Successful erections and sexual activity to climax involve the complex interplay of the vascular system, the nervous system, hormones and the largest sexual organ, the brain. When one of these very important team players is not performing well, the team fails- No Home Run! Here we will review common causes of male sexual dysfunction.
Poor Libido – (low sex drive) Changes in sex drive can begin at any age but is more common for men in their 40s. Many factors such as fatigue, stress and relationship issues can lead to lower sex drive. Mental health issues such as depression and anxiety can lower the desire for sexual activity. Regular use of alcohol and other recreational drugs- marijuana and cocaine, can dampen the interest as well as the ability to have good sexual activities. Many men may not be willing to relate their use of drugs and alcohol to a lower interest in sex.
Health Issues– Diabetes is a common medical condition associated with poor erections. Blood flow into the two chambers alongside the urethra- the corpus cavernosa, as well as into the glans (head) of the penis- the corpus spongiosum are must haves for penile tumescence. Blood pressure as well as blood pressure medications can limit good erections by interfering with the critical blood flow into the penis.
Low Testosterone– Men with low testosterone can experience lower libido as well as lower ability to have strong erections necessary for successful sexual activity. I often ask about sexual desire when evaluating men for erectile dysfunction- if the desire is strong, the testosterone level is often, but not always, adequate. Nitric oxide production is lower in men with low testosterone and when nitric oxide production is inadequate, the ability to maintain an erection is reduced.
Atherosclerosis– Hardening of the arteries- atherosclerosis- occurs when cholesterol rich plaques develop within blood vessels. When this happens in the coronary arteries, men are at risk for heart attacks and strokes. When this happens in the hypogastric arterial system that supplies the penile artery, blood flow is diminished and erections are limited. Smokers and diabetics are at increased risk of atherosclerosis that interferes with penile blood flow. Other medical conditions that are related to erectile dysfunction include obesity, sleep apnea and elevated cholesterol levels.
There are many conditions associated with erectile dysfunction, a medical evaluation including lab assessments, can identify risk factors and direct active steps to reverse and manage erectile dysfunction.
Dr Horton is a board-certified in Family Medicine with expertise in the management of male intimate wellness issues including erectile dysfunction.