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causes of erectile dysfunction

director: Chris Steidle, MD

The Effects of Disease States and Drugs on Erections

• Cardiovascular Disease is the most common cause of ED and is due to endothelial dysfunction. Studies have demonstrated that two million people have heart disease but have no symptoms, and one out of four men with no risk factors will die suddenly of a cardiovascular event. Other studies indicate that ED may be present for 2-3 years prior to the diagnosis of heart disease.
  
  
• Smoking is one of the greatest health enemies and is responsible for over 400,000 deaths per year. Smoking causes endothelial dysfunction, which causes ED. I firmly believe that if manufacturers added a warning to cigarette labels that smoking will make erections go away, no man would smoke.
  
  
• Diabetes is the most common cause of sexual dysfunction in men. It has been estimated that up to 50-75 percent of diabetic men have erectile dysfunction, because diabetes causes endothelial dysfunction. Diabetics must pay attention to diabetic neuropathy -- the loss of vibratory sensations of the lower extremities. With this disease, there is always the possibility of peripheral neuropathies. Other diseases that are associated with peripheral neuropathies include chronic renal failure, carcinomas, rheumatoid arthritis, hypothyroidism, herpes zoster, anemias, breathing problems, such as chronic obstructive pulmonary disease, as well as a long list of hereditary neuropathies.
  
  
• Hypertension (HTN) or high blood pressure is one of the most common health conditions. HTN is the second most prevalent disease in men with ED. HTN causes endothelial dysfunction, which leads to ED. However, the treatment of HTN can also cause ED.
  
  
• Enlarged Prostates or BPH can be the cause of ED as well. Treatment of the prostate disease can reverse ED but cause ejaculatory disorders.
  
  
• Prostate Cancer as well as the treatment of prostate cancer can lead to ED.
  
  
• Dyslipidemia or abnormal concentrations of lipids in the blood. These high concentrations of bad cholesterol will cause endothelial dysfunction, which leads to ED.
  
  
• It is estimated that fifty percent or more of men with Multiple Sclerosis have erectile dysfunction. Bladder dysfunction can be also be associated with the erectile dysfunction in multiple sclerosis. 
  
  
• Parkinson's disease and temporal lobe abnormalities are risk factors for erectile dysfunction.
  
  
• Stroke and alcoholism create a very high risk because of damage to the testicles and the resulting decrease of testosterone in the body. 
  
  
• Aging is a common risk for erectile dysfunction, often related to a decrease of male hormones and endothelial dysfunction. The Massachusetts Male Aging Study indicated that 50 percent of men age 40-70 have a minimal, moderate or severe degree of erectile dysfunction.
  
  
• Chronic renal insufficiency is another potential factor. Many drugs used to treat the type of high blood pressure associated with chronic renal insufficiency can cause erectile dysfunction, and many drugs are, by themselves, the culprit.

Drugs That Cause Impotence

Recreational drugs are a major cause of erection problems and the number one problem drug is tobacco. Experiments show that even two cigarettes will markedly decrease the blood flow to the penis if smoked before sex. Marijuana, cocaine and alcohol are also big causes of erection problems. Prescription drugs are also big culprits, especially blood pressure drugs.

The major problem drugs include: 

1. Estrogens used in men with prostate cancer 
2. Antiandrogens (flutamide) used in men with prostate cancer 
3. Lupron - prostate cancer drug 
4. Proscar - for men with enlarged prostates, can decrease the volume of ejaculate 
5. Diuretics - used for men with heart disease and hypertension 
6. Methyldopa - older treatment for blood pressure 
7. Beta blockers - for heart disease and hypertension 
8. Calcium Channel Blockers- newer treatments for hypertension 
9. Tranquilizers 
10. Decongestants 
11. Seizure Medications 
12. Drugs to lower Cholesterol 
13. Cimetidine - a drug for ulcers 
14. Digoxin - a drug for heart failure 
15. Antidepressants
16. Antihistamines

Other causes of ED include surgical treatments for prostate problems, bladder removal for cancer, urethral stricture, urinary surgery, carcinoma of the penis, priapism, renal transplantation, colon surgery, radiation, lumbosacral surgery, penile amputations, and penile surgery in children to correct congenital problems.

Updated January 2007

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