Male Sexual Dysfunction – Causes & Treatment

By BSc, MSc (embryologist), BSc, MSC, PhD (gynecologist), (embryologist) and (invitra staff).
Last Update: 12/11/2019

Sexual impotence, also called erectile dysfunction, is the inability of a man to maintain an erect penis long enough to achieve a complete and satisfying sexual intercourse.

You should keep in mind that a minimum of three months has to pass in order to consider a possible problem of impotence.

Normally, the most common cause of erectile dysfunction is damage to arteries, nerves, muscles, and fibrous tissues. However, psychological factors also play an important role in this male pathology.

How does an erection occur?

An erection is a complex process involving several mechanisms. Erection is the hardening of the penis after it has been filled with blood.

Generally speaking, erection of the penis begins with mental stimulation (fantasies, memories, etc.), stimulation of the senses through sight or touch, and even a combination of sensory and mental stimulation. The central nervous system sends nerve impulses that cause increased blood flow in the penis. This blood is trapped by the corpus cavernosum, causing the penis to expand and stiffen. In addition, the veins that would drain blood from the penis contract, thus allowing for an erection.

The corpora cavernosa are two cylindrical chambers that fill with blood during an erection. These structures are located at the top of the penis.

When the muscles of the penis contract, blood flow into the penis is interrupted and blood flow through the veins is opened. This mechanism causes the erection to be reversed and the penis to become flaccid.

What is erectile disfunction?

Erectile dysfunction (ED) or sexual impotence is considered a benign disease characterized by the inability to achieve or maintain an erection of the penis long enough to achieve full sexual intercourse.

Erection problems in men can occur at any time in their lifes. Whats more, the frequency of a man suffering from erectile dysfunction increases with age and affects 14% of men aged 40-49, 25% of men aged 50-59 and 49% of men aged 60-69.

On the other hand, men who suffer from diabetes, hypertension or smoking have a greater tendency to suffer from erectile dysfunction.

Causes of erectile dysfunction

As we have already mentioned, male erection is a rather complex neurological and vascular process that requires a sequence of processes. Therefore, erectile dysfunction can occur when some of these processes are interrupted.

Usually, sexual impotence is due to physical causes by hormonal and vascular factors, among other things. However, this pathology may also be due to psychological factors such as anxiety or stress.

In the following sections we are going to detail the different factors that cause erectile dysfunction.

Organic Causes

Organic or physical sexual impotence is the most common in men. This is a type of erectile dysfunction caused by disorders in the penis or by the effects of administering certain medications.

The types of organic sexual impotence are described below:

Vascular
when little blood reaches the penis or is not properly retained inside the corpora cavernosa. As a result, blood leaks out and makes it impossible for the penis to have an erection. Diabetes, hypertension and cardiovascular disease are among the most common causes of vascular sexual impotence.
Neurological
caused by problems in the transmission of orders to the penis from the brain and spinal cord. This type of sexual impotence is caused by diabetes, diseases of the spinal cord, surgery for cancer of the prostate, bladder and rectum, etc.
Hormonal
due to a testosterone deficit. This male hormone increases sexual desire and frequency of intercourse.
Medicines
many of the drugs used to treat diseases of the nervous system affect the erection of the penis.

Psychological Causes

When a man is not emotionally stable, he is more likely to manifest erectile dysfunction. The brain is a key point for the activation of the processes that initiate the erection in men

Therefore, there are many causes of psychological origin by which a man can begin to have this type of problem. The most frequent ones are the following:

  • Anxiety.
  • Fear of pregnancy, that is, the man is worried about getting his partner pregnant. This can obviously affect a man's concentration and sexual performance.
  • Stress and tension.
  • Depression.
  • Marital conflicts. When a relationship is not satisfactory, it’s normal for a man to have erectile dysfunction.

Diagnosis

Male sexual impotence is often a symptom of other health problems. Therefore, it is essential that man consult a specialist to establish a diagnosis.

The first step in evaluating erectile dysfunction is to obtain detailed information about the medical and psychological history of patients and their partners. It is important to create a relaxed atmosphere in the practice between the specialist and the patient to make it easer for the patient to ask questions about erectile function and other sexual aspects.

The second step would be to perform a physical examination focusing on the genitourinary, endocrine, vascular and neurological systems. This type of test may give clues about systemic problems.

As the third step, the specialist will request a series of analytical tests adapted to the patient's symptoms and risk factors. All patients should be tested for blood glucose, lipids and total testosterone. When testosterone levels are low, the determination of prolactin, FSH or LH will be requested.

Finally, one of the tools for diagnosing erectile dysfunction would be to control and monitor nocturnal erections in order to rule out certain psychological causes. This erection control is not completely reliable, though.

Treatment of erectile dysfunction

Most doctors prefer that treatments for erectile dysfunction be carried out following an ascending pattern.

In any case, erectile dysfunction has different treatments that allow you to enjoy full sexual relations. It is vitally important to identify the causes and choose the most appropriate treatment for each case.

Psychological therapy

When a physical cause of erectile dysfunction has been ruled out, it is best to see a psychologist. In these cases, treatment of erectile dysfunction consists of re-education of sexual behaviors and attitudes, sensory focusing, and management of anxiety associated with sexual performance.

Generally speaking, any psychological treatment for erectile dysfunction is combined with relaxation techniques to control anxiety. This will make it easier to regain sexual activity and erections.

Medicines

After making a diagnosis of erectile dysfunction, the specialist will prescribe some medication to take orally in order to achieve and maintain an erection. The most common ones are vardenafil, tadalafil or sildenafil. They all act by increasing blood flow to the penis and therefore help maintain an erection.

Some commercial brands of these drugs are Levitra, Cialis and Viagra and their effectiveness is similar, so the choice will depend on cost, ease of use and / or side effects.

On the other hand, these types of drugs are not recommended if the patient is being medicated with nitrates to treat a heart condition because it could cause a sudden drop in blood pressure, fainting and dizziness.

Penile pump, surgery and implants

When none of the above treatments solves the problem of erectile dysfunction, the doctor will indicate other options. Here are some of them:

Surgery
can be arterial or venous in the penis. The goal of arterial surgery is to increase the flow and pressure of blood within the penis. Venous surgery involves tying or removing some veins from the penis so that blood does not leak out.
Vacuum pump
also known as penis pump. This is a hollow plastic tube with a hand pump or batteries that is placed over the penis. Through this pump the air that is inside the tube is sucked out to generate a vacuum. This causes blood to reach the penis.
Penile Implants
which are placed on both sides of the penis to keep it firm but flexible. With these devices it is possible to control the time and duration of an erection.

Natural Remedies

Although many of these popular remedies have been challenged by doctors, many men rely on their effectiveness. For example, according to traditional Chinese medicine, ginseng is widely used to increase the erection of the penis.

Sprouted wheat, oats and sesame also help overcome erectile dysfunction. Apart from that, it is advisable to take cinnamon and nutmeg for their aphrodisiac properties or some vegetables such as tomato.

Prevention

As far as possible, the prevention of erectile dysfunction is aimed at avoiding the risk factors that contribute to its onset. Therefore, it is recommended to:

  • Monitor existing diseases and have regular check-ups.
  • Quit smoking.
  • Exercise regularly.
  • Reduce stress.

Therefore, erectile dysfunction can be prevented by adopting a healthy lifestyle from a young age or by modifying those habits that are wrong.

FAQs from users

How can I get pregnant if my husband suffers from erectile dysfunction?

By Dr. Marita Espejo Catena BSc, MSC, PhD (gynecologist).

The inability to deposit sperm in the vagina during sexual intercourse has traditionally been one of the absolute causes of infertility.

Until the introduction of the most complex assisted reproduction techniques, the only option that could be contemplated was the use of a donor sperm sample.

With the development of in vitro fertilization (IVF) techniques, and especially with oocyte insemination by means of sperm microinjection (ICSI), the possibility of conceiving with a scarce number of spermatozoa is feasible.
In patients suffering from impotence that is not a consequence of andrological or psychological medical treatment, an epididymal aspiration or testicular biopsy may be performed.

Epididymal aspiration consists of extracting the sperm stored in the epididymis using local anesthesia, where they acquire the ability to move after being generated in the seminal ducts.

Biopsy is reserved in cases of epididymal aspiration with negative results and requires access to mature sperm directly from the testicular tissue. Although it can be performed under local anesthesia, it can also be performed under anesthetic sedation, which allows the procedure to be performed at different points or on both testicles.

Does diabetes cause erectile dysfunction?

By Marta Barranquero Gómez (embryologist).

Erectile dysfunction can be a symptom of many pathologies, including diabetes. Therefore, it is very important to consult a doctor about any erection problem so that the possible cause can be diagnosed.

Does erectile dysfunction cause loss of sex drive?

By Marta Barranquero Gómez (embryologist).

No, although they are closely related. Erectile dysfunction can lead to a loss of sexual interest due to the inability to maintain or achieve an erection of the penis.

How does tobacco affect ED?

By Marta Barranquero Gómez (embryologist).

The main substance in tobacco, nicotine, negatively affects all blood vessels in the body. If the blood vessels in the penis are affected, the blood flow here will not be adequate and consequently problems will arise in initiating or maintaining an erection.

In addition, the possibility of erection problems associated with smoking increases with age and the number of cigarettes smoked.

Suggested for you

Erectile dysfunction is a cause of male sterility due to post-testicular factors. You can read more about this in the following article: Post-Testicular Factors of Male Infertility - Causes & Treatment.

We also recommend you to have a look at the article Treatmens for Male Infertility.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Authors and contributors

 Cristina Mestre Ferrer
Cristina Mestre Ferrer
BSc, MSc
Embryologist
Bachelor's Degree in Biological Sciences, Genetics & Human Reproduction from the University of Valencia (UV). Master's Degree in Biotechnology of Human Assisted Reproduction from the UV and the Valencian Infertility Institute (IVI). Embryologist at IVI Barcelona. More information about Cristina Mestre Ferrer
Dr. Marita Espejo Catena
Dr. Marita Espejo Catena
BSc, MSC, PhD
Gynecologist
Graduated in Medicine and Surgery from the University of Valencia in 1992. Specialist in Gynaecology and Obstetrics. Doctor in Medicine from the University of Valencia in 2000. Master in Assisted Human Reproduction by the Rey Juan Carlos University and IVI in 2008. Currently, she is the director of Instituto FIVIR. More information about Dr. Marita Espejo Catena
License: 464616497
 Marta Barranquero Gómez
Marta Barranquero Gómez
Embryologist
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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