Key Information From a Urologist About ED

It is an awkward conversation for men to discuss…so here is key information from a urologist about ED (erectile dysfunction)

As a urologist it was very common for me to see patients for the diagnosis and treatment of impotence. Impotence refers to the ability to achieve and maintain an erection for sexual intercourse. Before treatment I had to arrive at the correct diagnosis.

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Through the process of history taking, a physical exam and testing, we first categorize impotency as either physical or psychological. Over the decades of evaluating men, it became quite evident that when a man has a physical cause of impotency, there is often psychological overlay worsening the physical cause. This often makes treatment more challenging.

The are subcategories to physical impotency. This may be caused by neurological disorders, vascular disease, physical changes, hormone issues or medications.

Of the neurological disorders, some are easily identifiable through history or physical exam. Typical causes are diabetes mellitus, alcoholism, multiple sclerosis, spinal cord and nerve injuries and nerve injuries due to pelvic surgery such as prostate surgery.

Regarding the vascular causes, this could be due to either the arteries (inflow) or veins (outflow). There has to be more inflow of blood than outflow in order to have an erection.  The most common inflow abnormality is atherosclerosis (hardening of the arteries). This can be caused by smoking, high cholesterol levels in the blood or may be familial. If the valves in the veins are incompetent, this may cause the erection to be incomplete or early loss of an erection.

There are multiple physical changes which can occur. The most common are Peyronie’s disease, penile fracture, pelvic injury or pelvic surgery.

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Low testosterone or thyroid hormonal changes can cause impotency.

There are multiple medications which may cause impotency. These commonly are antidepressants, antihypertensives, chemotherapy medications, Parkinson’s medications, prostate cancer medications and anti anxiety medications. Drugs that affect or suppress the central nervous system such as alcohol, barbiturates, nicotine and opioids can be suspect in causing impotence. My experience with patients using cannibus is that for some it improves erections and others it worsens them.

Finally psychological issues can cause impotence. The most common I saw in my practice was performance anxiety. This is when a man is so worried about having difficulties that he psychs himself out of it. Other causes can be depression, loss of sleep, relationship issues, anxiety, stress and low self esteem.

After resolving the cause or causes of impotence, the physician has a better guide as to treatment.