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The Categories and Causes of Erectile Dysfunction

April 20, 2017

Today we will explore the different categories of Erectile Dysfunction and what their causes might be.  Depending on the origin of each case of ED, whether medical or psychological, there are different methods of analysis and treatment.  On one hand, there is a 10-20% chance that a case of Erectile Dysfunction is caused by psychological factors.  Many men who come into my office are convinced that it is “impossible” for their ED to stem from a psychological issue, but after normal testing and a referral to a sexual psychologist, we find out that I was merely talking to the “tip of the iceberg”, metaphorically speaking.


Psychological Erectile Dysfunction is often due to performance anxiety or “stage fright”.  Usually there is a single inciting event early or late in life whereby a patient does not perform up to his expectations.  This event was incredibly embarrassing and thus created anxiety.  This anxiety then undermines the ability to have a normal erection, propagating a positive feedback loop that spirals down towards the absolute inability to perform at all.  This paradigm is more powerful than any male will acknowledge, but when identified, it can be unraveled with the intimacy of a supportive relationship.


On the other hand, ED may simply be a barometer of lifestyle stress and psychological baggage that may have accumulated throughout the course of one’s life.  In order to break down the possible psychological cause, questions I might ask include the following.  Did you ever suffer from emotional, physical, or psychological abuse?  Does your religion condemn your sexual orientation or preferences?  Are you addicted to watching pornography, making normal sexual encounters less intense? Have you turned to drugs or alcohol to handle the stresses of life?  This list could go on and on, but the point remains clear that psychology can affect a male’s sexual health, and it can be successfully treated in most cases by a well-trained sexual psychologist.


However, on the other hand, about 80-90% of the time a case of Erectile Dysfunction is due to a more organic, or medical, origin.  This is more often than not due to a vascular issue, causing a lack of blood flow.  However, ED can also be caused by neurological and endocrinological disorders due to nerves and hormones.  In fact, almost any disease may affect erectile dysfunction by altering the nervous, vascular, or hormonal systems.  Atherosclerosis, or hard arteries, and Diabetes are the two most common conditions that cause ED.  Other causes include prostate cancer treatments of surgery and radiation, pelvic trauma, low testosterone levels, and the use of psychotropic drugs, narcotics, and anti-hypertensives.  Interestingly, it is a common myth that low testosterone, or hypogonadism, is a very common cause of ED.  Low T only causes Erectile Dysfunction in about 20% of patients.  Therefore, testosterone replacement therapy does not improve ED in most cases.

Dr. Blick



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