Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries.
The major causes for erectile dysfunction include:
1- Psychological factors as depression, stress, anxiety and mental disorders
2- Cardiovascular diseases especially hypertension and atherosclerosis
3- Diabetes and obesity
4- Drugs as antidepressants and blood pressure drugs
5- As a complication for bladder or prostate surgery
6- Smoking and substance abuse
7- Low level testosterone
History: help define the degree and type of the dysfunction.
Physical examination: for penis and testicles.
Blood and urine tests: for diagnosis underlying diseases as hypertension or diabetes.
Ultrasound: to check penis blood flow.
NPT: Nocturnal penile tumescence to test erection while sleeping, lack of these erections may indicate there is a problem with nerve function or circulation to the penis.
It depends on the cause of the erectile dysfunction.
1- sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) enhance the effects of nitric oxide.
2- Alprostadil self-injection or penis suppository produces erection that last for long time.
3- Testosterone replacement is used if the dysfunction caused by low testosterone level in the blood.
4- Penile implants and pumps.
5- Psychotherapy is used when the cause of the dysfunction is psychological.
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