aetiology

Last reviewed 01/2018

Aetiology of erectile dysfunction can be:

• psychogenic
• history of sexual abuse, marital or  relationship stress
• performance anxiety
• overt psychological disorders, such as depression or schizophrenia
• drugs prescribed to treat psychological disorders
• organic
• vascular
• cardiovascular disease
• artherosclerosis
• hypertension
• diabetes
• hyperlipidaemia
• smoking
• major surgery or radiotherapy (pelvis or retroperitoneum)
• neurogenic
• central causes
• degenerative disorders (multiple sclerosis, Parkinson’s disease, multiple atrophy etc.)
• spinal cord trauma or diseases
• stroke
• CNS tumors
• peripheral causes
• type 1 and 2 diabetes mellitus
• chronic renal failure’
• polyneuropathy
• surgery e.g - pelvis or retroperitoneum, radical prostatectomy, colorectal surgery, etc.)
• anatomical or structural
• foreskin problems (phimosis, lichen sclerosus)
• penile curvature (congenital curvature or Peyronie’s disease)
• benign and malignant genital dermatoses.
• hormonal
• hypogonadism
• hyperprolactinemia
• hyper- and hypothyroidism
• hyper- and hypocortisolism (Cushing’s disease etc.)
• drug induced
• antihypertensives (diuretics are the most common medication causing ED)
• antidepressants (selective serotonin reuptake inhibitors, tricyclics)
• antipsychotics (incl. neuroleptics)
• antiandrogens; GnRH analogues and antagonists
• recreational drugs (alcohol, heroin, cocaine, marijuana, methadone)

However, in most patients both factors probably contribute to the failure to achieve an adequate erection.

Notes:

• head injury and gonadotropin deficiency (3)
• marked changes of the hypothalamo-pituitary axis have been documented in the acute phase of traumatic brain injury(TBI)
• following TBI as many as 80% of patients showing evidence of gonadotropin deficiency, 18% of growth hormone deficiency, 16% of corticotrophin deficiency and 40% of patients demonstrating vasopressin abnormalities leading to diabetes insipidus or the syndrome of inappropriate anti-diuresis
• longitudinal prospective studies have shown that some of the early abnormalities are transient, whereas new endocrine dysfunctions become apparent in the post-acute phase. There remains a high frequency of hypothalamic-pituitary hormone deficiencies among long-term survivors of TBI, with approximately 25% patients showing one or more pituitary hormone deficiencies

Reference:

• (1) Muneer A et al. Erectile dysfunction. BMJ. 2014;348:g129
• (2) European Association of Urology (2014). Guidelines on Male Sexual Dysfunction: Erectile dysfunction and  premature ejaculation
• (3) Behan LA et al. Neuroendocrine disorders after traumatic brain injury. J Neurol Neurosurg Psychiatry. 2008 Jul;79(7):753-9