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Causes of ED

  1. Vascular disease
    1. Heart disease such as prior heart attack
      1. The same process that can narrow blood vessels in the heart, can narrow blood vessels in the penis
    2. Prior stroke
    3. Peripheral vascular disease
    4. Pelvic trauma causing damaged blood flow
    5. High blood pressure
    6. High cholesterol
  2. Diabetes
    1. Damages the nerves initiating an erection
    2. May narrow blood vessels limiting blood flow
    3. Having uncontrolled diabetes makes erections worse at that time and increases damage causing patients to move on to more invasive treatments quicker.
      1. Keep your blood sugars under control!
  3. Neurological disease
    1. Many neurologic diseases can cause problems
      1. Multiple sclerosis
      2. Stroke
      3. Parkinson’s disease
      4. Encephalitis
      5. Temporal lobe epilepsy
      6. Tumors
      7. Dementia including Alzheimer’s disease
      8. Shy-Drager syndrome
      9. Head trauma/Traumatic brain injury
      10. Spinal cord injuries
        1. Spina bifida
        2. Spinal disk herniation
        3. Transverse myelitis
    2. Surgical treatments may damage nerves
      1. Prior prostate surgery or prostate radiation therapy
      2. Prior prostate cryotherapy or HIFU
      3. Abdominal perineal resection
      4. Rectal surgery
      5. Colon surgery
    3. Pelvic trauma damaging nerves
  4. Peyronie’s disease
  5. Chronic renal failure
  6. Hormonal disease
    1. Low testosterone
      1. Testosterone may not correct erectile dysfunction, but can allow some medications to be more effective
    2. High or low thyroid levels
    3. High prolactin levels
  7. Smoking
    1. Leads to narrowing of the blood vessels 
      1. Both short term changes and more damaging long term changes
  8. Medications
    1. Blood pressure medications (please do not stop your medication without first speaking with your physician)
      1. Beta blockers
        1. Atenolol, metoprolol
      2. Diuretics
        1. Thiazide
    2. Psychotropic medications
      1. SSRI antidepressants
        1. Citalopram, paroxetine, venlafaxine
      2. Antipsychotics
        1. Risperidone
    3. Antiandrogen medications
      1. Prostate cancer treatments
        1. Bicalutamide, LHRH antagonists
      2. BPH treatments
        1. Finasteride
      3. Antifungal
        1. Ketoconazole
    4. Other medications
      1. Opiates
        1. Oxycodone, Percocet, methadone
      2. Retroviral medications
        1. Ritonavir
      3. Cancer drugs
      4. Alcohol
        1. Particularly in higher amounts or with chronic use
    5. Psychogenic causes
      1. Anxiety
        1. As trouble with erections occurs, most men will begin to worry it may happen again
      2. Stress
      3. Depression


Tests for determining the cause of erectile dysfunction

  1. Blood testing
    1. Hormonal testing for testosterone, thyroid function, prolactin level
    2. HgbA1c to evaluate for previously undiagnosed diabetes
    3. Lipid profile to evaluate cholesterol
  2. Bulbocavernosus reflex latency
    1. UroVal testing
  3. Nocturnal penile tumescence and rigidity testing
  4. Intracavernosal injection pharmacotesting
    1. May also be performed with doppler ultrasound to measure blood flow
      1. Evaluates arterial inflow and vena-occlusive dysfunction (venous leak)
  5. CT angiogram
    1. Limited role for this test

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OhioHealth Urology Physicians
OhioHealth Riverside Methodist Hospital
Bing Cancer Center
500 Thomas Lane, Suite 3G
Columbus, Ohio 43214

Phone: (614) 788-2870
Fax: (614) 533-0177
 
 

OhioHealth Urology Physicians
OhioHealth Riverside Methodist Hospital
Bing Cancer Center

500 Thomas Lane, Suite 3G
Columbus, Ohio 43214

Phone: (614) 788-2870
Fax: (614) 533-0177