Erectile dysfunction

Although 20% of all men over 20 years of age suffer from erectile dysfunction, the prevalence of this disease is much higher in men over 40 years of age where many factors converge and cause the problem (cell damage, endothelial injury, decrease in male hormones, etc.). Age is the main non-pathological cause of erectile problems.

Diabetes causes such diverse alterations in the organism that it is difficult to determine exactly which of them causes erectile dysfunction. In fact, it is estimated that 52% of diabetic men in the world (regardless of their age) present erectile dysfunction of any intensity. However, diabetes alone does not generate the problem since it has been observed that patients who adequately manage their disease are unlikely to develop erectile dysfunction.

Diabetic neuropathy is a serious complication of diabetes in which the body’s nerves begin to become damaged, decreasing the quantity and quality of electrical impulses that communicate one region of the nervous system to another, including the penis. In this condition, the person begins to experience skin desensitization, progressive muscle paralysis and lethargy.

The relationship between blood cholesterol and LDL levels is proportional to the risk of atherosclerosis and endothelial damage in the body’s blood vessels, especially in the penis, where these structures are very thin and susceptible to injury.

As there is more LDL cholesterol in the blood and less HDL (better known as “good cholesterol”), the former tend to bind to each other in the walls of the arteries and cause damage to the endothelium, clogging the blood vessel and hardening it. As a result, it is more difficult for blood to flow freely and nourish the tissues.

This is key in erectile dysfunction, where the blood vessels in the penis are damaged and do not dilate enough to allow erection.

Arterial hypertension has a high prevalence among the population, not only among women and men but also among young individuals. This is due to many factors but mainly genetics, high salt intake, diabetes and dyslipidemias. Hypertension is almost always accompanied by poorly controlled diabetes, atherosclerosis and heart problems.

With the passage of time and as with the previous causes, the high tension exerted by the blood on the walls of the body’s blood vessels promotes damage to the endothelium (endothelial dysfunction) leading to problems for this layer to regenerate, produce substances, exchange nutrients to and from the blood and tissues, and react to physiological mechanisms such as penile erection.

Why the prostate, the reason is simple. This walnut-sized male organ has a close anatomical relationship with the nerves leading to the penis from the central nervous system.

If the prostate becomes inflamed as in prostatitis (almost always of infectious origin), benign prostatic hyperplasia (BPH) or tumors of the gland (prostatic carcinoma), these nerves can become so compressed that they no longer innervate the penis and thus prevent erection and sensation of the penis even when no vascular problems are present.

It is also very common that after prostate surgeries, some of these nerves are accidentally cut and the penis loses innervation. This is why it is so important to monitor the gland, especially after the age of 40, which is when a man should visit the urologist at least once a year.

The pelvic and genital area of men is very exposed to injuries and blows, especially in athletes or those who work with heavy loads at work.

Although it may be hard to believe, some trauma to the lower abdomen, penis, testicles or lumbar back can cause injury to the nerves leading to the penis, decreasing the innervation of that area and the ability to respond to stimuli.

Alcohol is one of the substances that in excess can cause erectile dysfunction.

Alcohol can not only depress the central nervous system (as it activates GABA receptors, an inhibitory neurotransmitter) but can also produce and aggravate endothelial damage due to diabetes, arterial hypertension or dyslipidemia.

In men with erectile dysfunction it is advisable to reduce their alcohol consumption to the minimum possible, especially while trying some treatments.

Smoking causes so many problems in the body that it is difficult to describe its role in the development of erectile dysfunction. Most likely, this has to do with damage to the endothelium of the penile blood vessels, degeneration of the peripheral nerves, accumulation of toxic substances (beyond nicotine there are hundreds of chemicals harmful to the tissues) and an obvious decrease in oxygenation to the cells.

Hard drugs can also cause severe imbalances in the central nervous system and the way it processes information. Almost all men with hard drug dependence experience erectile dysfunction to any degree, depending on the type of drug, the dosage and the length of time on the drug.

This disease occurs when at some point in the tunica albuginea that covers the corpora cavernosa of the penis, a fibrotic process develops that is not very elastic and retracts the member when there is an erection, bending it and making penetration difficult.

The penis can become so curved with Peyronie’s disease that erection pain can occur. This causes many men to experience fear of just having an erection, resulting in erectile dysfunction.

Peyronie’s curvature and erectile dysfunction go hand in hand, when one of them worsens, so does the other. For this reason, both must be treated simultaneously to achieve results. However, Peyronie’s disease may be so advanced that there is no other option but to resort to surgery.