Category Archives: Erectile Dysfunction Classification

Drug Induced Erectile Dysfunction

Human body has a series of chemical reactions and secretions taking places continuously. External drugs could be a necessity but at times is a matter of choice.

In a lot of cases, drugs that are introduced into a person’s routine can also severely impact certain chemical cycles in the body. Assessing drug indiced sexual dysfunction can be sometimes tricky because it requires close investigation to determine whether a particular drug is the cause of the perceived erectile dysfunction or whether the dysfunction is a result of the underlying disease that is being treated by the drug. Not only that, the patient may be using several drugs in unison thus making it difficult to identify one primary source of the drug induced sexual disturbance.

Usage of a wide variety of drugs or medications can impact the erectile procedure adversely. The impact of drugs shows most prominently on the central nervous system and it influences the pituitary gland axis.

Out of the variety of groups of drugs, the certain drugs have been reported to cause the majority of the drug induced dysfunction. Among the anti-hypertensive medications, thiazides are the most common cause of ED, followed by beta-blockers. Alpha-blockers are, in general, very less likely to cause this problem. Antidepressant and other psychiatric medications, antihistamine medications, high blood pressure medicines and parkinson disease medications are the usual suspects.

Different medicines have different ways of disturbing the sexual cycles. Sedative-hypnotics can depress sexual arousal and desire, tranquilizers and antidepressants lead to inhibition between erection and ejaculation. Apart from medically legalised dosages by physicians – certain recreational drugs such as heroin, cocaine, nicotine and alcohol can also impact the male sexual functions. Some drugs such as MDMA, ecstasy accentuate initial sensory build up but mar erectile function. Recent studies have also identified the adverse function of cannabis on sexual performance. Earlier this was a bed of controversy but seems, like not any longer. Cannabis affects certain receptors in the mind and the penis making it difficult to sustain an erection.
In some cases medication such as risperidone nifedipine, hydralazine, haloperidol, hydralazine and some anticoagulants can cause priapism wherein the erection lasts for an abnormal time some times over four hours.  Priapism takes place because of blood getting trapped in erection chambers or in the cases when blood cannot circulate normally through the penis. Drugs interfere with regular blood flow leading to priapism, immediate treatment of priapism is essential, failure of which can lead to permanent erectile failure.

It is better to consult a doctor in case of drug induced erectile dysfunction so that alternative medicine with less impact can substitute the continuing ED. In all or most cases of erectile dysfunction a lot of damage can be avoided if one adheres to a healthy and proportionate lifestyle.

Neurogenic Erectile Dysfunction

Remember, we talked about endocrine related Erectile dysfunction.Just as Endocrine is for hormones, Neurogenic is for nerves. Neurogenic sexual dysfunctions are related to the nervous system and its well being.

Let’s understand how nervous system impacts sexuality in a little detail. Human nervous system contains of two parts- first being the central nervous system which consist of the brain and the spinal cord and it receives processes and integrates all the information and enables signals for coordinating activity of the different parts of the body. The second part of the nervous system is the Peripheral Nervous system which consists of the nerves around the brain and the spinal cord which connect them to the rest of the body organs. The cerebrospinal nerves transport or transmit stimuli and impulses for muscle activation. Apart from the cerebrospinal nerves, the peripheral system constitute of the autonomic system which regulates functional processes of the body such as digestion, breathing and heart rate etc.

Sexual activity and sexual function of both men and women involves the entire nervous system. While the brain becomes the headquarters of all control, the spine acts as the necessary channel for the transmission. The transmission happens via the autonomous nervous system wherein the cerebrospinal nerves carry the messages to the headquarter. The signals sent to the headquarters are processed and formulated into actions that the body must perform. There are some cases where the brain must not involve itself in “ordering” the body to perform, this happens in the case of intensified sexual reflexes or “genital reflexes” which occur due to direct stimulation of the gentiles and perineal area in men and lubrication in female. These reflexes are managed by the lower spinal cord area and the brain does not need to participate unless it wishes to change the course of the activity or to stop it.

Since the entire nervous system is responsible for sexual activity any kind or damage to the nerves can cause disruption in an even signal flow, specially the peripheral nerves which are not protected by the bones and spine which are more susceptible to injury unlike the nerves of the central nervous system.

Therefore spinal lesions are the most common cause of sexual dysfunction in men as well as in women since spinal cord is the most pertinent organ in the nervous system. Neurogenic erectile dysfunction is also caused due to some diseases like Parkinson, and Diabetes etc. Which harm the nerves in a growing fashion or leads to blockages in it.  Extensive alcohol abuse also leads to hammering of a properly functioning neurological system thereby leading to erectile dysfunction. The severity of the neurogenic dysfunction incides with the extent and continuity of the nervous disorder or injury and can be treated accordingly.

Endocrine Erectile Dysfunction

Hormones, which are produced out of various sections of the endocrine gland in the body are chemicals in released in the blood. Hormones are essential to enable metabolic reactions and processes in the body and are referred to as “internal Medicine”. Androgen is the male sexual hormone which majorly consists of testosterone which is the principal male sex hormone apart from androstenedione and dihydrotestosterone. Apart from certain virilising functions such as maturing of sex organs and secondary males sexual functions –  androgen also has excitatory functions that define endocrine erectile behaviour.

Hormonal dysfunctions or disturbances in the testosterone levels in the human body can cause sexual dysfunctions in men. Although, the role of androgens (male sexual hormone) in successful erections is not very clearly defined, but it does remain a cause of erectile dysfunction in some patients. Lack of Androgens in the serum can lead to lack of excitement and sexual libido and the nature of erections. This happens because of the emotional functions that hormones create apart from the physical functions. Low levels of testosterone in the blood lead to reduction in serum production and decrease in nocturnal erections. Loss of testosterone can be identified by hot flushes and sweating, reduced mass and muscle strength, increased fat in the body- mostly around the abdomen, loss of hair, loss of bone mass and depression.

Testosterone levels usually decline around the age of forty and almost one out of five men is faced with reducing testosterone, thus making it an age related dysfunction but there are a lot of other factors that may lead to fall in the levels apart from ageing such as obesity, lack of a healthy lifestyle etc.

Some testicular medical problems which could be from birth like the Klinefelter’s syndrome or other problems such as undecided testicles, loss of testicles or torsion (losing out of blood supply) or other vascular problems can also lead to hormone reduction. Also, since pituitary gland controls the release of androgens, presence of a benign tumor can inhibit pituitary gland from signalling the body to create testosterone.

Congenital abnormalities too can stop the hypothalamus from signalling the pituitary gland to release hormones. But this happens in very rare cases.

Depleting levels of testosterone levels impact the sexual libido in an adverse manner and may lead to reduced sperm production too.When there is hyponogodism, which means little of no hormone production in the body, testosterone replacement is a remedy that can increase the libido and nocturnal erections.

Vasculogenic Erectile Dysfunction

Vasculogenic Erectile Dysfunction is related to lack of regulated influx of blood through blood cells and arteries.

The penis contains two chambers called the Corpora Cavernosa. Copora Cavernosa is stretched through to the length of Penis. A spongy tissue fills the chambers. The Corpora Cavernosa is surrounded by a membrane called tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, arteries and veins and spaces.

An erection happens only when arterial influx happens into cavernosal arteries sufficiently. Therefore proper blood influx and a well functioning cavernosal mechanism is essential for proper erections. This means, that erection begins through touch or activation through sensory organs, all of which transmit mental signals through the nerves. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the cavernosal spaces. The blood creates pressure in the corpora cavernosa leading to the expansion of the penis and thereby cause erection. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection.

Any kind of disruption or destruction of this physical system containing nerves, vessels etc. can lead to sexual disturbances. The causes of vasculogenic dysfunction could be hardening of arteries due to fat, cholesterol or drugs that in effect create a wall of plaque around the arteries. This hardening of arteries is called arteriosclerosis.

The vasculogenic disruptions are caused due to filling up of carvenoloscar spaces leading to disrupted blood flow.  The reasons of arteriosclerosis could be diabetes, hypertension, severe nicotine abuse, multiple sclerosis, vascular disease, atherosclerosis and neurologic disease etc.  All the diseases which create vasculogenic disturbances are lifestyle related and can be minimised by keeping away from fat, alcohol, drugs and smoke. Another cause of vasculogenic dysfunction  is perineal trauma, which means any damage to the genitalia during childbirth, excessive masturbation(extremely rare), or any other kind of external physical abuse that occurs spontaneously or intentionally by surgical incision, injuries of the pudendal vessels or iatrogenic (pelvic medical surgery related) injuries.

Medically, arterial disturbances are caused because of physical external substances or alterations. Thereby vasoactive dysfunctions are not partner, situation or mind dependent unlike the psychogenic disturbances.

One of the very rare causes of primary erectile dysfunction is Ectopic veins. Ectopic venal leakage or pathologic cavernosal drainage via a single ectopic penile vein can lead to disruption of the vasucolgenic system. Correction of Ectopic veins can be done by a simple surgery that resects the ectopic vein.

Venous erectile dysfunctions are mostly due to alterations of the tunica albuginea, the fibrous covering of the testis or the cavernous tissue.

Degenerative alterations of these muscle cells and resulting loss of elasticity can lead to the incompetence of the cavernosal mechanism. The possibilities of functional injuries of the muscle cells of the corpora cavernosa caused by sparse or decreased release of neurotransmitters, a blockage in the receptors could also be a reason for quantitative disturbances of receptor status.

A substantively reduced number of neurotransmitters, electrical stimuli and endothelium could be traced in patients with Diabetes Mellitus. Also, competitive receptor blockage could also be caused by medical surgeries that and can mar the relaxation capacity of the muscle cells. Similarly, competitive blockages are sometimes observed in psychogenic disturbances even.

Since vasculogenic problems are more lifestyle related , a healthy food intake , certain breathing exercises and yoga can regulate the blood flow and clear out the pathways for regulated influx. It is advisable to consult a doctor before making any alterations to one’s physical lifestyle.

Psychogenic Erectile Dysfunction

Psychogenic erectile dysfunction is mind driven. Mind acts as the centre of most sexual activity and contains pituitary gland that controls the release of sexual hormones. But psychogenic disturbances are more reaction related than physical system related and depends on formulation and perception of signals into ideas.

Psychogenic dysfunction constitutes a very small part, only about ten percent, of the total cases of Sexual Dysfunction in men. But even with other types of sexual dysfunction, psychogenic dysfunction stems as a mental reaction to sexual grievance. Thus it remains the most easily acquired form of dysfunction.

Broadly there are two kinds of psychogenic influencers. The first category of disturbances are those that creep in during the primitive years of discovering sexuality, for e.g.  growing up in a particular social context where sexuality is broadly curtailed. This could arise out of societal or religious beliefs. Certain societies and religions discourage sexuality and associate lack of integrity of lack of purity with sexual activity. In these cases victims want to confirm to societal and religious beliefs for general acceptance in the society and develop a peculiar taste towards their own sexuality and never give their sexuality a space to flourish in a healthy manner.

The second category of disturbances arises out of specific situations or failure in a particular relationship, heartbreaks, marital discords and adultery. Lack of self confidence owing to an unsuccessful performance or an unpleasant sexual experience from the past can lead to anxiety that inhibits a successful sexual performance.  This category is usually more severe to deal with.

These contexts may generate some chronic psychological problems such as chronic depression, bipolar mood disorder, obsessive compulsive disorder, schizophrenia or post traumatic stress disorder (after being a witness to a tragic situation directly or indirectly. Sexual disorientation is a by-product of these psychological ailments.

A lot of sexual difficulties are cognition based. Cognitive sexual disorders are caused because of wrong perceptions towards sexual ideas. Lack of sexual knowledge about the technique, partner reaction, one’s own body etc. is perception or cognition related problems. Such ideas lead to actions which are not appropriate or well defined. Cognitive inaccuracy leads to wrong emotions and chemical reactions in the body that may lead to physical sexual disturbances too. This goes on to prove how intricately the physical sexual wellness is interconnected with psychogenic sexual well being.

Apart from the above mentioned causes, physical illness, temporary adjustment disorders such lack of job opportunities,  physical or mental stress can also lead to psychogenic disorders of sexuality.

It is imperative to gauge the nature of dysfunction, understand the root cause of it and to access whether the erectile dysfunction pertains to deterioration of libido or whether it is because of fear of performance that the erection cannot sustain. If it is a deteriorating libido it could be because of actual physical ailment (organic ailment) or low testosterone which could be cured but psychogenic problems are sometimes difficult to cure.

A lot of psychogenic dysfunctions can be treated by will power and proper and counselling. With a little more attention to self and the partner by keeping the comfort and happiness in mind several partner related psychogenic problems become easier to deal with. Doctors often advice that men suffering from performance anxiety should concentrate on the sexual pleasure rather than the performance and top achieve this some men are advised intimacy sessions without copulation – thereby getting them to experience pleasure without the impending anxiety of copulation. A number of such sessions often leads to increased confidence and comfort and the man can finally reach a stage where intercourse seems like the natural culmination of love making. Partner co-operation is crucial for such scenarios.

Types of Erectile Dysfunction

TYPES OF SEXUAL DYSFUNCTIONS:

Sexual dysfunction can be best described as disorder of the reproductive system that may be due to physical, transmission and action related in competencies, which can organic or due to an external injury. In addition to this, the fact that humans are endowed with very powerful minds adds additional layers to human sexuality and therefore also to sexual dysfunction.  Sexual activity has broadly five phases namely excitement, plateau, orgasm, and resolution and dysfunctional problems can occur in any of these four stages.

Men and women face different kinds of problems which could be common to both or specific to their own kind. Among men, dysfunction could lead to lack of interest in sexual activity-called loss of libido, infirm or inconsistent erections that do not sustain more than fifty percent of the intercourse attempts called Erectile Dysfunction; Premature, retarded or retrograde ejaculations or permanent failure of achieving sexual pleasure.

There are different kinds of treatment for the disorders based on the root cause of their existence. The treatment could be clinical, psychotherapeutic or advisory in nature. At times the treatment only helps short term, unless the root cause is not found. Recurring sexual insufficiencies can also worsen the problem.

There are several factors that may lead to sexual dysfunctions in men. To put it broadly, the problem could be A. Physical – external situations, medication, surgery or substance abuse related (or) B. Psychological – failure, trauma, sexual abuse and context related (or) age related. If you look deeper there are primarily 5 kinds of disturbances that cause erectile dysfunction. They are psychogenic, vascular, neurogenic, and hormonal or direct myogenic.

As discussed by the parallel established above, the human body is a complicated system with several interconnected mechanisms, thereby making it sometimes difficult to accredit a disease or dysfunction to one particular organ and mostly all disease have multiple origins or series of interconnected reactions.  The above mentioned types of origins could come together in various permutations and combinations to cause dysfunction among men. We shall discuss all of these one by one.