Table 5.1: Pathophysiology of ED

Pathophysiology of ED

  • Recreational habits (i.e. cigarette smoking)
  • Lack of regular physical exercise
  • Obesity
  • Cardiovascular diseases (e.g. hypertension, coronary artery disease, peripheral vasculopathy)
  • Type 1 and 2 diabetes mellitus; hyperlipidaemia; metabolic syndrome; hyperhomocysteinemia
  • Major pelvic surgery (e.g. radical prostatectomy) or radiotherapy (pelvis or retroperitoneum)
  • Central causes
  • Degenerative disorders (e.g. multiple sclerosis, Parkinson’s disease, multiple atrophy, etc.)
  • Spinal cord trauma or diseases
  • Stroke
  • Central nervous system tumours
  • Type 1 and 2 diabetes mellitus
  • Chronic renal failure, chronic liver failure
  • Polyneuropathy
  • Surgery (major surgery of pelvis/retroperitoneum) or radiotherapy (pelvis or retroperitoneum)
  • Surgery of the urethra (urethral stricture, open urethroplasty, etc.)
  • Hypospadias, epispadias; micropenis
  • Phimosis
  • Peyronie’s disease
  • Penile cancer (other tumours of the external genitalia)
  • Diabetes mellitus; Metabolic Syndrome;
  • Hypogonadism (any type)
  • Hyperthyroidism
  • Hyper- and hypocortisolism (Cushing’s disease, etc.)
  • Panhypopituitarism and multiple endocrine disorders
  • Chronic systemic diseases (e.g. diabetes mellitus, hypertension, metabolic syndrome, chronic kidney disease, chronic liver disorders, hyperhomocysteinemia, hyperuricemia, chronic obstructive pulmonary disease, rheumatic disease)
  • Psoriasis, gouty arthritis, ankylosing spondylitis, non-alcoholic fatty liver disease, chronic periodontitis, open-angle glaucoma, inflammatory bowel disease, chronic fatigue syndrome, allergic rhinitis, obstructive sleep apnoea, depression
  • Iatrogenic causes (e.g. TRUS-guided prostate biopsy)
  • Antihypertensives (i.e. thiazidediuretics, beta-blockers) *
  • Antidepressants (e.g. selective serotonin reuptake inhibitors, tricyclics)
  • Antipsychotics
  • Antiandrogens (GnRH analogues and antagonists; 5-ARIs)
  • Recreational drugs (e.g. heroin, cocaine, marijuana, methadone, synthetic drugs, anabolic steroids, excessive alcohol intake)
  • Generalised type (e.g. lack of arousability and disorders of sexual intimacy)
  • Situational type (e.g. partner-related, performance-related issues or due to distress)
  • Penile fracture
  • Pelvic fracture

GnRH = gonadotropin-releasing hormone; 5-ARIs = 5α-reductase inhibitors; TRUS = transrectal ultrasound.
*A symmetry analysis showed that cardiovascular drugs do not strongly affect the risk of subsequently being prescribed as anti-erectogenic drug. The analysis only assessed the short-term risk .