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30 causes of erectile dysfunction – physical and psychological

What is erectile dysfunction?

Erectile dysfunction is when you are unable to get an erection that lasts long enough, or is strong enough, to have sex. Getting an erection is a complex combination of psychological stimulation and physical response. When something goes wrong with either one of these functions, it can result in erectile dysfunction (ED), commonly called impotence. Although ED is not life threatening, it can have a serious impact on the quality of your life and relationships if you experience it. ED is very common and affects about half of men from 40 – 70 at some time or another.

How does an erection work?

An erection happens when your brain receives signals from your senses that trigger sexual arousal. These signals may be something you see, feel, smell, touch or hear. Chemical messages are then sent to the blood vessels in the penis, which dilate. This causes the sponge-like tissues of the penis to become engorged with blood, triggering expansion of its size and shape from flaccid to erect.

What are the causes of erectile dysfunction?

Causes of erectile dysfunction can be psychological or physical.

Physical causes of erectile dysfunction tend to fall into four main types. They include:

  • Vasculogenic conditions – that affect blood flow
  • Hormonal conditions – affecting hormone levels
  • Anatomical conditions – affecting the structure of the penis
  • Neurogenic conditions – affecting the nerves, brain and spinal cord.

Physical causes of erectile dysfunction

1. Atherosclerosis: This vascular disease is one of the most common causes of erectile dysfunction. It happens when fatty substances called plaques narrow and fur up your arteries. This can reduce blood flow to vital areas including the penis.

2. High blood pressure: Also known as hypertension, this condition is also a common cause of erectile dysfunction as it can affect the blood flow to your penis. It happens when high blood pressure causes damage to your arteries, making them thicker. This can restrict blood flow. There is medication to help treat ED caused by high blood pressure, although some drugs, like beta-blockers, can also trigger ED. If you're concerned, talk to your GP who may be able to change your medication for something else.

3. Diabetes: Erectile dysfunction is more common among people with diabetes for several reasons. When the condition is poorly managed it can result in high blood sugar levels, which can damage blood vessels, and reduce the blood flow to your penis. The condition can also damage nerve endings in the penis, which can cause a loss of feeling. Diabetes is also linked with increased risk of heart disease, depression and fatigue which can all impact your sexual health.

4. Kidney disease: Chronic kidney disease, or severe kidney injury, can cause problems with your hormones, circulation, nerves and energy levels. One serious complication, known as uraemia, causes waste products that should be flushed out of the body to build up in your system. Research shows that about half the men who have uraemia, also have low sex drive and erectile dysfunction. The psychological and physical stresses of this condition may also have an impact. There's some indication that a kidney transplant can improve ED, but in some cases sexual function and drive stay impaired even after surgery.

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