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Sexual health and LGBT population
Living with HIV
Post-exposure prophylaxis (PEP)
Erectile dysfunction may be due to purely psychological causes: anxiety, stress, a new sexual partner, a new sexual situation, depression etc. This form of ED is much more prevalent in the sexually active 20 to 40 year old male population. At times one episode of erectile dysfunction leads to a certain "anticipatory anxiety" that the problem experienced once may become recurrent. The performance anxiety can be such that it becomes a self-fulfilling prophecy – no erection or a poor quality erection.
When the cause is physical, your physician will pursue tests and appropriate treatment.
Vascular (blood vessel) problems - most common physical cause
This is due to narrowing of the vessels – the pipes can’t fill properly with blood and so erections are less than impressive. The disorder is called atherosclerosis (narrowed blood vessels) and is commonly associated with smoking, diabetes, high blood pressure and elevated cholesterol (often lifestyle issues).
Nervous system problems - There is a crucial communication between your brain (desire and/or stimulation) via the spinal cord to the genitals. In the event of poor communication – erections are disabled. Nervous system damage may result from disease; diabetes, multiple sclerosis, stroke, etc. Damage may be traumatic as with spinal cord injury or pinching of nerves from slipped vertebral discs. Any procedure that may compromise the genital nerve may perturb erectile capacity (i.e. prostate cancer surgery).
Hormonal disorders – particularly low testosterone levels. The importance of anabolic steroid drug use must not be underestimated – the use of anabolics sends a message to your own brain-testes hormone production cycle to shut down. This dysfunction may be temporary or permanent. Thyroid disease (responsible for thyroid hormone – implicated in metabolism and energy levels) may also be responsible in some men. Low testosterone levels are much more prevalent in men with HIV/AIDS and even moreso in those taking anti-retrovirals (anti-HIV medications). This leads us to the section on chemical causes of ED;
Legal and illegal drugs – if your problems start subsequent to the initiation of a new medication or drug – talk with your physician. There are many classes of medications which are responsible for erectile dysfunction, go over them all with your physician. Erectile dysfunction may be secondary to recreational drug and/or alcohol consumption. Remember, alcohol is a stimulant in its early phase, leading to disinhibition. This phase is rapidly followed by its "depressant" phase, whereby alcohol impedes erectile function. Tobacco also has its own direct influence on erectile dysfunction – one of the first steps in addressing ED should be the cessation of smoking!!