Erection problems: symptoms, causes and treatment

Medically reviewed: 1, February 2024

Read Time:8 Minute

Causes of erectile dysfunction

Problems with erection (erectile dysfunction) can be caused by organic causes associated with blood vessels, nerves and hormones, or psychological factors. Current statistics indicate that 80% of all problems with erection were caused by organic causes.

Usually an erection occurs when the imagination or sensations (sight, hearing, touch, smell, taste) get stimulation and the person experiences excitement. The central nervous system begins to send nerve impulses that increase blood flow to the penis. Blood fills the spongy tissues (cavernous bodies) inside the penis, which leads to its increase in volume and gaining rigidity.

  • For the appearance of an erection, the following four factors are necessary:
  • A normally functioning nervous system that will send out the necessary signals to the penis.
  • An intact system of blood vessels (cardiovascular system), allowing blood to flow freely into the vessels of the penis and flow without interference.
  • Healthy smooth muscle tissue of the penis, which should be relaxed so that the penis can be filled with blood and grow in volume.
  • The ability to hold the blood in the penis so that it remains rigid.

The number of organic causes of erectile dysfunction includes long-term (chronic) or short-term (acute) lesions and complications caused by surgery on the prostate or any other operation associated with nerve impulses or blood supply to the penis.

In men over 50, physical difficulties are often the cause of difficulties with erection.

What can cause erectile dysfunction?

  • Problems with the blood vessels (vascular system problems) can prevent the penis from filling up with blood or its finding inside the penis long enough to support an erection. For example, prolonged high blood pressure can damage blood vessels and lead to erectile dysfunction.
  • Problems with the nerves (neurological problems) can interfere with signals of excitation from the brain and spinal cord to reach the penis.

Nervous disorders such as Parkinson’s disease, Alzheimer’s disease, multiple sclerosis and angina pectoris can adversely affect the male ability to achieve an erection and reduce sexual desire. Nerve damage due to diabetes, postoperative complications and spinal cord injuries can also cause erectile dysfunction.

Problems with the structural feature of the penis or surrounding tissues can interfere with erection.

Hormonal factors, such as low levels of testosterone, can create problems with erection.

  • The side effects of medications (for example, those prescribed for high blood pressure or depression) may include problems with erection.

In some cases, it is possible to change the dose of the medicine or replace it with another.
The use of tobacco, alcohol or illicit drugs can lead to problems with erection. Termination of their intake or restriction in the use of these substances can alleviate the problem with erection.

  • Activities that limit blood flow to the penis can also lead to erectile dysfunction.

Some doctors have noticed that men who regularly cross long bike distances have erection problems more often than those who use the bicycle from time to time, especially if their bicycle seat is narrow and stiff. Nevertheless, the possible connection between riding a bicycle and problems with erection has not been proven.

  • Vasectomy usually does not cause problems with erection.

However, postoperative pain can have a negative effect on sexual activity for a while, and if a man feels uncomfortable with a decision to undergo a vasectomy, or if he has come to such a conclusion after mature reflection, this fact can negatively affect his psychological state.

  • The psychological causes of problems with erection include depression (which also has an organic component), anxiety, stress, grief, or problems with current or past relationships.

This negatively affects the erection, distracting the man from the things that usually aroused him. Erectile dysfunction in men under 40 years of age who do not have any organic risk factors is more likely to be caused by psychological rather than physical causes.

Problems in relationships can lead to erectile dysfunction. This can happen if a man has become widowed or has lost sexual interest in a particular partner.

Some men develop erectile dysfunction when they start thinking about marriage. Some men find it difficult to have sexual relations with a partner after the birth of the first child.

Blood vessels and erection problems

Since an erection causes the filling of the penis with blood, problems with the blood vessels can lead to problems with erection (erectile dysfunction). Such problems with vessels include:

  • Arteries hardening (atherosclerosis) in the penis, which can block the flow of blood to the penis or to the arteries filling the arteries of the penis.
  • Side effects of medications that negatively affect the blood vessels (for example, some diuretics or other medicines for high blood pressure) that can disrupt the process of filling the penis with blood.
  • The leakage of blood from the spongy cells (cavernous bodies) of the penis through the veins, which carry blood from the penis. This can lead to the inability to withhold an erection.

Hormonal factors and problems with erection

Hormonal factors can play a role in problems with erection (erectile dysfunction). Men with low production of the hormone testosterone (a disorder called hypogenitalism) may have a decreased sexual desire. Usually, if the doctor suspects such a problem, you are scheduled to undergo a blood test for testosterone. However, only a small percentage of men with erectile dysfunction have a lowered level of testosterone in the blood.

Increased production of the hormone prolactin (hyperprolactinemia) can also be the cause of problems with erection. A high level of the hormone prolactin disrupts the production of testosterone, leading to hypogenitalism.

There are special drugs for the treatment of reduced production of testosterone and increased production of prolactin.

Prescription drugs and erection problems

Some drugs can cause problems with erection (erectile dysfunction). Inform your doctor about taking these medications. If you have problems with erection, these drugs can cause or aggravate them. The doctor can change the dose of the medicine or prescribe an alternative treatment.

The number of drugs, in most cases causing problems with erection, includes:

  • Clomipramine hydrochloride, used to treat obsessive-compulsive disorder.
  • Flutamide, used to treat prostate cancer.
  • Leuprolide acetate, used to treat prostate cancer.
  • Naltrexone hydrochloride, used to treat alcohol dependence.

Among other drugs that can negatively affect erectile function, include drugs from:

  • Parkinson’s disease, for example levodopa.
  • Nausea and vomiting, such as prochlorperazine and promethazine.

Erection problems: what are the Symptoms?

Symptoms of problems with erection (erectile dysfunction) include the inability:

  • To achieve an erection at any time with the help of masturbation or with a sexual partner.
  • Maintain an erection sufficient for sexual intercourse.
  • Maintain an erection before the end of sexual intercourse.

Even having problems with erection, a man can continue to experience sexual desire, be able to reach orgasm and ejaculate.

Problems with erection (erectile dysfunction): What happens?

Most men have problems with erection (erectile dysfunction) from time to time. But when problems with erection become permanent, they can negatively affect your perception of yourself, your sex life and your relationship with a partner.

If you constantly suffer from erectile dysfunction, then the so-called “fear of a possible failure” can exacerbate the problem. If you can not maintain an erection sufficient to have sex, or you experience an orgasm before or immediately after intromission (premature ejaculation), you may feel frustrated and think that you are not satisfying your partner. All these factors can influence how you imagine your further relationship.

Fortunately, many of the organic and psychological factors that cause erectile dysfunction can be treated.

Premature ejaculation

Premature ejaculation is uncontrolled ejaculation, which occurs before or soon after the onset of intercourse. Ejaculation occurs earlier than a man would like, with minimal sexual stimulation.

Premature ejaculation is the most common form of male sexual dysfunction. Its cause is often unclear, but may be related to a lack of sexual experience or to psychological factors, such as fear or depression. In some cases, the underlying cause of the disorder may be the underlying health problem or the side effect of medications taken.

Treatment of premature ejaculation depends on its cause and can consist of counseling, behavioral therapy, or, in some cases, the taking of medications that delay or restrain orgasm.

What increases the risk

The risk of developing problems with erection (erectile dysfunction) increases with age.

  • Approximately half of men between the ages of 40 and 70 complain of erectile dysfunction.
  • More than fifteen out of a hundred men aged 40 years report periodical problems with erection. But 2 times more (30 men out of 100) at the age of 70 years report periodical problems with erection.
  • While only 5 men out of 100 at the age of 40 complain of severe erection problems, three times as many men (15 out of 100) at the age of 70 report serious problems with potency.

Diseases, physical or psychological problems and certain activities can also increase this risk.

The number of diseases affecting the blood vessels includes:

  • Diabetes. About half of diabetic men suffer from problems with erection.
  • Elevated blood pressure or other diseases of blood vessels.
  • Elevated cholesterol or low HDL cholesterol (high-density lipoprotein).

Diseases or procedures that negatively affect the nervous system:

  • Diabetes.
  • Multiple sclerosis.
  • Angina pectoris.
  • Parkinson’s disease.
  • Surgery on the prostate, bladder, rectum or urethra. These procedures can damage the nerve endings involved in achieving and maintaining an erection.

Other disorders that increase the risk of impotence include:

  • Problems with the thyroid gland.
  • Low levels of hormones necessary for normal development and functioning of the genital organs (hypogonadism), which leads to a decrease in testosterone levels.

The number of injuries or treatments that increase the risk of impotence include:

  • Injury of the penis or pelvic region.
  • Trauma of the spinal cord or nerve endings of the penis.
  • Operation in the pelvic region.
  • Irradiation in the pelvic region.

Medicines and other substances that increase the risk of impotence:

  • Some medicines for high blood pressure or depression.
  • Prolonged (chronic) alcohol abuse.
  • Drug addiction.
  • Consumption of tobacco.

Among the psychological risk factors are:

  • Depression.
  • Anxiety or stress.
  • Recent major changes in life (childbirth, retirement, job change, relationship breakdown or partner death, divorce or marriage).

Activities limiting penile blood supply, such as riding a long distance bicycle on a hard narrow seat, may increase the risk of developing erectile dysfunction. However, discussions on this issue among experts are still underway.

Vasectomy usually does not cause problems with erection. However, postoperative pain can have a negative effect on sexual activity for a while, and if a man feels uncomfortable with a decision to undergo a vasectomy, or if he has come to such a conclusion after mature reflection, this fact can negatively affect his psychological state.

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