Phsycological reasons It's now known that psychological reasons alone account for about a third of ED cases, with the rest being due to physical conditions or, much more frequently, to a combination of physical and psychological causes. As ED commonly gives rise to anxiety in men and can be a cause of stress in a relationship it is probably true to say that all men with ED have some degree of psychological component to their condition. Fortunately both the public and the medical profession have become better informed about ED, particularly in the past few years because of the recent appearance of far better treatments. Psychological causes of ED The presence of ED, for any reason, will almost always cause some worry or anxiety in a man about his ability to have sex, which in turn will make it more difficult to get an erection next time - and so on.

This 'performance anxiety' is a common cause of temporary ED and there can be very few sexually active men who have never experienced it in their lives. Being aware of this vicious circle and taking a more relaxed approach to sex will often defuse the anxiety. If sex is only seen as the achievement of penetrative intercourse, and a failure if that doesn't happen, then it can be pretty certain that anxiety-related ED will keep on happening.

Other commonly found psychological causes of ED include: * relationship difficulties. These may result in ED, or vice versa. Usually both co-exist. * unresolved gay feelings or other hang-ups focussed on sex. * bereavement and depression. * tiredness. * stress. Human beings are complex and don't usually fall into neat categories. Someone who is depressed might also for example be drinking too much alcohol , which in turn can cause or worsen ED. The depression might be secondary to some other condition or come directly from having ED and not knowing where to go for help, or knowing that ED is treatable.

ED is however highly treatable and there are a range of methods including medication, counselling, physical devices and surgery. See ' Treatments for erectile dysfunction ' for a fuller explanation of what is available.

It is clear from the many surveys that have been done on erectile dysfunction that it is: * common * gives rise to much stress and difficulty both at a personal and a relationship level * under-diagnosed and under-treated. Some of the problems lie in embarrassment about talking about ED or a feeling that ED is not a 'valid' or 'proper' medical condition, despite the obvious truth that the reverse is the case.

Although we have moved in the right direction concerning ED over the past couple of decades we still have a bit to go before it becomes a subject that everyone will necessarily feel able to discuss openly even with their own partner or doctor . That said however we have already reached a stage when effective treatment for ED is available, and more men need to avail themselves of it. Physical causes of ED The various biological processes involved in an erection are explained in the factsheet on the physiology of erection but in brief, erection occurs in response to signals from the brain. The erectile tissue in the penis consists of two cylinders of sponge-like material, largely composed of muscle fibres, When the penis is flaccid, these fibres are contracted and the sponge is 'wrung out'. When pro-erectile signals arrive from the brain, the muscle fibres relax and the sponge fills with blood, compressing the veins that normally drain blood back out of the penis. As a result, the penis expands and becomes rigid. Following ejaculation or the withdrawal of sexual stimulation, a change in the signalling from the brain causes the muscle fibres within the spongy tissue to contract again, the draining veins open up, the pressure within the penis falls and it once more becomes relaxed

For all this to happen there needs to be an intact system of nerves and blood vessels to the penis as well as connections within the spinal cord between the nerves that are connected with the penis and the higher centres in the brain. Conditions that affect either the nerves or the blood vessels are therefore also a common cause of ED. Diabetes Diabetes is the condition in which the level of blood glucose (sugar) is too high and for reasons that are not completely understood a high glucose level, if present for years, can damage the function of muscle fibres within blood vessles and vascular tissues, including the erectile tissue of the penis, and of the small nerves and arteries throughout the body. Thus ED can affect many men with diabetes, with some studies reporting that up to 60 per cent of diabetic men will eventually develop the problem. Although the chances of this occurring are reduced by good treatment of the diabetes they cannot be reduced to zero. A further and increasingly common problem is that the type of diabetes commoner in older people (called Type 2 or non-insulin dependent diabetes) can be accompanied by relatively few symptoms in the early stages, which mean that many people with Type 2 diabetes already show some damage to the nerves and arteries by the time they have their diabetes diagnosed. In the Massachusetts study 28 per cent of treated diabetic patients had complete ED. High blood pressure People with high blood pressure are more likely than average to develop 'hardening of the arteries'. The medical term for this is atherosclerosis (or arteriosclerosis). In atherosclerosis the arteries throughout the body tend to develop thicker walls and become narrower inside, so reducing the flow of blood through them. If this develops in the arteries going to the penis then it will be more difficult for the penis to fill with blood and so ED may result.

Smoking is the other major factor that increases the chance of atherosclerosis developing and smokers have an increased risk of developing ED.

Many of the medicines used to treat high blood pressure might also cause ED as a side effect, particularly those called diuretics (water pills) and beta-blockers. High blood pressure is however a very important problem that needs to be treated too, and it is essential never to stop taking prescribed medication for it (or any other condition) without discussing the matter with your doctor. Many men who think that they have ED as a side effect of the drugs they are taking do not mention the problem to their doctor, who in turn may omit to ask if ED is happening.

It is therefore important to mention ED either before your start taking treatment for high blood pressure, or if it develops after you have been given medication for it, as quite often a medication change will be possible and cause fewer side effects.

Hormones Testosterone is important in the development of the unborn male foetus and in the growth and development of the genitals and other sexual characteristics around puberty. In the mature man, it plays a role in maintaining sexual desire and affects nerve signalling within the brain and nervous system. However, a lack of testosterone alone is only very rarely the cause of ED. In such cases, the man will usually notice a marked reduction in sexual desire and an absence of night-time or early morning erections. However, this has not stopped testosterone being widely promoted as a treatment for ED and a range of other conditions by unscrupulous or poorly informed (or both) outlets. The Internet allows such uncontrolled advertising on a wide scale and anyone who uses email regularly will probably be familiar with unsolicited 'spam' messages promoting this type of treatment and its availability by mail order. Taking unnecessary testosterone is potentially harmful - it can adversely affect cholesterol levels or accelerate the growth of a pre-existing prostate cancer for example, so should be strictly avoided. Your doctor can check whether a lack of testosterone is a problem. Other physical causes of ED Any condition in which the nerve or blood supply to the penis is damaged can potentially cause ED so it can arise, for example, following prostate surgery or after some types of prostate cancer treatment. It could also possibly occur after injury to the genital area or pelvis. Surgery to the lower abdomen (within the pelvis) can carry the risk of unavoidable damage to these nerves.

Multiple sclerosis is a disease of the nervous system in which the function of many nerves throughout the body can become impaired, usually over the course of many years. Spina bifida can also cause ED, although this will have been a lifelong problem if it were the sole cause. Spinal cord injury, renal transplantation and renal failure are also possible causes of ED.

Polio, Parkinson's disease, and single gene neurological disorders are conditions that are unlikely to cause ED but are relevant as they are listed as conditions in the presence of which the National Health Service will allow GP prescription of certain ED treatments.
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Written by an associate of www.my-medicare.com