The main causes of ED.

So, in the third of these articles, we looked at the basic mechanics of how we get an erection. Just simple plumbing after all. But if our bodies are going to get the desired result, there is a precise checklist of steps to follow.

• the brain has to recognise that we are in the sex zone — sexual stimulation is not just a physical thing, the brain has to be in on the act so it can send those vital messages down to the guys operating the valves,
• “Start releasing the nitric oxide!”
• The chemical factory starts to churn and, before you can say, “Geronimo!” or whatever other words come to mind at a time like this,
• guanylate cyclase (GMP) and cyclic guanosine monophosphate are pumping out into the muscles
• and artery dilation, here we come.

This may look simple on paper, but if anything throws a spanner in the works to disrupt the sequence, the result is nada.

So let’s start breaking it down in manageable chunks.

We have to start in the brain. If anything is wrong with the initial response to the stimulation, there is no physical response of any kind. This can be a problem with the neurotransmitters — the chemicals that transfer messages between neurons and cells — or it can be psychological which can be just as terminal as a physical cause.

If we have messages, they then have to travel down the spinal cord and transfer to the area around the penis. Any damage that prevents the nerve messages from arriving at their destination, means there is no physical response.

If the messages arrive, you then depend on muscles to respond as they should to dilate arteries and compress veins, and fibrous tissue must absorb the blood.

So any damage to the central or peripheral nervous system, to the musculature, blood vessels or fibrous tissue can be the cause of the ED. This damage is most usually caused by disease. The most likely candidates are:

• kidney disease;
• liver diseases including fatty liver, hepatitis and cirrhosis which are associated with alcoholism;
• multiple sclerosis which affects the central nervous system;
• diabetes mellitus which may lead to cardiovascular disease or nerve damage;
• arteriosclerosis or other vascular diseases — about 40% of men with diabetes suffer with ED;
• hormonal problems, for example producing low levels of testosterone; and
• neurodegenerative disorders including Alzheimer’s, Parkinson’s and Huntington’s disease, amyotrophic lateral sclerosis, etc.

The way we live our lives may also actively contribute to our lack of sexual success, particularly if our choices have begun to cause cardiovascular problems. So heavy smokers, those who are carrying excessive weight and those who never take exercise are most at risk. Those who play sport or pick up an injury in an accident can fall prey to ED if there is damage to the penis itself, or to the spinal cord, pelvis, prostate or bladder.

Then we come to the unintended consequences of necessary surgery. For those who are diagnosed with cancer, sometimes radical surgery is required to cut away as much of the affected tissues and organs as possible. If these operations are for cancer of the prostate or bladder, the risk of damage to the nervous system and blood vessels near the penis is high. Similarly,  we may already be taking medication that causes ED as a side-effect. The most common classes of drugs that can have this undesirable effect are:

• for the relief of hypo or hypertension;
• antihistamines;
• tranquillisers and antidepressants;
• appetite suppressants; and
• used to treat heartburn and stomach ulcers, e.g. Tagamet.

Finally, there are a range of psychological conditions including:

• stress;
• anxiety;
• low self-esteem;
• guilt; and
• depression.

Whether directly or indirectly, all these mental states may contribute to performance anxiety where we develop an unreasonable fear of of sexual failure. It is estimated that about 15% of all ED cases have a psychological component. The difficulty with this estimation is that men who have physical illnesses also have the same list of possible feelings, so distinguishing cause and effect can be problematic.

Well, that’s a fair list of causes — probably a few more than you thought. Some of them are on the serious side which should send you warning messages that going to the doctor is always a good idea. ED is just a symptom. If all you do is to take Viagra, Cialis or Levitra you are leaving the underlying condition undiagnosed and untreated.

Do you really want to take that risk?