Impotence, or more recently termed erectile dysfunction, or ED, is defined as the inability to achieve and/or maintain an erection sufficient enough to have sexual intercourse. Erectile function is closely tied to male virility and impotence and therefore can lead to feelings of frustration, inadequacy, lack of self-confidence, stress and anxiety in men who suffer from it.
The Physiology of Erections
Sexual arousal and the onset of an erection is a complex physiologic process that involves the brain, nerves, hormones, blood vessels, smooth muscle and emotions. The penis contains two elongated tubular structures called the corpora cavernosa, which are composed of sponge-like tissue surrounded by a strong membrane. With mental or physical sexual stimulation, the aforementioned physiologic components act in tandem to fill the corpus cavernosa with blood which in turn makes the penis hard. Problems at any step along the way in this physiologic process can lead to impotence.
Physical Causes of Impotence
Most cases of impotence can be attributed to physical causes that interfere with the nerves, hormones, and blood vessels involved in the process of getting and maintaining an erection. Heart disease, atherosclerosis, hypertension or high blood pressure, and diabetes can all be associated with compromise of the small blood vessels necessary for erections. Stroke, Parkinson's disease and multiple sclerosis are all conditions that may interfere with the nerve function involved in generating erections. Other causes of nerve damage due to trauma or surgery may also be responsible for impotence such as certain types of prostate and/or bladder surgery, radiation to the pelvis, pelvic injury, and spinal cord injury or surgery. Nerve injury leading to erectile dysfunction can also occur from prolonged bicycle or horseback riding, and some types of gymnastics. Low levels of hormones such as testosterone (hypogonadism) and thyroid hormone (hypothyroidism) can cause impotence. Lastly, a condition of the penis known as Peyronie's disease, which causes scarring of the membrane around the corpora cavernosa resulting in a bent or curved penis, can also cause erectile dysfunction.
Lifestyle Causes of Impotence
Certain lifestyle practices can also be responsible for erectile dysfunction. Smoking and tobacco use causes changes in small blood vessels that may interfere with the ability to get an erection. Excessive consumption of alcohol can lead to nerve damage thereby playing a role in erectile dysfunction. Abuse of substances such as heroin, cocaine and marijuana can all play a causal role in impotence. The use of anabolic steroids interferes with hormonal balance and can cause impotence as well.
Medications That Can Cause Impotence
Many prescription and over-the-counter medications can cause impotence. General categories of such are antidepressants, antihistamines, antihypertensive or high blood pressure medications, certain pain medications, tranquilizers, and appetite suppressants.
Psychological Causes of Impotence
Only about 15 to 20 percent of impotence cases are attributed to psychological causes, with the remaining percentage due to the non-psychological factors listed in the categories above. The psyche can exert an enormous influence on sexual function and conditions such as stress, anxiety, and depression can interfere with the physiologic process of erections and result in impotence. It is often a viscous cycle that men with erectile dysfunction experience stress, anxiety and depression as a result of their condition, which in turn causes their ED to become even worse. Post traumatic stress disorder can also be a cause of impotence. Finally, difficulties within relationships and problems experienced with sexual identity are also psychological burdens that can result in impotence.
