How ED Happens

How Erectile Dysfunction ( ED ) happens ?

ED can be caused by multiple factors and can be broadly classified into three categories

  • Vascular ( Blood Flow Related )
  • Neural ( Nerve Function Related )
  • Biochemical ( Hormonal/Metabolic/Neurotransmitter)
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Vascular (Blood Flow Related)

Vascular diseases affect blood vessels. They lower blood flow to organs such as the heart, brain, and kidneys. If they cut blood flow to the penis, they can cause erectile dysfunction. These diseases may be the cause of ED in as many as 50% to 70% of men who have it.

The good news is that lifestyle changes and drug treatments usually help fight the types of vascular disease that can cause erectile dysfunction.

Usually, a vascular disease happens when cholesterol and other substances build up and block blood vessels. In some men, the arteries and veins in the penis, and the rest of the body, may not work properly. They may keep blood from flowing when they're not supposed to.

Some common health conditions are linked with vascular disease and clogged arteries:

  • Coronary artery disease (clogged arteries in the heart)
  • High blood pressure
  • Diabetes
  • High cholesterol
  • Obesity
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Peripheral vascular disease, which affects the blood vessels that send blood to the legs and pelvis If you have one of these conditions, it's more likely that the problem can affect the blood vessels in your penis and cause erectile dysfunction.

It’s also linked to diabetes, Peyronie's disease (a buildup of scar tissue in the penis that leads to curved, painful erections),

When your heart pumps, blood goes through arteries to get to different parts of your body. To get to the penis, blood first goes through arteries in the belly and then branch off. When it's time for an erection, these arteries widen, or dilate. More blood flows into the penis, making it swell.

Erectile dysfunction often means at least some of the blood vessels on that path aren't in perfect health. Even if you don’t have a blocked artery yet, the lining of your blood vessels might not work as well as it should.

Atherosclerosis isn’t the only reason that ED can happen.

Most men with ED have risks that make them more likely to get atherosclerosis, such as:

  • Atherosclerosis in family members
  • High cholesterol levels
  • High blood pressure
  • Diabetes
  • Obesity
Neural ( Nerve Signal Related )

Impaired blood flow to the penis is the most common cause of ED. While altered neural function is generally regarded as a second critical component of ED, this factor is difficult to assess and its contribution may therefore be underestimated.

Both the dorsal penile and perineal nerves contain a variety of axons that differ in cross-sectional diameter and the presence and degree of myelin. A careful consideration of the impact of neural deficits on erectile function must differentiate between activities conducted in small diameter fiber pathways (ie A and unmyelinated C fibers) and activity conveyed in relatively large diameter, myelinated fiber systems (A and A).

The assessment of sensory function provides a non-invasive means of assessing the integrity of the neural innervation of the penis, and the evaluation of multiple modalities affords the ability to differentiate function within specific axon types, for instance, the determination of absolute threshold for the detection of vibration measures transduction and conduction of activity in relatively large diameter, myelinated axons, while the assessment of thermal thresholds provides an index of activity in unmyelinated C fiber pathways and small myelinated A fibers .

Neuropathy at the penis exists in all forms of erectile dysfunction including arterial and venous disease. Additionally, in some cases (eg diabetes) dysfunction of the penile nerves antecedes deficits in cutaneous function detected at the finger (general neuropathy).

Since neurologic erectile dysfunction may be related to multiple causes including chronic diseases (eg diabetes mellitus, multiple sclerosis, Parkinson's disease, Alzheimer's disease), surgery or trauma (eg radical retropubic prostatectomy, herniated lumbar disk), and neural malformation (spina bifida) to name a few.Loss of sensation may be related to a change in fiber density (loss of axons distalaxonopathy), deficits in transduction (generator potential), deficits in conduction (velocity synchrony), or non-structural defects such as redistribution of ion channels.

Nerve Signal Related Neural ED Causes and ED Treatment
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Biochemical Factors

Penile erection is a complex physiologic process that occurs through a coordinated cascade of neurologic, vascular, and humoral events

There are currently two hypotheses of pathophysiology: one proposes a structural basis of ED, while the other focuses on metabolic imbalances in the corpus cavernosum.

One area of active research in MED is to identify vasoactive factors, cytokines, autacoids, and/or neurotransmitters that may play a role in maintaining the connective tissue/smooth muscle balance. Among the potential candidates are transforming growth factor β1 (TGF-β1) and prostaglandin E, both of which are synthesized by the corpus cavernosum smooth muscle cells. These vasoactive substances are regulated by oxygen tension; TGF-β1 is induced under lower oxygen tension conditions consistent with flaccidity, while PGE is synthesized under conditions consistent with oxygen tensions during erection. In human corpus cavernosum smooth muscle cells in culture, TGF-β1 can induce a 2.5- to 4-fold increase in collagen synthesis in these cells, and this synthesis can be repressed by a single dose of PGE1. While these are in vitro observations, it is interesting to note that nocturnal penile tumescence may provide a daily oxygenation of the corpus cavernosum regardless of sexual activity that may help to maintain a functional corpus cavernosum smooth muscle/connective tissue balance. While research has yet to supply an answer to a number of the questions involved, strategies to alter the corpus cavernosum structure is a means to treat ED.

An alternate hypothesis regarding the pathophysiology of MED is attributed to a metabolic imbalance between contractile and relaxatory factors in the corpus cavernosum. Under normal physiological conditions in the penis, contractile factors (norepinephrine, ET, and contractile prostanoids) are in balance with relaxatory factors (NO, VIP) such that when the contraction of the corpus cavernosum diminishes and relaxatory factors are present, erection ensues. In the case of dysfunctional antagonism, contractile factors predominate, are overexpressed or relaxatory factors are inhibited, such that the trabecular smooth muscle remains contracted and the penis remains flaccid. However, in most cases of vasculogenic ED, a decrease in NO production and release probably plays some role in the dysfunction. In actual practice, the pathophysiology of erectile dysfunction probably has both structural and metabolic components.

Molecular Physiology of Penile Erection  (ED) treatment
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