Erectile Dysfunction: Causes, Diagnosis, and Modern Treatment Methods

What is Erectile Dysfunction?

Erectile dysfunction (ED), or impotence, is the inability to achieve and/or maintain an erection sufficient for satisfactory sexual intercourse. This condition is a common problem that significantly reduces the quality of life of men and their partners [2]. ED can be an indicator of more serious systemic diseases, such as cardiovascular pathologies, and requires a careful approach to diagnosis and treatment [2].

Main Causes of Erectile Dysfunction

The causes of ED are diverse and often interrelated. It is important to understand that an erection is a complex physiological process depending on the state of the blood vessels, nervous system, hormonal balance, and psychological state.

• Cardiovascular diseases: One of the most significant causes of ED is systemic vascular disease. Men who have suffered a myocardial infarction (MI) often face erectile dysfunction, which is associated with the general condition of the vascular system [2]. ED after MI is associated with a lower quality of life [2].
• Lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH): There is a close link between LUTS, often caused by BPH, and erectile dysfunction [1]. These conditions frequently coexist, and their combined treatment can be more effective [1].
• Foreskin dysfunction: Although the foreskin is not strictly necessary for penile function, its dysfunction can lead to significant problems and discomfort [5]. Various penile dermatoses can cause or exacerbate foreskin dysfunction, sometimes requiring medical intervention or circumcision [5].
• Neurological and hormonal disorders: ED can be the result of damage to the nerves involved in the erection process or hormonal imbalance (e.g., low testosterone levels).
• Psychological factors: Stress, depression, anxiety, and relationship problems can also play a significant role in the development of ED.
• Endocannabinoid system: Research shows that cannabinoid receptors and endocannabinoids are present in the tissues of the lower urinary and genital tract, including the penile erectile tissue [4]. This system may play a role in regulating reproductive functions and dysfunctions, opening up new prospects for research and potential treatment [4].

Diagnosis of Erectile Dysfunction

For an accurate diagnosis of ED and the identification of its causes, an integrated approach is necessary.

• Anamnesis and questionnaires: The doctor collects a detailed medical history, including information about concomitant diseases, medications taken, and lifestyle. To assess the severity of ED, standardized questionnaires are often used, such as the 5-item version of the International Index of Erectile Function (IIEF-5) [2]. Questionnaires can also be used to assess general quality of life, for example, the SF-36v2 questionnaire [2].
• Objective research methods:
  • Penile ultrasound with dopplerography: This method allows for the evaluation of blood flow in the penile vessels at rest and after the injection of vasoactive drugs, which helps identify vascular disorders underlying ED [2].
  • Echocardiography and carotid artery dopplerography: Since ED is often associated with systemic vascular diseases, these studies allow for the assessment of the cardiovascular system and the detection of atherosclerotic changes [2].
• Laboratory tests: Include determining hormone levels (testosterone), blood glucose, and lipid profile to rule out endocrine and metabolic disorders.

Modern Approaches to the Treatment of Erectile Dysfunction

Treatment for ED should be individualized and aimed at eliminating both the symptoms and the underlying causes.

• Pharmacotherapy:
  • Phosphodiesterase type 5 (PDE-5) inhibitors: These drugs are the first-line therapy for ED [1, 6]. They work by relaxing the smooth muscles of the penis and increasing blood flow, which helps achieve an erection. These include sildenafil, tadalafil, vardenafil, avanafil, and others [6]. PDE-5 inhibitors are characterized by high efficacy, a rapid onset of action, and the possibility of "on-demand" intake [6]. Interestingly, PDE-5 inhibitors also have a beneficial effect on lower urinary tract symptoms [1].
  • Alpha-1-blockers: These drugs are considered the most effective monotherapy for LUTS associated with BPH [1]. Some alpha-1-blockers, such as alfuzosin, may even improve sexual function in men with concurrent LUTS and sexual dysfunction, although tamsulosin may cause anejaculation [1].
  • Combination therapy: Given the close link between LUTS and ED, as well as the different mechanisms of action of the drugs, combination treatment with alpha-1-blockers and PDE-5 inhibitors is often prescribed [1]. Studies confirm that tadalafil, a long-acting PDE-5 inhibitor, has a minimal effect on blood pressure when taken together with selective alpha-1-blockers such as alfuzosin or tamsulosin [1].
• Surgical treatment:
  • Penile prosthesis: In cases where conservative methods are ineffective, surgical implantation of penile prostheses may be considered.
  • Foreskin surgery: For foreskin dysfunction caused by dermatoses or other reasons, circumcision may be required [5].
  • Surgeries for BPH: It is important to note that surgical treatment for BPH, although effective for LUTS, may be associated with the risk of ejaculatory dysfunction [3]. There are various surgical techniques (electresection, laser procedures, ablation), and the choice of method can affect the frequency of ejaculatory disorders [3].
• Lifestyle changes: Includes smoking cessation, moderate alcohol consumption, regular physical activity, a balanced diet, and weight management.
• Psychological support: Consultations with a psychologist or sexologist can be useful for addressing psychological problems associated with ED.

Impact on Quality of Life and a Comprehensive Approach

Erectile dysfunction is not just a physiological problem; it has a profound impact on a man's self-esteem, relationships, and overall quality of life [2]. Therefore, a comprehensive, interdisciplinary approach to treatment is crucial. This means not only eliminating the symptoms of ED, but also identifying and treating concomitant diseases such as cardiovascular pathologies, diabetes, or LUTS [2]. Collaboration between urologists, cardiologists, endocrinologists, and psychologists makes it possible to achieve the best results and significantly improve the patient's quality of life.

Sources

1. Lower urinary tract symptoms and sexual dysfunction: a common approach. (BJU international, 2008)
2. Erectile dysfunction and quality of life after myocardial infarction: a cross-sectional study with routine point-of-care penile Doppler ultrasonography. (Polish archives of internal medicine, 2026)
3. Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men's ejaculatory function: Time for a bespoke approach? (International journal of urology : official journal of the Japanese Urological Association, 2016)
4. The significance of endocannabinoid receptors and endocannabinoids in the lower urinary and genital tract. (World journal of urology, 2025)
5. The dysfunctional foreskin. (International journal of STD & AIDS, 2001)
6. Phosphodiesterase inhibitors in clinical urology. (Expert review of clinical pharmacology, 2013)

Disclaimer: The information presented in this article is for reference purposes only and is not intended for self-diagnosis or self-treatment. Always consult a qualified medical professional for an accurate diagnosis and an individualized treatment plan.