Risk factors for erectile dysfunction

Risk factors for erectile dysfunction

Risk factors for organic erectile dysfunction (see Table 1, page 20) mainly
stem from the fact that the erectile mechanism is avasodilatory response
dependent on smooth muscle function under neurogenic control. Aging, which has
the strongestassociation with erectile dysfunction, probably exerts its
effects mainly through impaired vasodilatory and venoocclusivemechanisms.
Atheroma of the internal iliac arteries and their pudendal branches may be one
factor, but age-relateddegeneration of intracorporeal smooth muscle
mechanisms is probably more important. Venous leakage, another
age-relatedphenomenon, may in itself be a manifestation of deterioration of
intracorporeal smooth muscle function.

DIABETES MELLITUS

This disease is an important risk factor for erectile dysfunction. Damage to
small blood vessels is the main etiology and,therefore, erectile dysfunction
often occurs in association with diabetic retinopathy. Diabetic peripheral
autonomic neuropathyis a further contributory factor. Erectile dysfunction
may develop as a result of the progressive loss of small unmyelinated
so-called C fibers secondary to diabetes. Several groups have reported that
diabetes is associated with loss of NO synthase fromNANC nerve endings and
endothelial cells in the corpora. This may explain the pathophysiological basis
of the erectiledysfunction that so commonly accompanies diabetes.

HYPERTENSION

This is frequently associated with erectile dysfunction. Approximately
one-third of men beyond middle age have a diastolicblood pressure >90
mmHg. Hypertension causes damage to small blood vessels and this may adversely
affect intracorporealvasodilatory mechanisms. Moreover, many of the agents
used to control hypertension, especially P-blockers and diuretics,
areassociated with the development of erectile dysfunction. It has been
postulated that, because high intracorporeal pressures arerequired to
produce penile rigidity, the reduction of blood pressure by any agent is likely
to increase the incidence of erectiledysfunction. However, a-blockers,
perhaps through the induction of intracorporeal vasodilatation, appear to
enhance erection,while still lowering both systolic and diastolic blood
pressures.

HYPERLIPIDEMIA

This disease often occurs in association with hypertension and is also a
cause of damage to the peripheral vascular system.Hypercholesterolemia and
elevated serum triglyceride levels are both also associated with erectile
dysfunction.

SMOKING

Although there have been few epidemiological studies to confirm this, it
appears likely that heavy smoking is associated witherectile dysfunction
because of its deleterious effects on blood vessels and its action leading to an
increase of plateletstickiness.

PEYRONIE'S DISEASE

Fibrosis developing in the corpora albuginea may result in permanent scarring
and consequent deformity of erection. Whenthe fibrosis is severe (Figure
38), penetrative intercourse may be impossible. As a result of the loss of
tunica elasticity, Peyronie'sdisease may also be associated with venous
leak-induced erectile dysfunction.