Part 18: Pathogenesis and Organic Etiology of Erectile Dysfunction

◇A Guide to Caring for Your Husband's Health as a Good Wife◇

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Treatment and recuperation of common diseases

1. Non-organic lesions: This refers to increased inhibition of sexual arousal by the cerebral cortex and decreased excitability of the spinal erection center. This is also known as functional cause, where no organic lesion exists. It could be due to long-term masturbation or excessive sexual activity, causing the nervous system to be constantly in a state of over-excitation, eventually leading to exhaustion due to over-excitation. It could also be caused by chronic diseases, physical weakness, or excessive fatigue, resulting from physical or mental labor leading to physical or neurasthenia. Another cause is psychological factors, such as fear of pregnancy, a poor sexual environment, marital discord, or concerns about sexual function due to past nocturnal emissions or excessive masturbation, or even fear stemming from a lack of sexual knowledge or fear of being blamed by the female partner.

2. Organic causes: Erectile dysfunction caused by old age, diseases of various organ systems, medication effects, or surgery, etc., occurs in approximately 60% of cases where the penis cannot achieve an erection even under strong sexual stimulation. In summary, the causes of organic erectile dysfunction include:

(1) Neurological disorders: such as spinal cord injury, spinal cord transection, spinal cord tumor, temporal lobe lesion, can all cause impotence due to neurological disorders of conduction excitation.

(2) Insufficient blood supply: Atherosclerosis or other vascular diseases can lead to insufficient blood supply. Atherosclerosis, if it occurs in the arteries supplying the penis or the blood vessels that provide nutrition, can also cause erectile dysfunction.

(3) Endocrine disorders: mainly diabetes mellitus, hypothalamic-pituitary abnormalities, and primary hypogonadism.

Diabetes: Approximately 50% of patients with diabetes experience erectile dysfunction, 2 to 5 times more likely than the general population of the same age. Peripheral and autonomic neuropathy, as well as vascular abnormalities, can further exacerbate erectile dysfunction. The severity of erectile dysfunction generally does not correlate with the degree of diabetic retinopathy. The main factors contributing to erectile dysfunction include parasympathetic neuropathy affecting the perineum caused by diabetes, decreased penile blood flow due to arterial stenosis caused by diabetes, metabolic disorders caused by diabetes, and psychological factors.

Hypothalamic-pituitary abnormalities: These account for approximately 7% to 19% of erectile dysfunction cases, primarily pituitary tumors, but other causes include infiltration of surrounding lesions or pituitary blood supply disorders. Factors contributing to erectile dysfunction include decreased gonadotropin-releasing hormone (GnRH), leading to decreased luteinizing hormone (LH) or follicle-stimulating hormone (FSH) levels, and increased prolactin levels.

Primary sexual dysfunction: There are two common types: congenital and acquired. The former includes congenital bilateral anorchia, while the latter includes mumps complicated by orchitis, vascular diseases, chemotherapy or radiotherapy, etc.

Increased cortisol levels caused by Cushing's syndrome, bilateral adrenal hyperplasia, adenoma, or adenocarcinoma can inhibit gonadotropins and testosterone secretion by interstitial cells of the testes, leading to impotence.

Hyperthyroidism: Approximately 56% of men with hyperthyroidism experience erectile dysfunction, but the mechanism is not yet clear.

Hypothyroidism: Hypothyroidism leads to decreased secretion of thyroid hormones, resulting in decreased testosterone and testosterone-binding globulin, and increased prolactin. Erectile dysfunction is related to systemic protein synthesis disorders leading to degenerative changes in the seminiferous tubules of the testes and a reduction in interstitial cells.

Adrenal insufficiency: It is associated with emaciation, malnutrition, and decreased secretion of luteinizing hormone and testosterone by interstitial cells of the testes.

Feminizing tumors: These tumors can occur in the adrenal glands or testicular interstitial cells. Laboratory tests show increased estrogen levels, leading to gynecomastia in men and testicular atrophy causing impotence.

3. Other:

(1) Drug effects, such as guanethidine, reserpine, methyldopa, medroxyprogesterone acetate, anticholinergic drugs, estrogen, etc.

(2) Various surgical complications, such as perineal prostatectomy, sympathectomy, and radical resection of rectal cancer, can affect the anatomy and physiology of erection and cause impotence.

(3) Inflammatory lesions, such as chronic prostatitis.

(4) Toxic substances, such as lead and rust removers.

(5) Trauma, such as testicular trauma, pelvic fracture, penile trauma, etc.

(6) Urinary system diseases, Peyronie's disease, hydrocele, varicocele, phimosis, elephantiasis of the scrotum, etc. can all cause impotence.