Understanding Erectile Dysfunction

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Erectile dysfunction is when a man has difficulty getting an erection. Or keeping it long enough for sex.

Gaining an erection

The penis is a fleshy organ that covers the urethra; the small tube from which you urinate and ejaculate. Surrounding the urethra is muscular tissue filled with arteries. These allow blood in. Then, just under the skin, are the veins, which let blood out.

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What can cause ED?

ED is the result of an underlying problem, or combination of problems, that can be psychological or physical in nature. Psychological reasons include anxiety or depression. Physical issues can involve damage to various parts of the body such as nerves or arteries. There are various diseases or issues that are linked to these psychological and/or physical problems. Below is a list of common causes.

Potential causes of ED

There are four main types of health conditions that can cause physical problems resulting in erectile dysfunction. These are:

  • conditions affecting the flow of blood to your penis – vasculogenic
  • conditions affecting your nervous system, which is made up of your brain, nerves and spinal cord – neurogenic
  • conditions affecting your hormone levels – hormonal
  • conditions affecting the physical structure of your penis – anatomical

Injuries and surgery

Penis injuries or surgical treatment of the penis, pelvis or surrounding areas can sometimes lead to erectile dysfunction.

Erectile dysfunction is also thought to occur in up to 15-25% of people who experience a severe head injury.

Vasculogenic conditions

Examples of vasculogenic conditions that cause erectile dysfunction include:

  • cardiovascular disease – a disease of the heart or blood vessels, such as atherosclerosis (hardening of the arteries)
  • high blood pressure (hypertension)
  • diabetes – a condition caused by high blood sugar levels. This can affect both the blood supply and the nerve endings in your penis, so it is also a neurogenic condition

Erectile dysfunction is strongly associated with cardiovascular disease. For this reason, it may be one of the first causes your GP considers when making a diagnosis and planning your treatment.

Neurogenic conditions

Examples of neurogenic conditions that cause erectile dysfunction include:

  • multiple sclerosis – a condition that affects the body’s actions, such as movement and balance
  • Parkinson’s disease – a condition that affects the way that the brain coordinates body movements, including walking, talking and writing
  • a spinal injury or disorder
  • stroke – a serious condition that occurs when the blood supply to the brain is interrupted

Hormonal conditions

Examples of hormonal conditions that cause erectile dysfunction include:

  • hypogonadism – a condition that affects the production of the male sex hormone, testosterone, causing abnormally low levels
  • an overactive thyroid gland (hyperthyroidism) – where too much thyroid hormone is produced
  • an underactive thyroid gland (hypothyroidism) – where not enough thyroid hormone is produced
  • Cushing’s syndrome – a condition that affects the production of a hormone called cortisol

Anatomical conditions

Peyronie’s disease, which affects the tissue of the penis, is an example of an anatomical condition that can cause erectile dysfunction

In some men, certain medicines can cause erectile dysfunction, including:

  • diuretics – these increase the production of urine and are often used to treat high blood pressure (hypertension), heart failure and kidney disease
  • antihypertensives – such as beta-blockers, that are used to treat high blood pressure
  • fibrates – medicines used to lower cholesterol levels
  • antipsychotics – used to treat some mental health conditions, such as schizophrenia
  • antidepressants –  used to treat depression and some types of pain
  • corticosteroids – medication that contains steroids, which are a type of hormone
  • H2-antagonists – medicines used to treat stomach ulcers
  • anticonvulsants – used to treat epilepsy
  • antihistamines – used to treat allergic health conditions, such as hay fever
  • anti-androgens – medication that suppresses androgens (male sex hormones)
  • cytotoxics – medication used in chemotherapy to prevent cancer cells from dividing and growing

Speak to your GP if you are concerned that a prescribed medicine is causing erectile dysfunction. Alternative medication may be available. However, it is important never to stop taking a prescribed medicine unless you are advised to do so by a qualified healthcare professional who is responsible for your care.

Possible psychological causes of erectile dysfunction include:

  • depression – feelings of extreme sadness that last for a long time
  • anxiety – a feeling of unease, such as worry or fear

Erectile dysfunction can often have both physical and psychological causes. For example, if you have diabetes, it may be difficult for you to get an erection, which may cause you to become anxious about the situation. The combination of diabetes and anxiety may lead to an episode of erectile dysfunction.

There are many emotional issues that may also affect your physical ability to get or maintain an erection. These include:

  • relationship problems
  • lack of sexual knowledge
  • past sexual problems
  • past sexual abuse
  • being in a new relationship
Other possible causes of erectile dysfunction include:

  • excessive alcohol intake
  • tiredness
  • using illegal drugs, such as cannabis, heroin or cocaine


Men who cycle for more than three hours per week may be recommended to try a period without cycling to see if this helps improve erectile dysfunction.

Riding in the correct position with a properly fitted seat may also help to prevent regular cycling from leading to erectile dysfunction.


Increased risk

There are some things that can make erectile dysfunction more likely. These are very similar to the risks of cardiovascular disease and include:

Erectile dysfunction itself can also be a sign of cardiovascular disease.

Source: NHS Direct. Erectile dysfunction (impotence) – Causes

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You should make sure you discuss possible causes of ED with your doctor, nurse or pharmacist. Do not stop taking medication prescribed to you without discussing this with them.

Market Demand & Demographics

Global ED market estimated at $5.5 billion

IMS Health 2013

Middle East

The current Middle Eastern ED market exceed 10,000,000 unit sold per year from the PDE5 drugs including Viagra, Levitra, Cialis, Snafi as well as generic to serve the PDE5 inhibitors responders, patients represent 51% of the total ED patients; the unmet need counter” indicated and non responders to PDE5 medicines represent 49% still need to be served.
Several local studies showed that the prevalence of ED was >60% among Arab men. Risk factors and medical comorbidities that negatively affect the cardiovascular system, endothelial function and ultimately erectile function were common in men in Arab countries. For instance, at least five Arab countries are included in the top 10 countries worldwide with a high prevalence of diabetes mellitus. The global statistics showed that other risk factors such as obesity, smoking, hypertension and dyslipidaemia are also very prevalent in Arab countries. This fact can explain the high incidence of both cardiovascular disease and ED among Arab men.