Erectile Dysfunction or Impotence
Erectile dysfunction or impotence is an inability to begin and maintain an erection with enough firmness to allow for vaginal penetration. If you are having problems only occasionally, there may not be a need to panic or have anxiety. Anxiety over maintaining an erection can itself be a cause of ED. So, relax. Here we will explore some of the causes of erectile dysfunction and sometimes the remedy can be as easy as changing some lifestyle choices or making some changes to medication regimens. Always consult with your doctor before making changes to your medications. Persistent inability to maintain an erection may be a signal of an underlying medical issue that needs to be addressed.
Sexual arousal in men involves the brain, hormones, emotions, nerves, muscles and blood vessels. The Causes of ED issues can be a combination of physical and psychological issues.
Smoking is a No No with you want to maintain healthy erections. Smoking has long been associated with narrowing of the blood vessels and contributes to heart disease and hypertension all of which are also associated with ED. If you smoke, talk to your doctor about ways to quit. In fact, a study in published in the British Jounal of Urology in 2004 found that stopping smoking had significant benefits in the improvement in ED issues. (1)
The prevalence of obesity in North America is steadily rising. What people may not realize is that Obesity may decrease male fertility and increase the prevalence of ED issues. There have been several etiopathological theories mentioned in the literature explaining the relationship between obesity and ED issues. Obesity is associated with an increase in the aromitization of testosterone to estrogens. Men need testosterone to facilitate arousal and erections. Obesity may cause organic ED because of associated metabolic syndrome which is a combination of at least three of five of the following: diabetes, hypertension, high serum triglycerides, obesity, and low high-density lipoprotein levels. Further, Obese individuals may develop psychogeneic ED as obese people can have a negative body image and can develop a lack of self-esteem which may lead to some depression. (2)
As the prevalence of obesity rises in North America so has the prevalence of diabetes. Epidemiological data has shown a threefold increased risk of ED development as compared with non-diabetic men. Diabetes results from an increase in circulating sugars in the body. Type 2 diabetes which accounts for over 90% of all diabetics is often the result of inactivity and being overweight. Poorly controlled blood glucose levels can damage the blood vessels and small nerves in the body. These small blood vessels and nerves need to be functioning properly in order to start and maintain an erection. Proper diabetes monitoring and control can go a long way to improve erectile dysfunction symptoms. (3)
4. Hypogonadism/ Low T.
Hypogonadism refers to low testosterone levels which may lead to ED issues. A meta-analysis in 2000 showed improvements in ED symptoms with testosterone monotherapy and improvements in sexual performance, desire, and motivation to engage in sex (4). Serum testosterone levels correlated with sexual dysfunction. Loss of libido was noted at levels below 430 ng/dL and ED symptoms were noted at levels of 230-300 ng/dL. Testosterone supplementation was noted to improve these symptoms after 4 weeks (5) (6).
1. Pourmand G, Alidaee MR, Rasuli S, Maleki A, Mehrsai A (2004). “Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study”. BJU Int. 94 (9): 1310–13. site link
2. El Salam MAA. Obesity, An Enemy of Male Fertility: A Mini Review. site link
3. Maiorino MI, Bellastella G, Esposito K. Diabetes and sexual dysfunction: current perspectives. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2014;7:95-105. doi:10.2147/DMSO.S36455.
4. Jain P, Rademaker AW, McVary KT. Testosterone supplementation for erectile dysfunction: results of a meta-analysis. J Urol. 2000;164(2):371–5.
5. Porst H, Burnett A, Brock G, Ghanem H, Giuliano F, Glina S, et al. SOP conservative (medical and mechanical) treatment of erectile dysfunction. J Sex Med. 2013;10(1):130–71.
6. Pastuszak AW. Current Diagnosis and Management of Erectile Dysfunction. Current sexual health reports. 2014;6(3):164-176. doi:10.1007/s11930-014-0023-