What are the causes of erectile dysfunction?

Causes of Erectile Dysfunction

Erectile dysfunction (ED) is primarily caused by organic factors including vascular disease, neuropathy, endocrine disorders, medication side effects, and anatomical abnormalities, though psychological factors frequently contribute to or exacerbate the condition. 1

Major Physiological Causes

Vascular Causes

• Cardiovascular disease - ED is a well-recognized index of cardiovascular risk and an independent predictor of coronary artery disease 2
• Atherosclerosis - Accounts for approximately 40% of ED cases in men over 50 years 3
• Hypertension - Both the condition itself and antihypertensive medications can contribute to ED 2
• Diabetes mellitus - Most common endocrine cause affecting approximately 50% of diabetic men through vascular and neuropathic complications 1
• Dyslipidemia - Hypercholesterolemia is an important risk factor for ED 4

Neurological Causes

• Autonomic neuropathy - Particularly in diabetic patients (odds ratio 5.0) 2
• Peripheral neuropathy - Common in diabetic patients (odds ratio 3.3) 2
• Parkinson's disease and other neurological conditions 3
• Nerve damage from pelvic surgery - Can disrupt neural pathways necessary for erection 3

Endocrine Causes

• Hypogonadism - Low testosterone levels decrease libido and erectile function 1
• Thyroid disorders - Both hyperthyroidism and hypothyroidism affect sexual function 1, 4
• Hyperprolactinemia - Causes decreased testosterone levels 4

Medication-Induced ED

• Antihypertensives - Particularly thiazide diuretics, beta-blockers, vasodilators, central sympathomimetics, ganglion blockers, and ACE inhibitors 2, 5
• Psychiatric medications - Antidepressants (especially SSRIs and tricyclics), antipsychotics 2, 1, 5
• Hormone treatments - Particularly antiandrogens 1
• Other medications - NSAIDs, antacids, opioids, and medications causing hyperprolactinemia 1, 5

Anatomical/Structural Causes

• Peyronie's disease - Penile fibrosis affecting erectile function 3
• Corporal veno-occlusive dysfunction - Impaired ability to trap blood in the penis 6

Psychological Causes

• Anxiety and depression - Common contributors to ED 2, 3
• Sexual phobias and stress - Can initiate or maintain ED 2
• Relationship issues - Partner-related problems affecting sexual function 1

Lifestyle Factors

• Aging - Strong risk factor with increasing prevalence with age 2, 7
• Obesity - Associated with hormonal imbalances and vascular disease 6
• Lack of physical activity - Contributes to vascular risk factors 6
• Smoking - Damages blood vessels and impairs blood flow 1
• Excessive alcohol consumption - Affects hormone levels and nervous system function 1

Clinical Implications

• ED may be the first sign of undiagnosed cardiovascular disease, diabetes, or hypertension 7
• New onset or progressive decline in erectile function should be considered an alarming marker of threatening ischemic heart disease 2
• ED affects approximately 30 million men in the United States, with many cases remaining undiagnosed 7
• Drug-related ED accounts for approximately 25% of cases and is often reversible when the offending agent is stopped 5

Risk Assessment

• Cardiovascular risk assessment is recommended for all men with ED 1
• Screening for diabetes, hypertension, and dyslipidemia should be performed in men presenting with ED 1, 6
• Evaluation of medication history is essential to identify potential iatrogenic causes 2, 5

Understanding these multifactorial causes is crucial for proper diagnosis and targeted treatment of erectile dysfunction, ultimately improving quality of life and potentially identifying underlying health conditions requiring attention.