In purely psychological terms, erectile dysfunction (ED) can arise from a number of different causes.
It may be a self-induced state brought on by anxiety. As that anxiety turns into fear that you will not be able to perform, so ED becomes the expected outcome. Similarly, when you are having problems in your long-term relationship, your desire to have sex with your partner may diminish. As you form the habit not to have sex with her, you may also be teaching your body how not to have sex with any woman. This can lead to a general loss of sexual appetite. Libido is very much a matter of mood. If the emotional connection is not made between pleasure and sex, you will tend to lose interest in sex. In more serious depressive illnesses and schizophrenia, ED is quite common. The precise reasons for this are not properly understood but the speculation is that the body does not produce enough nitrous oxide to begin the cycle of an erection.
The following are the most common physical causes:
- Any disease of the brain, spinal cord or nervous system, whether peripheral or those nerves specific to the sexual function, can produce ED. Thus, damage can result from Diabetes, renal failure, vitamin deficiency and toxic events resulting from chronic alcohol and other recreational drug abuse. These and other conditions result in a loss of the relevant neurotransmitters. About half the men with chronic Diabetes Mellitus suffer ED. Over time, the disease degrades the performance of both the neural and vascular elements in producing an erection. This means that drug therapy is unlikely to have any effect.
- When men have well-established illness and diseases affecting breathing or heart action, it is common to find anxiety and depression surrounding sexual activity. Because of the fear of aggravating the physical condition, ED becomes a learned habit.
- Arterial diseases may affect the flow of blood into the penis. In some cases, surgery can restore sexual function. But surgery is not helpful to repair damage resulting from ageing, arteriosclerosis and Diabetes. If the levels of cholesterol are too high, it can build up on the walls of the arteries, restricting the passage of blood and causing erectile problems.
- More direct causes may be a response to traumatic injury or radical surgery affecting the neural pathway.
- Disturbance to the hormonal balance in the body may also affect libido. Tumors can produce a reduction in the size and activity of the gonads. Similarly, both under and overactive thyroid function may affect sex drive.
- There are a number of specific conditions affecting both the corpus cavernosum itself (the part of the penis designed to absorb the inflow of blood to produce the erection) and the more general chemistry, musculature and blood vessel system of the penis.
- Many drugs are known to play a part in producing ED. The most commonly prescribed are classes of drugs for antipsychosis and antidepression. In more everyday contexts, large quantities of alcohol can have a sedative effect and, over time, this can cause a reduction in the size of the gonads. Cigarette smoke also acts as a vasoconstrictor and this may affect the operation of the penis.
- Many “healthy” men find that there is a gradual decline in sexual function through ageing. The response between stimulation and erection slows, erections become less firm and the volume of semen ejaculated decreases. The required recovery time between sexual intercourse also lengthens. This can lead to some performance anxiety and loss of satisfaction. A similar problem occurs when a man puts on excessive weight or has insomnia.