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Article by Jean-Marie Besnard

Erection: causes of impotence

Updated on 4 November 2023.

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Explosive cigarettesImpotence or erectile dysfunction is a sexual disorder that unfortunately affects many men.

Because it’s generally difficult to talk openly about, we’ve decided to discuss it here to help these people move forward.

After all, hiding the problem won’t solve it. No, to find a solution, you need to confide in a friend, your partner or a specialized doctor. In short, you need to talk about it…

Here, then, are the most common causes of erectile dysfunction explained in detail:

Erection and aging

Impotence causesThere are two reasons why older men are more likely to experience erectile dysfunction than younger men. Firstly, older men are more likely to develop illnesses (such as heart attacks, angina, cardiovascular disease, stroke, diabetes and high blood pressure) that are associated with erectile dysfunction.

Secondly, the aging process alone can cause erectile dysfunction in some men, mainly through decreased tissue stiffness in the corpus cavernosum, although it has been suggested, but not proven, that there is also a decrease in nitric oxide production in the nerves that stimulate penile muscles.

Erection and diabetes

Erectile dysfunction tends to develop 10-15 years earlier in diabetic men than in non-diabetic men. In a population study of men aged 50-60 with type I diabetes for more than 10 years, 55% were affected by erectile dysfunction.

The increased risk of erectile dysfunction in men with diabetes may be due to an earlier onset and greater severity of atherosclerosis of the arteries, which narrow and reduce the distribution of blood to the penis. When not enough blood is delivered to the penis, it’s not possible to achieve a strong enough erection. Diabetes also causes erectile dysfunction by damaging two sensory and autonomic nerves, a condition known as diabetic neuropathy. Cigarette smoking, obesity, poor blood glucose control and diabetes are the most frequent causes responsible for erectile dysfunction disorders.

In addition to atherosclerosis and/or neuropathy causing erectile dysfunction, many men with diabetes also develop myopathy (muscle disease) as a result of erectile dysfunction. This erectile disorder causes the content of the corpus cavernosum muscles to be diminished, and presents clinically as an inability to maintain an erection for as long as desired.

Erection and hypertension (high blood pressure)

People suffering from hypertension or essential arteriosclerosis are at high risk of developing erectile dysfunction. Essential hypertension is the most common form of high blood pressure; it is called essential hypertension because it is not caused by any other disease (e.g. kidney disease).

However, it turns out that people with essential hypertension have low nitric oxide production throughout the body’s arteries, including the arteries of the penis. High blood pressure also accelerates the progression of atherosclerosis, which can in turn contribute to erectile dysfunction. Scientists suggest that decreased nitric oxide levels in patients with essential hypertension may contribute to erectile dysfunction.

Erectile dysfunction and cardiovascular disease

The most common cause of cardiovascular disease is atherosclerosis, the narrowing and hardening of the arteries that reduces blood flow.

Atherosclerosis generally affects arteries throughout the body, and is aggravated by hypertension, high blood cholesterol levels, smoking and diabetes mellitus. When the coronary arteries (arteries supplying the heart muscle) are narrowed by atherosclerosis, heart problems can occur. When the cerebral arteries (arteries that supply blood to the brain) are narrowed by atherosclerosis, strokes can occur.

Similarly, when the arteries to the penis and pelvic organs are narrowed by atherosclerosis, blood is insufficiently distributed to the penis to enable erection. There is a close correlation between the severity of atherosclerosis in the coronary arteries and erectile dysfunction. For example, men with more severe coronary atherosclerosis also tend to have more severe erectile dysfunction compared with men with benign coronary atherosclerosis.

Some doctors suggest that men with recent erectile dysfunction should be screened for silent coronary arteries (advanced coronary atherosclerosis that has not manifested itself).

Erection and smoking

Active smokers are twice as likely to suffer from erectile dysfunction as non-smokers. What’s more, men who don’t smoke but are exposed to smoke run just as high a risk of developing this form of impotence as active smokers.

Erectile dysfunction affects thousands of men worldwide, and each for different reasons. However, if you quit smoking, you’ll drastically reduce the risk of suffering from erectile dysfunction. To help you decide, it’s important to know the following facts:

  • Smoking can cause serious cardiovascular and cerebral accidents, as well as blockages in your arteries. What’s more, heart attacks are also commonplace for smokers. In short, smoking can slow down or obstruct the blood flow needed to achieve an erection.
  • Research recently undertaken among smokers with no previous history of erectile dysfunction showed that these men were 2 times more likely to experience moderate or worsened erectile dysfunction than non-smokers.
  • Smoking can also cause erectile dysfunction for reasons other than altered blood pressure.
  • Smoking influences other factors in the human body, including the nervous system (i.e. mental stimulation) and hormones.

Fortunately, such dysfunction can be cured (totally or partially) by quitting smoking. In fact, men who have experienced erectile dysfunction in the past and decided to stop smoking have seen an improvement in their physical and mental condition. The longer you keep smoking, the more damage you’ll continue to do to your body, which plays a major role in your ability to get an erection!

Erection and substance abuse

Marijuana, heroin, cocaine, methamphetamine and alcohol abuse are major contributors to erectile dysfunction. Alcoholism, in addition to causing nerve damage, can lead to atrophy (shrinkage) of the testicles, thus affecting testosterone levels.

Low testosterone levels

Testosterone (the primary sex hormone in men) is not only necessary for libido, but also for maintaining nitric oxide levels in the penis. Consequently, men with hypogonadism (testicular function resulting from low testosterone production) may have low libido and experience erectile dysfunction.

Erection and spinal cord injury

Damage to the spinal cord and nerves in the pelvis can also be the cause of erectile dysfunction. Nerve damage can result from disease, trauma or past surgery. Examples include spinal cord injury due to car accidents, pelvic nerve injury, surgery due to prostate cancer (prostatectomy), benign prostate enlargement surgery, multiple sclerosis (a neurological disease with the potential to cause extensive nerve damage), and long-term causing diabetes mellitus.

Erection and medication

Many common medications lead to erectile dysfunction as a side effect. Medications that can cause erectile dysfunction are often used to treat high blood pressure, antihistamines, antidepressants, tranquilizers and appetite suppressants.

Examples of common drugs that can cause erectile dysfunction include propranolol (Inderal) or other beta-blockers, hydrochlorothiazide, digoxin (Lanoxin), amitriptyline (Elavil), famotidine (Pepcid), cimetidine (Tagamet), metoclopramide (Reglan), indomethacin (Indocin ), lithium (Eskalith, Lithobid), verapamil (Calan, Verelan, Isoptin), phenytoin (Dilantin), and gemfibrozil (Lopid).

Erection, depression and anxiety

Psychological factors can also be responsible for erectile dysfunction. These include stress, anxiety, guilt, depression, widower’s syndrome, low self-esteem, post-traumatic stress disorder, and fear of sexual failure (performance anxiety).

It’s also worth noting that many drugs used to treat depression and other psychiatric disorders can cause erectile or ejaculatory dysfunction.

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