What Causes Erectile Dysfunction?
Erectile dysfunction (ED) affects at least 12 million men in the United States of America and is characterized by an inability to achieve or sustain an erection that is sufficient for satisfactory sexual function.
Broadly speaking, there are four main causes of ED – vascular, neurologic, hormonal and psychological.
In this article, we will be expounding on each of these causes as well as shed some light on lifestyle measures to counteract and potentially reverse ED.
During an erection, the spongy tissue of the penis – known as the corpora cavernous, become engorged with blood.
Sexual arousal stimulates the release of nitric oxide (NO), a vasodilatory compound that causes this highly vascular tissue to dilate and consequently accommodate more blood.
Underpinning this stimulation, the central and peripheral nervous system facilitate the excitation of neurotransmitters such as dopamine in order to cause the smooth muscles of the corpora cavernosa to relax and engorge with blood.
The most common cause of ED is that of vascular disease. Comorbidities such as diabetes mellitus, hypertension (elevated blood pressure) and hyperlipidemia (elevated cholesterol) lead to chronic atherosclerosis.
Atherosclerosis is characterized by the thickening of the arteries which funnel blood throughout our body.
Although atherosclerosis is widely known to cause coronary heart disease and stroke due to the lack of perfusion of the heart and brain, it also causes the perfusion of the penile corpora cavernosa to be compromised.
As a result, the flow of blood to the penis is reduced, leading to suboptimal or failed erections.
As smoking accelerates atherosclerosis, this is also a significant risk factor for the development of ED.
Although an erection is maintained through vascular flow, it is initiated through neurological mechanisms.
After all, erections are usually initiated through sexual arousal…
Specifically, the parasympathetic sacral plexus (a group of nerves in the pelvic region) is responsible for firing nervous impulses to cause the relaxation of the penile corpora cavernosum.
Aging men who have concomitant diabetes mellitus, Parkinson’s disease, multiple system atrophy or temporal lobe epilepsy may have challenges in initiating erections due to a non-functioning parasympathetic sacral plexus.
Neurologically mediated erectile dysfunction is challenging to treat, as the problem is a nervous one rather than a vascular one.
An often-overlooked cause of erectile dysfunction is psychological ED.
Psychological ED tends to affect younger men who have a generalized anxiety disorder, major depressive disorder, performance anxiety and inexperience with sexual intimacy.
These patients do not have a neurological problem or vascular problem, and typically experience challenges in initiating and sustaining an erection.
As they are often misdiagnosed with organic (neurological, vascular or both) ED and prescribed Viagra (sildenafil), they cultivate a dependence on the drug and are difficult to wean off.
This underscores the importance of ruling out psychological ED prior to beginning pharmacological treatment.
Yet another cause of ED is hormonal dysfunction…
Unbeknownst to many men who take hormone-active agents (e.g. finasteride for hair loss), a disruption of the normal synthesis and metabolism of testosterone can reduce libido and lead to erectile dysfunction.
It is strongly advised that over-the-counter or store-bought hormonal products be discussed with your physician prior to consumption.
Active bodybuilders who ingest or administer testosterone supplements are also at risk of disrupting these normal hormonal regulatory mechanisms.
How to Treat Erectile Dysfunction Naturally
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In fact, 4 core lifestyle measures have been shown to increase the production of nitric oxide and testosterone – physical activity, losing weight to achieve a normal BMI, optimizing one’s diet as well as abstinence from cigarette smoking.
Dietary modification through the inclusion of whole-grain foods, legumes, vegetables, and fruits as well as the limitation of red meat, full-fat dairy products, and high-sugar beverages has been associated with a reduced risk of ED.
Vegetables and fruits such as beets, kale and spinach are rich in nitrates which serve as active metabolites for nitric oxide.
In particular, the Mediterranean Diet which is rich in nuts, seeds, legumes, seafood, poultry, and olive oil has shown the greatest success in ameliorating and even preventing ED.
This may be because of the rich nitric oxide content found in vegetables and seafood.
Although moderate consumption of alcohol has been shown to be protective in ED, patients should be careful not to overdo it, lest they incur problems secondary to alcoholism.
Alcohol has been shown to increase the bioavailability of high-density lipoprotein (good cholesterol) which in turn increases the availability of nitric oxide within the penile corpora cavernosa.
The importance of lifestyle measures, including exercise and diet in treating and even preventing ED cannot be overstated.
Indeed, one study on young men in 2018 which was published in the Journal of Sexual Medicine, found that an increased intake in nitrate-rich fruits, vegetables, and flavonoids decreases the risk of ED.
Another study in 2017 which evaluated the efficacy of the Mediterranean Diet in regard to ED, found that it was moderately successful in preserving sexual function and preventing ED.
Yet another study in 2016 found that increasing one’s intake of flavonoid-rich foods (e.g. tea, citrus, berries, red wine, apples, and legumes) was associated with a reduced incidence of ED.
Men who suffer from ED should not hesitate to adopt these lifestyle measures in stages, with an end-goal of integrating these lifestyle measures in perpetuity.
This is especially because the aforementioned lifestyle measures confer a plethora of benefits to other organ systems (i.e. cardiovascular health and endocrine health).
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References
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Di Francesco, S. and Tenaglia, R. L. (2017) ‘Mediterranean diet and erectile dysfunction: a current perspective', Central European Journal of urology, 70(2), pp. 185-187.
Gratzke, C., Angulo, J., Chitaley, K., Dai, Y.-t., Kim, N. N., Paick, J.-S., Simonsen, U., Ückert, S., Wespes, E., Andersson, K. E., Lue, T. F. and Stief, C. G. (2010) ‘Anatomy, Physiology, and Pathophysiology of Erectile Dysfunction', The Journal of Sexual Medicine, 7(1pt2), pp. 445-475.
Kobayashi, J., Ohtake, K. and Uchida, H. (2015) ‘NO-Rich Diet for Lifestyle-Related Diseases', Nutrients, 7(6), pp. 4911-4937.
Kurtz, T. W., DiCarlo, S. E., Pravenec, M. and Morris, R. C. (2018) ‘Functional foods for augmenting nitric oxide activity and reducing the risk for salt-induced hypertension and cardiovascular disease in Japan', J Cardiol, 72(1), pp. 42-49.
Maiorino, M. I., Bellastella, G. and Esposito, K. (2015) ‘Lifestyle modifications and erectile dysfunction: what can be expected?', Asian journal of andrology, 17(1), pp. 5-10.
Mykoniatis, I., Grammatikopoulou, M. G., Bouras, E., Karampasi, E., Tsionga, A., Kogias, A., Vakalopoulos, I., Haidich, A. B. and Chourdakis, M. (2018) ‘Sexual Dysfunction Among Young Men: Overview of Dietary Components Associated With Erectile Dysfunction', J Sex Med, 15(2), pp. 176-182.
