Erectile dysfunction (ED), which is also commonly called impotence, is a persistent or intermittent impairment of the ability to perform or keep an erection sufficient for satisfactory sexual intercourse.

This problem can occur in men of different age groups, but it is most often found in people over 40. According to several epidemiological studies, from 40% to 60% of men over 40 experience various forms of erectile dysfunction, and with age, the likelihood of encountering ED only increases.

Despite the reasonably high prevalence of this condition, erectile dysfunction often remains taboo due to the delicacy of the issue: many men prefer not to contact specialists, trying to cope with the problem on their own. A timely consultation with a doctor helps not only to improve the quality of sexual life but also to identify more serious pathologies.

Erectile dysfunction often signals the onset of cardiovascular, endocrine, and neurological disorders.

Primary causes and risk factors

The reasons for erectile dysfunction are varied. Often, the causal factors can be combined, aggravating the situation. They must be known and identified since erectile dysfunction is often not only an independent disease but an indicator, a primary symptom of other pathological processes that are more dangerous to life and health.

For example, erectile dysfunction and cardiovascular diseases have almost the same risk factors, and these are the most common and life-threatening diseases. Therefore, the causes of impotence should be examined in more detail.

So, the causes are as follows:

- Neurogenic causes - damage, diseases, or dysfunctions of the nervous system that affect the body's ability to transmit nerve impulses necessary to achieve and maintain an erection. Among them, it is necessary to highlight:

• Multiple sclerosis - an autoimmune disease can damage nerve fibers in the brain and spinal cord, which can affect the nerve signals necessary for sexual function;
• Spinal cord lesions - various injuries or diseases of the spinal cord can disrupt the connection between the brain and the genitals, preventing an erection;
• Stroke - circulatory problems in the brain can damage the nerve centers responsible for sexual function;
• Parkinson's disease - a neurodegenerative disease often leads to decreased libido and erectile dysfunction;
• Nerve tumors;
• Diabetic neuropathy - diabetes can cause damage to peripheral nerves (including those responsible for erection), leading to impotence;
• Pelvic fractures - can damage the nerve pathways associated with the genitals;
• Chronic alcohol abuse - causes damage to the central and peripheral nervous system;
• operations on the pelvic organs - can damage the nerves responsible for erection, for example, removal of the prostate gland due to a tumor.
  

- Vasculogenic or vascular causes - are associated with impaired blood supply to the penis. To achieve a stable erection, adequate blood supply is necessary - an influx of arterial blood and to maintain an erection, partial obstruction of the outflow of blood from the "holy of holies" through the veins is required. Accordingly, erectile dysfunction occurs either when the blood inflow is impaired or when the outflow is pathologically increased - venous leakage. Therefore, any conditions affecting the blood vessels can cause problems with erection.

These include:

• Cardiovascular diseases - are often accompanied by impaired blood circulation, which can affect the ability to have an erection. It is important to remember that erectile dysfunction is often the first symptom of systemic cardiovascular pathology, so organic impotence is a mandatory indication for consultation with a cardiologist;
• High blood pressure - can damage the lining of blood vessels, the endothelium, reducing their elasticity and ability to expand, which impairs blood flow to the penis;
• Atherosclerosis - a common condition in which arteries thicken and harden due to the deposition of cholesterol and other substances on their walls, which can narrow the vessels and limit blood flow to the penis and make it difficult to achieve an erection;
• Venous insufficiency - occurs when veins cannot hold blood in the penis long enough to maintain an erection. In venous leakage, blood quickly flows back through the veins, making erections unstable;
• Diabetes - in addition to nerve damage, diabetes can also cause vascular complications, such as dysfunction of small blood vessels, which impedes microcirculation and normal blood supply to the penis;
• Smoking - nicotine and other substances contained in cigarettes, including electronic ones, can damage blood vessels and contribute to the development of atherosclerosis, which worsens blood supply;
• Metabolic syndrome - a complex condition that includes obesity, impaired glucose metabolism, high blood pressure, and lipid imbalance. This entire tetrad negatively affects vascular health and contributes to the development of impotence;
• The formation of blood clots in blood vessels - can clog their lumen and limit blood flow to the penis.
  

- Hormonal or endocrine causes - almost all processes in the body are controlled by hormones, especially erection. Therefore, hormonal imbalances are a common cause of erectile dysfunction and, most importantly, are quite amenable to correction.

Among the endocrine causes, it is necessary to note:

• Hypogonadism - testosterone deficiency is one of the most common endocrine causes of impotence. A normal androgen profile is the key to a man's sexual health and of course, a quality erection;
• Thyroid disease - hyperthyroidism (excessive thyroid function) and hypothyroidism (insufficient thyroid function) can lead to erectile failure. With hyperthyroidism, this is associated with accelerated metabolism, and with hypothyroidism - with a slowdown in metabolic processes and a decrease in testosterone levels;
• Hyperprolactinemia - an increased level of prolactin can suppress the secretion of pituitary hormones and reduce testosterone levels, which leads to an unstable erection. Hyperprolactinemia can be caused by a pituitary tumor or taking certain medications;
• Diabetes mellitus and metabolic syndrome - in fact, they are also a hormonal problem that leads to a disruption in sugar metabolism, which damages nerves and blood vessels and contributes to the development of hypogonadism and erectile dysfunction.
• Hypercorticism - a long-term increase in the level of the hormone cortisol in the body. Most often, this condition is associated with an adenoma of the pituitary gland, which stimulates the adrenal glands to produce cortisol.
• Anatomical or structural causes - can lead to erectile dysfunction and other problems associated with sexual function.

The main anatomical causes are:

• Peyronie's disease - the formation of a fibrous plaque inside the penis, which causes its curvature and can lead to difficulty and painful erections;
• congenital anomalies - defects in the structure of the penis, such as hypospadias, when the urethra does not open at the top of the head, and epispadias - a less common anomaly in which the urethra opens on the upper side of the penis;
• priapism - a prolonged and painful erection that can lead to damage to the tissues of the penis;
• fibrous changes - formation of fibrous tissue in the cavernous bodies of the penis, which reduces its elasticity and ability to fill with blood;
• malignant tumors of the penis;
• penile fracture and pelvic bone fracture.

Drug-induced factors - taking certain groups of drugs that affect the nervous system, hormonal balance or blood circulation negatively affects the state of erection.

Such drugs include:

• antiandrogen drugs (analogs and antagonists of GnRH, 5α-reductase inhibitors);
• antipsychotic drugs;
• antihypertensive drugs (thiazide diuretics, β-blockers);
• antidepressants (selective serotonin reuptake inhibitors, tricyclics);
• narcotic drugs (heroin, cocaine, marijuana, methadone, synthetic drugs, anabolic steroids, alcohol abuse, etc.).

Scientific research and statistics

According to extensive epidemiological studies conducted in the USA, Europe, and several Asian countries, approximately 50% of men aged 40–70 years experience erectile dysfunction to varying degrees. The severity of the disorder may vary from occasional difficulties associated with stress or overload to a complete inability to maintain an erection.

According to published meta-analyses, the situation in Eastern European countries is similar to global statistics: regular problems with potency are observed in almost a third of men over 45–50 years of age.

In recent years, the number of cases of erectile dysfunction among younger men has been growing. The reasons for this are the early onset of type 2 diabetes, obesity, and an aggressive pace of life leading to chronic stress.

Statistics indicate that about 15–20% of men under 40 may already experience some form of ED. The increase in the incidence of diseases among young people forces urologists and andrologists to pay closer attention to the promotion of a healthy lifestyle and early diagnosis of cardiovascular pathologies.

Diagnostics of erectile dysfunction
If you have persistent problems with erection, it is recommended that you first consult a urologist or andrologist. The doctor will collect an anamnesis, clarify the nature of the complaints, and conduct an initial examination, including an assessment of the condition of the genitals and prostate gland. A whole range of examinations may be required to establish an accurate diagnosis:

• Laboratory tests: examination of hormone levels (testosterone, prolactin, LH, FSH), blood glucose, lipid profile.
• Pharmacological test tests: administration of vasoactive substances to assess the reactivity of the blood vessels of the penis.
• Dopplerography of the vessels of the penis: an ultrasound examination that allows you to assess the speed and volume of blood flow, exclude the presence of atherosclerotic plaques or venous leaks.
• Psychological counseling: if you suspect a psychogenic nature of ED, you may need to consult a psychotherapist to identify depression, anxiety disorders or psychological trauma.

Based on the diagnostic results, the doctor identifies the most likely causes of the dysfunction and selects an adequate treatment regimen.

Modern treatment methods

1. Drug therapy

PDE-5 inhibitors (phosphodiesterase type 5 inhibitors): drugs based on sildenafil, tadalafil, vardenafil, and avanafil are now considered the "gold standard" for the treatment of erectile dysfunction. They help relax the smooth muscles of blood vessels and increase blood flow to the penis. PDE-5 drugs, however, have several contraindications, especially in cardiovascular diseases and taking nitrates.

Hormone replacement therapy: if testosterone deficiency is detected, the doctor may recommend male sex hormone drugs, but only after a thorough examination. Uncontrolled use of testosterone can lead to unwanted side effects and suppression of one's own hormonal regulation.

Other medications: In cases where PDE-5 inhibitors are ineffective or contraindicated, alternatives are prescribed, such as intracavernous injections of alprostadil (prostaglandin E1) or other vasodilators.

2. Hardware methods

Vacuum therapy: a special vacuum device is used to create negative pressure around the penis, which leads to blood flow and an erection. An elastic ring is then placed on the base of the penis, preventing the backflow of blood and allowing an erection to be maintained during intercourse.

Physiotherapy and shock wave therapy: According to some data, low-intensity shock wave therapy (Li-ESWT) can help improve tissue blood supply, stimulate neoangiogenesis and have a positive effect on the restoration of penile function. Although final conclusions on the effectiveness of the method require further research, it is already finding clinical use.

3. Surgical intervention

Vascular surgery: indicated for significant vascular pathologies, when there is a pronounced impairment of blood flow. The surgeon corrects the blood supply to the penis by bypassing or eliminating venous leaks.

Penile prosthesis: implantation of a prosthesis (semi-rigid or hydraulic) is a radical but effective way to treat severe forms of ED when other methods have failed. Modern prostheses allow for a good imitation of a natural erection, but the surgery requires a highly qualified approach.

Recommendations and prevention

Weight control and diet: overweight and obesity are one of the key risk factors. A balanced diet with reduced consumption of saturated fats, sugar and fast carbohydrates, as well as an increase in the proportion of vegetables, fruits and protein will help reduce the risk of developing both cardiovascular diseases and erectile dysfunction.

Regular physical activity: moderate aerobic exercise (walking, running, swimming, cycling) improves blood circulation and has a beneficial effect on the heart and blood vessels. In addition, training helps to increase testosterone levels and improves the psycho-emotional state.

Quitting bad habits: smoking and alcohol abuse are among the most common factors that aggravate ED. Reducing or completely eliminating tobacco and ethanol has a positive effect on the vascular system and stabilizes potency.

Regular check-ups: especially important for men over 40. Checking the level of hormones, sugar and cholesterol in the blood, as well as monitoring blood pressure and the state of the cardiovascular system allow you to detect deviations in time and take the necessary measures.

Quality sleep and stress management: constant lack of sleep and nervous tension have a negative effect on libido and the quality of an erection. It is recommended to develop healthy sleep habits and find ways to reduce stress (yoga, meditation, walks in the fresh air, psychological counseling).
Sexual activity and partnerships: regular sexual life and open interaction with a partner help maintain sexual function at the proper level. It is also important to talk about your experiences, not to keep silent about emerging problems and, if necessary, contact a sexologist.

The Boottom Line

ED is a multifactorial disorder that occurs at the intersection of physiological, psychological, and social aspects of men's health. According to scientific research, the problem occurs in a significant part of the male population, and its prevalence continues to grow due to lifestyle changes and the deterioration of the environmental situation.

ED can significantly reduce the quality of life. Today, there are effective treatment methods, ranging from drug therapy with PDE-5 inhibitors to modern surgical methods of restoring potency.

To successfully solve the problem, it is extremely important to consult a doctor promptly. Competent diagnostics allow you to identify the root cause of the dysfunction and select the most effective treatment methods - be it lifestyle correction, rational pharmacotherapy, or more radical interventions. Moreover, erectile dysfunction is often the first sign of serious problems in the cardiovascular and endocrine systems.

Thus, a comprehensive approach to the problem helps not only to restore full sexual activity but also to prevent the development of life-threatening pathologies.

Finally, in matters of prevention, the key elements are a healthy lifestyle, giving up bad habits, paying attention to the mental state, and regular check-ups with specialists. Men of any age need to remember that maintaining potency is not only a matter of self-esteem and sexual well-being but also an indicator of the general condition of the body. When the first signs of difficulty with erection appear, do not postpone a visit to the doctor.

Timely detection of the problem and adequate treatment help to achieve a lasting improvement in sexual function and improve the overall quality of life.