The central and peripheral nervous system get involved in the process of erection. Other local factors such as the endocrine and vascular systems also contribute to erection. The erectile tissue within the penis receives the efferent nerves of these pathways or the products of stimulation of the organs and systems that release substances that lead to erection. The stimulus stimulates the cell bodies within the brain to send impulses through descending nerve pathways to synapse with the peripheral nerves of the lumbo-sacral region of the spinal cord. The pelvic splanchnic plexus emerges from the spinal cord to the erectile tissue and the blood vessels to the penis. The blood flow to the penis increases and the smooth muscle within the penis relax to increase the blood entering into the tissue thus increasing the rigidity of the penis. The compression of venous channels blocks them thus limiting the drainage of blood from the penis thereby maintaining rigidity of the penis (Babu & Babu, 2012 p.259). Detumescence, the termination of erection, results from the reduction of muscle-relaxing hormones and impulses in the penis thereby expelling blood from the penis making it flaccid. Erectile dysfunction results from an interruption of this pathway in by either psychological or physical means (Lue, 2000 p. 1805). Since most of the pathway occurs within the body carious places, physical causes are the key causes of erectile dysfunction.
PHYSICAL CAUSES OF ERECTILE DYSFUNCTION
The interruption of the pathway for erection by physical means involves the involvement of diseases, medication or even the surgical means. Traumatic pressures to the body might also cause a case of erectile dysfunction. These interfere with either the nervous aspect of erection or the vascular and hormonal part of erection. The integrity of the penile tissue might also interrupt the erection process. (Lue, 2000 p. 1810)
Various diseases lead to the occurrence of erectile dysfunction. On diagnosis of erectile dysfunction, a medical professional should rule out the presence of various diseases before proceeding to verify other causes of erectile dysfunction. High blood pressure due to inefficiency of the heart’s pumping function causes vasoconstriction all around the body. These phenomena ensure that blood reaches the key body organs (Babu & Babu, 2012 p 258). This disables the dilation of vessels within the penile tissue hence inhibiting the flow of blood into the penis to make it rigid. Vascular diseases that compromise the elasticity of arteries or cause obstruction also prevent the process of erection. The hormonal functions of the endocrine organs that release hormones that cause erection also get analyzed, in the case of erectile dysfunction, to determine the cause of the problem.
Scleroderma can cause erectile dysfunction as it causes hardening of the skin disabling the penis from changing its state as the skin is rigid. Furthermore, penile trauma can lead to Peyronie’s disease in which the penile tissue cannot accommodate enough blood within it to cause erection due to the presence of scar tissue within it. The extensive use of bicycles has also resulted in erectile dysfunction, as motor nerves, in the perineum, are sensitive to pressures making them unable to function ((Babu & Babu, 2012 p 259). The motor nerve fibers lose their conductivity when subjected to high pressures thus preventing the propagation of impulses to the penis in the erectile process. Trauma and disease to the erectile tissue thus results in erectile dysfunction due to lack of functioning of the erectile tissue or the nerves within it.
Hormonal imbalances also cause erectile dysfunction in humans as the hormones play a crucial role in numerous physiological functions. Hypothyroidism and hyperthyroidism lead to a change in the production of pituitary hormones. Hyperthyroidism causes the excessive body wasting and general body weakness. The energy required for erection of the penis demands much from the body, and thus detumescence will occur, shortly after achieving erection. Hypothyroidism causes an increase in the excessive release of thyroid secreting hormone from the adenohypophyses (anterior pituitary gland). The overworking of the pituitary leads to its hypertrophy running the risk making it cancerous (Rizvi, Hampson, & Harvey, 2001 p.96). The increased release of adrenocorticotrophin leads to an increase in production of the adrenal steroids that cause arteriolar vasoconstriction within the body and sympathetic dominance. This prevents erection, as the process itself is a result of parasympathetic action. Prolactinomas also cause infertility and a reduction the production of androgens such as testosterone. These are essential in erection, and thus their deficiency would lead to erectile dysfunction.
Medications also cause erectile dysfunction as they interfere with the erectile pathway. The treatments for certain diseases include drugs that affect the erectile process and such side effect usually disappears with the completion of the treatment. Antidepressants, antipsychotics and antihypertensive drugs have the common effect of causing erectile dysfunction. They promote the formation of phosphodiesterases that catalyze the cycling of mononucleotides within the body to cause muscular contraction (Rizvi, Hampson, & Harvey, 2001 p.95). The contraction of smooth muscles gets initiates by the activation of protein kinases in the cells of the bodies that cause the smooth muscles to contract, and within the penile region, the flow of blood gets inhibited to prevent erectile dysfunction. Alcohol abuse also causes erectile dysfunction by constricting blood vessels due to excessive water loss when it inhibits anti-diuretic hormone (Rizvi, Hampson, & Harvey, 2001 p.96). The constriction of the vessel is a reflex to prevent hypovolemic shock, but it also prevents blood flow within the penis causing erectile dysfunction. Drugs that interfere with the mind like marijuana and cocaine also cause erectile dysfunction at higher motor levels.
PSYCHOLOGICAL CAUSES OF ERECTILE DYSFUNCTION
The psychological means by which erectile dysfunction transpires include the accumulation of mental stress and anxiety before the involvement in sexual activity. This disables the response to the stimuli that cause the erection process. Performance anxiety leads to a considerable number of erectile dysfunction cases (Rajiah, 2012 p. 446).
Age and depression can also cause failure of the erectile process in individuals with perfectly normal physical and physiological functioning of the erectile apparatus within the body. This comes along with disinterest in sexual activity, as individuals may be preoccupied with other issues in their lives other than sex (Rajiah, 2012 p. 450). The widower syndrome has such effects on individuals causing erectile dysfunction.
Certain feelings can cause an individual to have erectile dysfunction. These include nervousness, or self-consciousness or even shame might cause erectile dysfunction. Former erectile dysfunction due to either physical or psychological reasons can lead to the worsening of the condition due to psychological reasons such as feelings of shame. (Rajiah, Veettil, Kumar, & Mathew, 2012)
TREATMENT OF ERECTILE DYSFUNCTION
Aerobic exercise provides commendable treatment for erectile dysfunction as it increases blood supply to both parts of the body increasing their functioning. This therapy can cure erectile dysfunction effectively.
The use of negative pressures to draw blood into the penis to achieve erection uses vacuum pumps to treat erectile dysfunction. These pumps come with a compression ring, which hold the blood within the penis and prevent it from draining away from the penis to cause detumescence. The pumps come in handy before sexual intercourse to achieve erection.
Sildenafil Citrate, or by its common name, Viagra, is among a class of other drugs that inhibit phosphodiesterases type 5 within the penile tissue to enable erection (Stuckey, et al., 2003 p. 280). The prevention of cycling of AMP and GMP within the body cells maintains the smooth muscles of the penis in a relaxed tone enabling blood flow into the penis to achieve erection.
The use of penile prosthesis in treating erectile dysfunction is an option taken after the conclusion that other non-invasive means of treatment do not prove to be effective. It involves the implantation of a device within the penis to enable it to achieve erection. Heart failure patients’ drugs do not interact well with these implants and thus they cannot use such treatment.
In most cases, counseling treats psychological erectile dysfunction. The use of antidepressants is also prevalent as it helps reduce the stresses one is under to enable him to achieve erection.
Erectile dysfunction mainly occurs due to physical impacts on the erection pathway in the form of diseases, trauma, drugs and hormonal imbalances. The psychological causes of erectile dysfunction might be the sole causes of the disorder, or they may be a promoter to an already present condition of erectile dysfunction. Aerobic exercise, phosphodiesterase type 5 inhibitors, penile pumps and implants get used to treat the condition.