Erectile dysfunction refers to the inability to obtain and maintain an erection long enough to allow penetration. The mechanism of erection is complex and involves different factors like: vascular, neurological and endocrine.
Normally, an erection is determined by two processes:
An important blood inflow to the corpora cavernosa of the penis achieved through a major arterial vasodilatation;
Maintenance of the vasoconstriction that prevents venous return to this level. After ejaculation, the two processes cease and the penis becomes soft. The whole phenomenon takes place under the strict control of the nervous system.
Causes of erectile dysfunction are multiple. They can be grouped into: somatic or organic and psychogenic causes. In turn are two types of organic causes:
Vascular causes which include: atherosclerosis, high blood pressure, stroke, ischemic heart disease, dyslipidemia.non-vascular causes can have various reasons like:
Neurological: spinal trauma, tumor, the herniated disc, surgical resection of the rectum, etc.;
Metabolic: diabetes mellitus (50% of patients experience erectile dysfunction in vascular complications of this disease);
Endocrine: testosterone deficiency, hypo or hyper thyroid function, treatment with anti-androgens in prostate cancer.
Treatment with different drugs such as anti- androgens, tranquilizers, beta blockers, diuretics, inhibitors of histamine.
Psychogenic cause usually affects young healthy men. In this case male genital system is morphologically normal but its function is deficient because of numerous factors such as unhappy sexual experiences, wrong partner, lack of sexual attraction, fear of failure and disappointment, poor sex education in adolescence, sexual abuse etc. Also there are cases of erectile dysfunction caused both by organic and psychological factors.
The only symptom of erectile dysfunction is the inability to maintain or obtain an erection in order to support a sexual act. However, before the diagnosis of erectile dysfunction there are a number of issues to be considered:
The duration of erectile dysfunction.
The existence or absence of spontaneous erections, in the morning or during masturbations, which can make the difference between organic and a psychogenic cause.
A decrease over time of the rigidity and the number of erections might suggest more an insufficiency of blood pressure.
Difficulty only in maintaining erection suggests the venous run.
Any current medication that could cause erectile dysfunction.
Consumption of too much alcohol or tobacco addiction.
Partner’s attitude regarding erectile dysfunction is very important in the development of psychological erectile dysfunction.
If the patient suffered from priapism. This refers to a prolonged and painful erection but without ejaculation. If it is not quickly intervene surgically, priapism lead to permanent erectile dysfunction.