chronic liver disease or kidney failure often have ED. Diabetic men commonly develop ED from damage to the small blood vessels and nerves in the pelvis. Men with sleep disorders such as sleep apnea often complain of erection problems. It is thought that when ill, the body conserves limited energy and so it reduces less vital functions, such as erections, that are not necessary to immediate survival
Age itself is not a cause of ED, but is often associated with health changes that result in ED. The aging population has a higher rate of impotence from many problems seen more commonly in older men. This includes small blood vessel damage, high blood pressure, elevated cholesterol, diabetes, depression and sleep apnea.
The bottom line - if you have erection problems, be sure you ask your doctor for a complete evaluation. It could be something easy to remedy, or it may be an early warning of something far more serious. The good news, whatever the cause, safe and very effective treatments exist to restore your normal erections.
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