Erectile Dysfunction: what it is and what’s behind it

What is erectile dysfunction and why does it occur?

Erectile dysfunction is defined as the persistent or recurrent inability to achieve and/or maintain an erection sufficient for sexual activity. It can be mild when penile rigidity is incomplete but allows completion of sexual activity, moderate when a complete or incomplete erection is achieved but lost before penetration can be achieved, and severe when only tumescence or no degree of erection is achieved.

Erectile dysfunction can occur throughout life, although it is more frequent in recent decades due to diseases associated with aging and their treatments. When it occurs in young men, it is usually caused by psychological disorders.

Erectile dysfunction is a disease that has a dimension greater than what is believed, since it affects both the sufferer and his partner, leading to disorders of self-esteem, of the couple’s relationship and of family, work and social life, and can trigger psychological pathologies as important as depression.

Erection is a highly complex function involving many factors (psychological, endocrinological, neurological, vascular, structural, etc.) at different levels (brain, spinal cord, penis). There are a great number of causes that can alter erection:

  1. Relationship, work or economic problems, as well as psychological disorders of different kinds.
  2. Testosterone deficiency.
  3. Neurological injuries or diseases (e.g. spinal cord injuries, radical prostate surgery due to cancer).
  4. Vascular pathologies and their risk factors (heart disease, diabetes, arterial hypertension, smoking, high cholesterol, obesity, sedentary lifestyle).
  5. Drugs (antihypertensives, antidepressants, hormonal drugs, etc.).
  6. Diseases or injuries of the penis (trauma, curvatures such as Peyronie’s disease).
  7. Drugs and other intoxicants.
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It should never be forgotten that, regardless of the origin of erectile dysfunction, the cerebral control of erection is affected in the short or long term.

What diseases may be behind the dysfunction?

In clinical practice, it is very common that important diseases such as arterial hypertension, diabetes, hypercholesterolemia or testosterone deficiency are often discovered after consultation for erectile dysfunction. Given the small size of the arteries that irrigate the penis, it is understandable that they can become obstructed by cholesterol and cause symptoms long before the coronary arteries, for example, which are of a much larger caliber, are affected. By being able to demonstrate that erectile dysfunction is of a vascular type, it allows us to initiate a series of measures that can prevent myocardial infarction in the future.

Therefore, erectile dysfunction, apart from the consequences it has on the sexual life of the affected person and his partner, can be the first manifestation of important diseases for general health that can be discovered or foreseen with an adequate diagnostic study by the andrologist, a specialist in male sexual function. The physician will perform a good clinical history and physical examination and, according to the data obtained, may request blood tests, a vascular study of the penis, tests to assess nocturnal erections or a psychological assessment of the patient.