Physiology & Pathophysiology
Problems with Erection
Any defect in this complex cascade of events can result in erectile dysfunction with varying patterns. Some men with ED may report the inability to experience any erection from the beginning of a sexual experience, while others experience an erection that is not maintained at penetration. Other men may lose the erection during sexual intercourse, and others can only experience erection upon awakening or during self-masturbation.
Today it is well-recognized that organic, non-psychological causes of ED play a significant role in the development of ED. Pure psychological (emotional) mechanisms are causative in 15% to 20% of cases while in at least 80% of ED cases an organic cause can be held responsible. In some men, the situation is "mixed," with significant secondary psychological and social components such as guilt, depression, anxiety, tension or marital discord being present in addition to one or more underlying organic components.
Psychological problems that can cause ED:
- Stress
- Fatigue
- Depression
- Low self-esteem
- Guilt
- Difficulty coping with anger
- negative feelings for or by a sexual partner
Usually ED caused by these psychological factors is mostly temporary or in case of persistence should be treated by adequate measures.
The interplay between underlying conditions and impaired endothelial function in ED1
Adapted from Saenz de Tejada I et al. In: Erectile dysfunction. Jardin A et al. (eds). 2000; 65–102
Organic problems:
Endogenous factors can lead to ED which include:
- Endocrine imbalances (diabetes, hypogonadism)
- Cardiovascular disease
- Dyslipdemia
- Metabolic syndrome
In most cases these underlying conditions lead to endothelial damage and in untreated to endothelial dysfunction and successive vascular problems which first are prominent in the small vessels of the penis. This is why experts meanwhile see ED as a predictor for future cardiovascular diseases.
Why does ED occur sooner than CV disease?2
Adapted from Montorsi et al. Am J Cardiol 2005; 96: 19M–23M
Together with an also existing hypogonadism these risk factors form a vicious triangle from which patients often cannot escape without professional help.
References:
1. Adapted from Saenz de Tejada I et al. In: Erectile dysfunction. Jardin A et al. (eds). 2000; 65–102.
2. Adapted from Montorsi et al. Am J Cardiol 2005; 96: 19M–23M
