Erectile dysfunction (ED) is manifest currently in 20-30% of adult men in the United States. Multiple large surveys reveal that men 40 years and older have experienced some (minimal, moderate or complete) ED. A touchy subject (no pun intended) for many often because of the many misconceptions regarding the source of ED. Those with ED worry (contributing to the ED) that their partner(s) will think that they are not sufficiently virile or “manly” or “potent”. In addition, those whose partners suffer from ED worry that the ED is a result of their not being attractive or some other “fault” of theirs.

Here are some of the myriad of reasons ED occurs:

  • Use of “anti-depressants”: Medication used to increase serotonin levels in the brain often has sexual side effects including ED.
  • Use of neuroleptics: Medication used to treat various conditions including bipolar disorder, insomnia, anxiety, schizophrenia and other psychotic disorders as well as other psychiatric conditions almost invariably increase prolactin levels in the blood resulting in ED.
  • Use of 5 alpha-reductase inhibitors: Medication (Finasteride aka Proscar or Propecia or Dutasteride aka Avodart) used to treat male pattern baldness and prostate enlargement by reducing levels of dihydrotestosterone (DHT) can sometimes cause ED.
  • Use of nicotine and cigarette smoking: These increase risk of ED via several mechanisms including negative effects on vasculature, nitric oxide production, and the central nervous system.
  • Endocrine imbalance/dysfunction: Low testosterone and/or high prolactin levels can lead to ED as well as other sexual dysfunction.
  • Psychological factors: Depression, anxiety (general or performance-related), and PTSD can also effectuate ED. An interesting psychological factor of late with the advent of the internet is psychogenic hypo-arousal ED related to overexposure to pornography.
  • Anatomical irregularity: Valvular dysfunction (essentially a “leak” allowing blood to leave the penis) and penile tissue scarring (Peyronie Disease) can result in blood flow related ED.
  • Dyslipidemia: High “bad” (LDL) cholesterol and/or low “good” cholesterol can lead to ED via their negative effects on the vasculature.
  • Chronic periodontitis: Bacterial disease that leads to negative effects on the vasculature.
  • Diabetes, cancer, obesity, stroke, and hypertension: Each of these morbidities increases risk of and is associated with ED via several possible mechanisms.

Treatment of ED typically just requires patience as a systematic approach to determine the cause(s) can be used starting with a thorough patient history. It is rare that the ED cannot be successfully treated, so there is no reason not to address it with your medical provider.

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