Men's Health Guide: In-depth Analysis of the Causes of Erectile Dysfunction

Clinical Diagnosis and Treatment of Erectile Dysfunction

Erectile dysfunction (ED) is the most prevalent and severe type of male sexual dysfunction. According to foreign literature, ED accounts for approximately 30-40% of male sexual dysfunction cases. Domestic surveys indicate that about 10% of adult men experience ED. However, treatment for these patients is not uniform; reliable clinical examination is necessary to identify the cause and provide targeted treatment. Otherwise, effective treatment is unlikely. Below is a brief introduction to the basic diagnostic methods and procedures for ED and its clinical treatment from a clinical perspective, helping patients understand the basic process and methods of clinical diagnosis and treatment, facilitating accurate medical consultation, correct diagnosis and treatment, and early recovery.

(I) Basic Concepts of Erectile Dysfunction

ED generally refers to the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse, despite sexual desire. However, occasional erectile dysfunction in normal men due to excessive fatigue, excessive alcohol consumption, fever, or other reasons should not be considered erectile dysfunction, as erectile function will recover after eliminating these factors.

Clinically, we often encounter young men who have never had sexual intercourse but believe they are impotent simply because they haven't experienced an erection recently, and seek treatment at the hospital. Some newlywed men experience erectile dysfunction due to excessive fatigue from pre-wedding preparations, excessive drinking at the wedding banquet, lack of sexual experience, excessive tension, or lack of cooperation from their partners, leading to several failed sexual encounters after marriage. They believe they are impotent, and the resulting psychological pressure further affects normal erectile function, creating a vicious cycle that leads to psychogenic sexual dysfunction. Some patients also experience sexual failure due to factors such as a thick hymen or vaginal spasms in their partners. Strictly speaking, none of the above situations should be considered erectile dysfunction. These are situations many married men have personally experienced, and they usually resolve naturally with mutual adaptation and increased understanding of sexual knowledge between partners. These patients generally do not require clinical treatment.

(II) Causes of Erectile Dysfunction

Erectile dysfunction is mainly divided into two categories: organic and non-organic.

1. Organic Erectile Dysfunction

① Erectile dysfunction caused by insufficient arterial blood supply (ischemic): Normal penile erection depends on sufficient blood supply from the penile arteries to fill the corpora cavernosa and achieve an erection. However, with age, the elasticity of the arterial walls decreases, and some patients may even develop arteriosclerosis. These factors can cause insufficient arterial blood supply to local organs and tissues, leading to symptoms such as weak erections or short erection duration. In these patients, arteriosclerosis not only affects sexual function in the genital area, but can also occur in other parts of the body and organs, such as coronary artery sclerosis, which can cause myocardial infarction. Therefore, in addition to sexual function examinations, older patients should undergo an electrocardiogram (ECG) to rule out coronary heart disease. If necessary, a cardiologist should be consulted. Some young and middle-aged patients may experience impaired local blood supply due to stenosis or occlusion of the internal pudendal artery caused by various reasons, ultimately leading to erectile dysfunction. Arterial erectile dysfunction can be definitively diagnosed through internal pudendal artery angiography, and arterial dilation or thrombolysis can be performed during the angiography procedure.

② Rapid venous return or venous fistula: This occurs because arterial blood flows away from the penile veins before the corpora cavernosa are fully filled, preventing penile erection. Previously, it was generally believed that rapid venous return was mainly due to local venous closure dysfunction. However, recent studies have shown that during penile erection, the blockage of venous return is not an active closure of local veins, but rather due to the high pressure generated by the cavernous sinus blocking a large amount of venous blood return. This blockage of venous blood return is passive, not a function inherent to the veins themselves. The previous view that venous valve closure blocks blood return is inaccurate. In the process of blocking penile blood return, the tension of the smooth muscle cells in the corpora cavernosa plays a crucial role. If the contractile function of these smooth muscle cells weakens for various reasons, even with sufficient local blood supply, a normal erection cannot be maintained. Therefore, erectile dysfunction caused by excessively rapid venous return is not a simple problem; its occurrence is closely related to the penile arterial blood supply and the normal function of the smooth muscle cells in the corpora cavernosa. Some suggest performing a corpora cavernosa biopsy on such patients to understand the pathological changes in penile smooth muscle cells, which is of great significance for the clinical diagnosis and treatment of erectile dysfunction.

③ Nerve conduction disorders: Spinal cord injury, tumors, diabetes, surgery, etc., can all cause local conduction disorders of nerve function, leading to erectile dysfunction.

④ Endocrine dysfunction: Hypothalamic-pituitary dysfunction, but with decreased GnRH, leads to decreased luteinizing hormone (LH) or follicle-stimulating hormone (FSH), increased prolactin (PRL), and decreased testosterone levels. These pathological changes can cause decreased libido and erectile dysfunction. Furthermore, hyperthyroidism, hypothyroidism, adrenal insufficiency, and Cushing's syndrome can all cause sexual dysfunction.

⑤ Certain serious systemic diseases: High fever, malignant tumors, cerebral palsy, myasthenia gravis, multiple sclerosis, severe heart disease, pulmonary insufficiency, malnutrition, abnormal liver function, and renal insufficiency can all cause permanent or temporary sexual dysfunction.

⑥ Drug-induced erectile dysfunction: Long-term use of medications that affect penile erection can cause erectile dysfunction. These medications include sex hormone antagonists (e.g., cyproterone acetate, chlorpromazine); diuretics (e.g., spironolactone, furosemide, thiazide diuretics); antidepressants (e.g., imipramine, chlorpromazine, thioridazine, lithium carbonate, phenothiazines, fluphenazine); hypnotics (e.g., nitrazepam, thiamethoxam, barbiturates); antihypertensive drugs (e.g., methyldopa, guanethidine, hydralazine, reserpine, clonidine); medications affecting the cardiovascular system (e.g., propranolol, coronary heart disease medication); and atropine. Alcohol consumption is also a factor; the relationship between alcohol and sexual function is complex. Some people experience relaxation and excitement from moderate alcohol consumption, which can increase and promote libido, while others experience inhibitory effects, affecting sexual function. However, frequent and excessive drinking will definitely lead to erectile dysfunction due to alcohol's inhibition of the central nervous system. A significant number of patients with alcohol poisoning experience sexual dysfunction.

2. Non-organic Erectile Dysfunction

This type of erectile dysfunction is also known as psychogenic, psychological, or functional erectile dysfunction. It is mainly caused by a lack of sexual knowledge, self-doubt about reproductive organ abnormalities, sexual tension, emotional distress in both partners, sexual incompatibility, psychological trauma (such as the death of a loved one), work stress, and physical fatigue. Once these factors are resolved, the erectile dysfunction symptoms disappear.

3. Mixed Erectile Dysfunction

This type of erectile dysfunction refers to patients with organic erectile dysfunction who also have psychological problems. For these patients, in addition to medication, psychological counseling is necessary to achieve good treatment results.