How to differentiate in organic and psychogenic erectile dysfunction

Erectile dysfunction (ED) is defined as the recurrent inability, of three months’ duration or longer, to attain or maintain an erection sufficient for satisfactory sexual performance. Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

ED varies in severity. For some men, it’s an occasional annoyance that can get in the way of sex every now and then. For others, ED may be a severe, long-term issue that has a serious impact on the person’s ability to enjoy sex. Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction.

Certain factors may increase your risk of developing erectile dysfunction. You might be more prone to Erectile dysfunction if you’re older, have been diagnosed with a disease or medical condition, take a prescription medication or have certain habits, such as smoking or excessive drinking.

Causes and Classification of erectile dysfunction-

Types of impotence (Erectile dysfunction)

  1. Venogenic impotence: The most common type. The veins leak the blood & penis fail to maintain an erection.
  2. Diabetic impotence.
  3. Psychogenic impotence: Due to depression, anxiety, stress…
  4. Aeteriogenic impotence: in hypertensive patient where penis is unable to receive sufficient blood for erection.
  5. Neurogenic impotence: any injury to the back particularly affecting spinal cord or vertebral column or surgery to urinary bladder, prostate or rectum.
  6. Endocrinologic impotence: imbalance in testosterone or estrogen level in blood. Anabolic steroids cause impotence

Erectile dysfunction is divided into two etiologic categories: psychogenic (starts sharp & associated with certain events of life) and organic (progressive course). Most causes of erectile dysfunction were once considered to be psychogenic, but current evidence suggests that up to 80 percent of cases have an organic cause.

 

Organic Erectile dysfunction

Organic ED involves abnormalities the penile arteries, veins, or both and is the most common cause of ED, especially in older men. When the problem is arterial, it is usually caused by arteriosclerosis, or hardening of the arteries, although trauma to the arteries may be the cause.

Types of organic ED-

Vasculogenic ED consists of arterial insufficiency and venous leak syndrome.

Arterial insufficiency is where insufficient arterial blood is pumped to the penis. 

Venous leak syndrome is where that arterial blood pumped to the penis following sexual stimulation is inadequately trapped in the erectile tissue of the penis for a sufficient period of time to permit a satisfactory erection is dysfncional.

In either case, the vascular system responsible for either achieving or maintaining an erection is dysfunctional.

Patho- physiology of Organic ED-

Usually men have underlying organic pathology as the principal cause or contributing factor to their condition. The common denominator in all organic impotence is hormonal, vascular, neurogenic, or anatomic derangements, but probably a combination of these factors. The organic causes of impotence in decreasing order of frequency: arterial, venous, neurological, and endocrine.

Vascular impotence can be secondary to arterial or venous pathology. Arterial causes are usually encountered in older men with a history of diabetes mellitus (DM) and peripheral vascular disease, or in young men with penile vascular injury secondary to perineal trauma. Thus, a problem in either small or large vessels can cause inadequate inflow of blood to the penis, with resultant inability to engorge the blood vessels. 

Venous “leak” impotence is secondary to abnormal venous drainage of the corpora, and/or inadequate corporal smooth muscle relaxation. Thus, the penis receives adequate inflow of blood but is unable to trap enough volume into the vessels for tumescence. This condition leads to erectile dysfunction and will persists lifelong if not treated correctly.

Neurogenic impotence can be secondary to central (CNS) or peripheral nervous system (PNS) dysfunction. The classic and most common PNS lesion is peripheral neuropathy in patients with longstanding DM. 

Patients with spinal cord injury have varying degrees of erectile dysfunction, depending on the level and completeness of the cord lesion. Patients with other spinal cord diseases and lesions of the cerebral hemispheres also have varying degrees of impotence. Another category of neurogenic erectile dysfunction is iatrogenic (i.e., in patients after radical pelvic or lower bowel surgery with resultant interruption of the erectile nerves).

All these physical and associated causes of various lifestyle disorders such as hypertension, DM, arteriosclerosis etc leads to interruption in the flow of normal arterial, venous and nerve functioning of the penis resulting in erection issues.

Psychogenic Erectile Dysfunction-

Although most causes of erectile dysfunction are physical in nature, many cases of ED develop as a result of emotional or psychological issues. When erectile dysfunction is related to a psychological problem, it’s referred to as psychological ED, or psychological impotence.

Psychogenic erectile dysfunction is defined as the persistent inability to achieve or maintain erection satisfactory for sexual performance owing predominantly or exclusively to psychological or interpersonal factors. About 40% of erectile dysfunction (ED) cases are considered psychogenic. While erectile dysfunction can affect men at any age, many psychogenic ED cases occur in young men.

A new definition and classification of psychogenic erectile dysfunction has been proposed based on recent clinical and research findings. According to this new classification, psychogenic erectile dysfunction is categorized as generalized or situational type, with subcategories of each type proposed.

Like with Organic ED, there’s no single psychological cause that can trigger erectile dysfunction in men. Instead, a variety of issues can all cause or contribute to psychological ED, such as:

  • Anxiety, whether general in nature or specifically related to sex
  • Fear or sexual failure or poor sexual performance
  • Feelings of guilt about engaging in sexual activity
  • Stress about sex or chronic stress related to other issues
  • Depression and other mood disorders
  • Relationship problems
  • Excessive porn consumption
  • Low self-esteem

Some medications used to treat psychological issues, such as antidepressants, can also play a role in the development of erectile dysfunction. Many of these triggers are closely linked, and it’s entirely possible that you could be affected by one or more at a time. 

Patho-physiology of Psychogenic ED-

Psychogenic erectile dysfunction can work in a vicious cycle. Anxiety or depression may precede erectile dysfunction and create problems when a person engages in sexual activity. Or, a person experiencing ED may develop symptoms of anxiety or depression as a result of their dysfunction.

 

Diagnosis of ED

To determine the root cause of any type of ED, speak with a healthcare provider. They will conduct a thorough evaluation, reviewing the person’s medical and sexual history, past substance use, and overall health and vital signs.

Healthcare providers may utilize a variety of tests and tools to investigate the cause of ED, including but not limited to:

Blood tests: Help identify potential underlying causes that may be contributing to ED, such as heart problems, anemia, or hormonal abnormalities, including testosterone, which is a foundation for erectile dysfunction. These can also check kidney and liver function.

Nocturnal penile tumescence (NPT) test: Measures erectile function during sleep.

Urine tests: Can look for the presence of diabetes as an underlying condition.

Thyroid tests: The thyroid helps regulate sex hormones. A thyroid deficiency could be causing ED.

Based on your answers and the results of your laboratory tests, your healthcare provider may recommend a psychological evaluation to further explore the potential cause of your ED.

Whether you’ve talked to a healthcare professional or not, there are a few signs to look for that may suggest that your erectile dysfunction is psychological in nature. Ask yourself the following questions:

Are you interested in sex and attracted to your partner, but have trouble performing?

Are you able to achieve an erection while masturbating?

Do you experience morning erections?

Are you under a lot of stress or experiencing an abnormal amount of anxiety?

Do you get nervous about pleasing your partner?

Answering “yes” to any of these questions doesn’t always mean that your ED is psychological, but it’s a sign that one or several psychological factors may play a role in your symptoms.

It’s especially important to talk to a healthcare provider if you think that your ED symptoms may have something to do with a clinical mental health issue such as anxiety or major depression.

Treatment of Organic and Psychological ED-

Patients suffering from erectile dysfunction should first be evaluated for any underlying physical and psychological conditions. If treatment of the underlying conditions doesn’t help, medication and assistive devices, such as pumps, can be prescribed.

ED can be treated in many ways, including:

Oral medications: Medications such as sildenafil (Viagra®), vardenafil (Levitra®), or tadalafil (Cialis®) may help improve sexual function in men by increasing blood flow to the penis.

Sex therapy: Education about sex, sexual behaviors, and sexual responses may help a man overcome his anxieties about sexual dysfunction. Talking honestly with your partner about your needs and concerns may also help to overcome many barriers to a healthy sex life.

Penile injections: Men are taught how to inject medications directly into the erection chambers of the penis to create an erection. Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve and psychological conditions. The three most common medicines are prostaglandin E1 (alprostadil), papaverine (Papacon®), and phentolamine (Regitine®).

Vacuum devices: Aids such as vacuum devices and penile constriction rings serve as erectile aids for some men. A vacuum constriction device (above) is a cylinder that is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is maintained by slipping a band off of the base of the cylinder and onto the base of the penis. The band can stay in place for up to 30 minutes. The vacuum device can be safely used to treat most causes of erectile failure.

Hormonal medication: Low hormone levels may play a role in ED. Hormone replacement in the form of topical gels, creams, patches, injections and pellets are only used after physician evaluation.

Surgery (penile implant): A penile implant, or penile prosthesis, is a treatment for erectile dysfunction (ED). The surgery involves placing inflatable or flexible rods into the penis. Inflatable rods require a device filled with saline solution and a pump hidden in the scrotum. When you press on the pump, the saline solution travels to the device and inflates it, giving you an erection. Later, you can deflate the device again.

Ayurvedic treatment:

Take Aswagandhadi churan half teaspoon in the morning & in the night.

Take Capsule SHILAJIT one in the morning and one in the night,

Take tablet manmath Ras one in the morning and one in the night.

Take tablet Pushp dhanva Ras one in the morning and one in the night. And take tablet Sidh makardhwaj Vati with gold, one in the morning and one in the night after food.

All the above preferably with hot milk or with water

Also apply and message Shri Gopal tail on your penis three times a week for 2 to 4 minutes.

Avoid junk food, oily and spicier food, alcohol, tobacco, tension and anxiety.

Start doing brisk walk or running or cardio exercises for at least 30 min a day. Start doing yoga, pranayama, meditation, Vajroli mudra. Ashwini mudra, kegel exercise for at least 30 min a day.

Start taking hot milk twice a day.

2-3 dates in the morning and in the night with milk.

Do all the above suggested treatment for 3 months and see the results. 

Take-Away

Erectile dysfunction affects a significant portion of the male population and is probably one of the most undertreated conditions in the United States. Thanks to aggressive research, vital improvements in the diagnosis and treatment of this ailment have occurred, with more options soon to be available. Organic and psychological erectile dysfunction should be differentiated and treated according to proper diagnosis.

You can also contact me on my private chat or directly in my clinic. We can send you the medicines by courier.

My website: www.kayakalpinternational.com