Causes and Classification of Erectile Dysfunction

Causes and Classification of Erectile Dysfunction

Normal erectile function requires the coordination of psychological, hormonal, neurological, vascular, and cavernosal factors. Alteration in any one of these factors is sufficient to cause erectile dysfunction. Not uncommonly, a combination of factors is involved.

Causes of Erectile Dysfunction

Psychologic causes
Young age with abrupt onset associated with specific emotional event Dysfunction in certain settings while normal function in others Persistence of nocturnal erections Previous history of erectile dysfunction with spontaneous improvement Excessive life stressors--work, relationships Mental status findings suggestive of depression, psychosis or anxiety disorder.

Penile injury/disease
Peyronie's disease
Priapism
Anatomic abnormalities

Medications

Aging
Chronic disease
Diabetes mellitus
Heart disease
Hypertension
Lipid disorders
Renal failure
Liver disease
Vascular disease

Life style
Cigarette smoking
Chronic alcohol abuse

Organic causes
Vasculogenic--arterial

Persistent interest in sex Older age with gradual onset Impaired function in all settings Presence of chronic disease (particularly diabetes, hypertension) Use of prescription/over-the-counter medications associated with erectile dysfunction.

Smoking
Elevated blood pressure, evidence of peripheral vascular disease (bruits, decreased pulses, skin and hair changes consistent with arterial insufficiency).

Vasculogenic-venous
Inability to maintain erection once established
Prior history of priapism
Local anomalies of thepenis.

Neurogenic
History of spinal cord/pelvic trauma or surgery
Presence of chronic disease (diabetes, alcoholism)
Presence of neurologic condition (multiple sclerosis, stroke)
Abnormal neurologic examination of genitals/perineum.

Hormonal
Loss of interest in sexual activity
Small atrophic testis
Low testosterone, elevated prolactin.

The drugs may have a direct effect or may act indirectly through bringing about nerve, vascular or hormonal imbalance.

As many as 25 percent of cases of erectile dysfunction are related to medication side effects. If you are taking any of these drugs, please tell your doctor. At the same time, many patients only know their medications by their trade names, which is why it becomes so essential for you to tell the doctor all the medications you are on.

The list given below is only that of allopathic, or what is called by many as "Western" medicines. Many people with diabetes, tend to take herbal medications in the hope of "curing" diabetes. Even medicines given by those practicing alternative medicines such as homeopathy, ayurveda, unani branches of medications may have erectile dysfunction as their side effects. It would be much better to discontinue these medications under medical guidance as they may be unknowingly the reason for your erection problems! .

Drugs Causing Sexual Dysfunction

Drug/Drug Class

Possible Alternative

Antiarrhythmics
Amiodarone
Mexiletine
Procainamide
Anticonvulsants
Carbamazepine
Ethosuximide
Phenytoin
Valproic acid
Antidepressants
Amitriptyline
Amoxapine
Clomipramine
Doxepin
Maprotiline
Protriptyline
Trazodone
Imipramine
Desipramine

* Some patients who experienced sexual dysfunction with amoxapine and clomipramine were successfully switched to imipramine and desipramine, respectively.

Antihypertensives
Atenolol
Clonidine
Hydralazine
Labetolol
Methyldopa
Metoprolol
Pindolol
Prazosin
Propranolol
Verapamil
Reserpine
Guanethidine
Penbutolol,
Timolol
Captopril
Enalapril
Diltiazem
Nifedipine
Antipsychotic
Chlorpromazine
Haloperidol
Thioridazine
Trifluoperazine
Loxapine
Antispasmodic
Baclofen
Dantrolene
Diuretics
Amiloride
Indapamide
Thiazide diuretics
Spironolactone
Furosemide
Anti-Ulcer
Cimetidine
Ranitidine
Metoclopramide
Famotidine
Antihyperlipidemic
Clofibrate
Gemfibrozil
Non-Steroidal Anti-lnflammatory
Naproxen
Ibuprofen
Diclofenac