Understanding Erectile Dysfunction

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Understanding Erectile Dysfunction


Dr. Raymond Costabile and Dr. Ryan Smith specialize in the diagnosis and treatment of erectile dysfunction.

Definition of Erectile Dysfunction

Erectile Dysfunction is the inability to attain or maintain a penis erection that is firm enough for sexual intercourse.  To initiate and maintain an erection, the penis must fill with blood. One type of blood vessel opens wide to allow blood into the penis. Meanwhile, a second type of blood vessel squeezes down to keep the blood from leaving the penis. In normal penis function, nerve signals cause the proper coordination of the blood vessels.


Blood Vessesl and Nerves of the Mail Pelvis Copyright © Nucleus Medical Media, Inc.

Causes of Dysfunction

Impairment of Neurovascular Function

Problems with the nerves and blood vessels often cause erectile dysfunction. Common conditions that can cause problems include:

  • Nerve dysfunction.  This can reduce feeling in the penis, resulting in erectile dysfunction.
  • Diabetes.  This disease interferes with nerve signals .
  • Hardening of the arteries. This condition can cause reduced blood flow.
  • Peripheral neuropathy, spinal cord injury, and surgery (e.g., prostate removal).  These circumstances can damage nerve function.
  • Certain medications.  Anti-depressants, for example, commonly cause some degree of erectile dysfunction.


Psychological Factors

Many of the nerve signals needed for an erection come from the brain. Emotional problems and stress may play a role in men who suddenly develop erectile dysfunction.

Summary of All Risk Factors
Age:  65 and older


Medical conditions:

  • Diabetes.
  • Obesity.
  • Hardening of arteries.
  • Chronic kidney disease.
  • Liver failure.
  • Peyronie's disease—bending of the penis caused by scar tissue.
  • Endocrine disorders.
  • Neurological disorders such as multiple sclerosis, peripheral neuropathy, and stroke.
  • Hypertension
  • Psychiatric disorders, such as anxiety and depression .


Traumatic conditions:

  • Vascular surgery.
  • Pelvic surgeries, particularly for prostate cancer .
  • Spinal cord injury.



  • Alcohol use.
  • Illegal drug use.
  • Anabolic steroid use.
  • Heavy smoking.
  • Interpersonal conflicts with a sexual partner.



  • Anti-hypertensives, for high blood pressure.
  • Anti-histamines, commonly used as allergy medication.
  • Anti-depressants.
  • Tranquilizers.
  • Anti-psychotic drugs.



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