Erectile dysfunction (previously used the term “impotence”) is a very common disease in the world, characterized by the inability to achieve and maintain an erection in a state that ensures sexual intercourse. It is known that among men older than 21 years, problems with erection are encountered in every tenth, and after reaching the age of 60, every third man is not capable of sexual intercourse. The disease tends to progress, although few refer to this problem. Most men do not consider erectile dysfunction disease, writing off failures in bed for stress or overwork, and many simply feel free to talk about their problem.

Meanwhile, erectile dysfunction may indicate a disease, the timely treatment of which will allow to normalize and sexual function.

Problems with erection: where to look for the cause?

In 20-40% of cases, violations of potency develop in physically healthy people and are psychogenic in nature. In about 50% of cases, erectile dysfunction develops due to internal diseases. 30-50% of cases of this amount are of vascular origin. It happens that several factors can be combined with each other.

Most often with disorders of sexual function have to meet a cardiologist. Impotence often accompanies diseases such as atherosclerosis, coronary heart disease,   arterial hypertension. Doctors of other specialties can also reveal this unpleasant condition. So, erectile dysfunction often occurs in men suffering from diabetes, obesity, chronic renal failure, multiple sclerosis, chronic alcoholism.

Sometimes problems with potency can occur during treatment with certain drugs, as an unpleasant side symptom.

A full erection is provided by the interaction of hormonal, neurogenic and vascular factors. At violation at least in one of these links dysfunction develops.

Erectile dysfunction in cardiac patients

The basis for the development of erectile dysfunction in people with heart and vascular diseases is a common pathological process for these diseases – endothelial dysfunction. The term “endothelial dysfunction” is understood as changes in the function of the inner layer of the vascular wall (endothelium) in certain diseases.

Endothelial dysfunction is an independent risk factor for cardiovascular diseases. Erectile dysfunction of vascular genesis can also be attributed to endothelium-dependent diseases. It is for this reason that erectile dysfunction is more common in cardiac patients.

Arterial hypertension

Approximately 50% of patients with high blood pressure have erection disorders. Arterial hypertension is a complex disease in which many organs are involved in the pathological process, they are called “target organs”. These organs include the heart, kidneys, brain, retina. Target organs include vessels, including vessels of the penis.

Ischemic Heart Disease (CHD)

60% of patients with coronary heart disease are diagnosed with erectile dysfunction due to the fact that the diseases have similar risk factors.

And the presence of associated conditions such as atherosclerosis, hypertension, and diabetes mellitus in coronary heart disease further increases the likelihood of the development of sexual dysfunction.

Atherosclerosis

Studies have shown that men suffering from systemic atherosclerosis also have problems with erection. Erectile dysfunction in atherosclerosis develops in 80% of cases. A detailed examination of such men revealed:

• The arteries supplying the penis were also signs of atherosclerosis;
• The deposits on the walls (plaques) were similar in structure with atherosclerotic plaques in other vessels;
• The arteries of the penile arteries were narrowed, the arterial blood flow was reduced.

This means that atherosclerosis can also affect the arteries of the penis, including problems with sexual function.

Multiple sclerosis

Multiple sclerosis   – A chronic disease of an autoimmune nature, in which the nervous tissue is replaced by connective tissue. The process is common, sclerotic changes occur in the nervous tissue throughout the body.

In this disease, erectile dysfunction in men develops in almost 90% of cases. The clinical manifestations are not well understood. But it is noted that erectile dysfunction in multiple sclerosis is often accompanied by impaired urination and defecation (constipation).

There are opinions that erectile dysfunction in multiple sclerosis develops as a result of damage to the spinal cord.

Diabetes

The absence of normal potency, which could ensure the commission of sexual intercourse and the enjoyment of it, is found in diabetes mellitus, both of the first and second types.

In the pathogenesis of the development of disorders of erectile function in diabetes mellitus, various factors can be involved:

• Neurogenic cause of erectile dysfunction

Associated with the development of neuropathy – changes in the nerve fibers of the penis, disrupting the normal conduct of the impulse along the nerves.

• Vascular causes

The development of erectile dysfunction occurs as a result of macro- and microangiopathies developing in diabetes mellitus. Changes in the vessels in diabetes are the cause of atherosclerosis of the cerebral vessels, coronary vessels, aorta, limbs, including the arteries supplying the penis.

Also, with this disease, changes occur at the “local level”. It is noted that in the cavernous bodies (the structural unit of the male penis) of patients with sugar dibet accumulation of collagen (connective tissue) occurs, the elasticity of cavernous tissue decreases.

• Causes of endocrine nature

In some patients, diabetes mellitus is accompanied by a decrease in testosterone levels. Some associate this phenomenon with metabolic disorders and obesity, which are frequent companions of diabetes.

• Psychogenic factors

In approximately 10% of patients with diabetes mellitus, erectile dysfunction has a psychogenic nature. The diagnosis of diabetes is a great stress for many, and occasional failures in bed are regarded as a manifestation of a serious illness, which is why the following attempts at sexual activity also fail.

Obesity

People who are obese often have sexually related problems. This is due to the revealed relationship between the level of serum testosterone and the volume of visceral adipose tissue in the body.

• A decrease in testosterone levels in the blood leads to an accumulation of fatty tissue around the organs;
• Visceral obesity (accumulation of intra-abdominal fat) leads to a decrease in total testosterone levels in the blood.

Such a complex relationship between male sex hormones and adipose tissue underlies the development of erectile dysfunction in obesity.

Erectile dysfunction, caused by obesity, is easily reversed. Even a moderate decrease in body weight gives good results – an erection is restored.

As a side effect of medication

Violation of sexual function can have a medical nature. Some   drugs used in the treatment of common diseases can have a negative impact on erection. Most often this is observed in the treatment of diseases of the heart and blood vessels.

Erectile dysfunction, as a side effect of treatment, develops when taking the following medicines:

• alpha blockers ;
• beta blockers;
• centrally acting diuretics;
• ganglioblockers ;
• ACE inhibitors.

As practice shows, it is the patients of the cardiology department who most need consultation on this intimate topic. The emergence of failures in sexual activity, leads patients to discontinue medication, which complicates the prognosis of the underlying disease.

To date, there are many drugs that adversely affect the male potency. These include:

• antidepressants;
• hormonal drugs;
• antipsychotics;
• antifungal medications;
• narcotic drugs.

As a rule, after discontinuation of the drug, the symptoms of erectile dysfunction disappear independently, the erection is restored in the same amount.