Etiology - ED

There are three types of erections (nocturnal, psychogenic, and reflexogenic); each of which may be impaired by any of the following etiologies.

• Psychogenic
• Vasculogenic
• Neurogenic
• Endocrine
• End-organ failure
• Iatrogenic and drug-induced
  
  
• Psychogenic impotence
  • Anxiety and fear of failure
  • Depression (drug or disease induced)
  • Marital conflict strained relationship
  • Ignorance, misinformation, and religious beliefs
  • Psychotic and personality disorder (obsessivecompulsive, anhedonia)
• Vasculogenic impotence
• Neurogenic impotence
• Endocrine and metabolic disorder
  • Hypergonadotropic hypogonadism (primary testicular failure) is the most common endocrinopathy causing sexual dysfunction
  • Congenital hypogonadotropic hypogonadism is associated with Kallmann's, Prader-Willi, and LaurenceMoon-Biedl syndromes
  • Hyperprolactinemia-drug induced, or from a prolactin-secreting pituitary tumor-is also associated with sexual dysfunction
  • Thyroid disorders are known to cause erectile dysfunction and are indirectly associated with changes in testosterone levels
• End organ factors
  • Congenital problems include:
    • Exstrophy/epispadias complex
    • Microphallus
    • Fusiform megalourethra
    • Severe penile chordee
  • Peyronie's disease
  • Priapism
  • Prostatitis
  • Seminal vesiculitis
• Latrogenic and drug-induced impotence
  • Vascular surgical procedures
  • Transplant and radical pelvic surgery
  • Surgery for priapism
  • Pelvic irradiation
  • Trauma to the lower urinary tract
  • Certain procedures performed on the spinal cord and brain
  • Drug-induced impotence; alcohol, recreational drugs, antihypertensives, and psychotropics

References

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