Definition, classification and psychological factors analysis of erectile dysfunction

**Erectile dysfunction**

Erectile dysfunction (ED) is a condition in which a man's genitals are weak and unusable, unable to achieve or maintain an erection sufficient for satisfactory sexual intercourse. Because the penis cannot penetrate the vagina for ejaculation, it can easily lead to infertility. According to statistics from relevant departments, in recent years, three-quarters of divorce cases in China have been initiated by women, and the majority of these are due to the husband's sexual dysfunction, particularly erectile dysfunction.

It is important to emphasize that normal sexual function is subject to physiological fluctuations. Temporary erectile dysfunction may occur when stimulated by factors such as mental or emotional instability, poor health, or the female partner's apathy or opposition to intercourse. However, such occasional occurrences should not be considered pathological. Only when the influence of the above factors is ruled out, and intercourse failure occurs repeatedly under normal sexual stimulation, can it be considered erectile dysfunction.

In fact, erectile dysfunction is a complex male sexual dysfunction with particularly significant overall effects. There are two types of erectile dysfunction: primary and secondary, and further classified as organic or psychogenic.

**I. Factors that cause erectile dysfunction**

There are many factors that can cause erectile dysfunction. Besides organic erectile dysfunction caused by anatomical defects of the sex organs, common causes include:

**1.** **Psychological factors** account for 85% to 90% of all cases.

(1) The couple has a bad relationship and is hostile to the woman; or the couple's sex life is not harmonious and they do not get sexual satisfaction, which causes them to feel disgusted by sexual behavior, leading to impotence.

(2) An unsuitable sexual environment, such as multiple people living in the same house, or being wary or worried during sexual intercourse, can also lead to impotence.

(3) Due to a lack of sexual knowledge, some people are afraid during intercourse, fearing that the intercourse will fail and the woman will be dissatisfied; or if they are not satisfied with a particular intercourse, they may think that they have impotence. Because these people have doubts or fears, they are tense, afraid and worried every time they prepare for intercourse, which results in the erect penis becoming soft and unable to have intercourse.

(4) Excessive masturbation and excessive sexual activity are also common causes of erectile dysfunction. Excessive sexual activity, especially frequent intercourse, i.e., having intercourse repeatedly after one time, requires stronger stimulation to achieve penile erection and ejaculation. Over time, the erection nerve center becomes inhibited, which can lead to functional erectile dysfunction.

**2.** **Pathological Factors**

(1) Anatomical abnormalities: such as congenital malformations, scrotal hydrops, testicular fibrosis, etc.

(2) Nervous system lesions: Amyotrophic lateral sclerosis (ALS), myasthenia gravis, Parkinson's disease, spinal cord tumors, multiple sclerosis and other brain and spinal cord lesions; peripheral neuritis can also lead to impotence to varying degrees.

(3) Endocrine system disorders: There are many types of endocrine diseases, among which pituitary damage, hypopituitarism, diabetes, hyperthyroidism, Cushing's syndrome, etc. are common causes of erectile dysfunction. Hypothyroidism, craniopharyngioma, anorchia, infantile disorders, hyperprolactinemia, oral estrogen, feminizing interstitial testicular tumors, etc.

(4) Diseases of the urogenital system: Diseases of the male urogenital organs are closely related to impotence, such as cystectomy, perineal prostatectomy, Peyronie's disease, phimosis, prostatitis, urethritis, cryptorchidism, and cryptorchidism.

(5) Hematologic diseases: Hodgkin's disease, leukemia, pernicious anemia (with other systemic diseases), sickle cell anemia.

(6) Infections: scrotal elephantiasis, genital tuberculosis, gonorrhea, mumps, penile skin infection, etc.

(7) Vascular lesions: arteritis, lipoma, arteriosclerosis, abdominal aortic bifurcation thrombosis.

(8) Other aspects: cirrhosis, chronic renal failure, obesity, poisoning (lead, herbicide poisoning), rheumatic fever, pulmonary insufficiency, emphysema, etc.

**3.** **Other Factors**

(1) Mental labor: According to statistics, the proportion of intellectuals suffering from impotence is relatively high, while the proportion of those engaged in physical labor is relatively low. This is because mental laborers are more prone to cardiovascular disease and diabetes than physical laborers. People with higher education levels generally have a fast pace of life, intense competition, and greater pressure, which makes them more prone to psychological disorders.

(2) Smoking and drinking habits: Long-term smoking can lead to spasm of penile micro-arteries, resulting in insufficient blood supply and impotence; long-term alcohol abuse damages liver function, affecting hormone secretion, and the peripheral blood vessels and nerves of patients with chronic alcohol poisoning are also damaged to varying degrees.

(3) Long-term medication: Long-term use of certain antihypertensive drugs, sedatives, etc. can also cause impotence.

**Part Two: Self-Assessment of Erectile Dysfunction**

The diagnosis of erectile dysfunction should be based on several parameters, including the speed and duration of penile erection response, and the rigidity of the erection. Abnormalities in any of these aspects can be considered erectile dysfunction. The reference standards are as follows:

1. No erectile dysfunction (normal) Normal libido, rapid erection response, erection lasts until ejaculation or disappears after interruption of intercourse, erection hardness allows free insertion into the vagina, good sexual pleasure, no significant change in the frequency of intercourse, and normal erection response during masturbation.

2. Mild erectile dysfunction (I°): Sexual desire is basically normal, erectile response is rapid, erection duration is unstable, sometimes it cannot be sustained, erection hardness is sometimes insufficient for vaginal penetration, sexual pleasure is basically normal, frequency of intercourse is less than before, and erectile response during masturbation is basically normal.

3. Moderate erectile dysfunction (II°): Decreased libido, slowed erectile response, frequent inability to maintain an erection, insufficient erection rigidity for vaginal penetration, diminished sexual pleasure, significantly reduced frequency of intercourse, and weak erectile response during masturbation.

4. Severe erectile dysfunction (III°): Loss of sexual desire, no erectile response, therefore no sustained erection, complete inability to penetrate the vagina, and no sexual pleasure.

In addition, it is important to understand whether the onset of erectile dysfunction is sudden (often caused by psychological stress, classified as psychogenic erectile dysfunction) or gradually worsens without the patient's awareness (indicating the presence of an organic problem), in order to help identify the type. Grade I and II erectile dysfunction are primarily psychogenic, but may also be early stages of organic erectile dysfunction. Grade III erectile dysfunction is more commonly caused by organic factors.

**III. Prevention of Erectile Dysfunction**

Popularizing sex education, correctly understanding the natural physiological function of sex, reducing anxiety about sexual activity, eliminating unnecessary worries, and preventing psychogenic erectile dysfunction. Avoiding all types of sexual stimulation and abstaining from sexual activity for a period of time allows the sexual center and sexual organs to regulate and rest, which is beneficial for willpower regulation and disease recovery.

Actively treat any underlying medical conditions that may cause erectile dysfunction, and avoid or discontinue any medications that may cause (or have been verified to cause) erectile dysfunction. The female partner should be understanding and considerate of the male partner, and should never blame or belittle him. This understanding and support will help the patient build confidence and promote mental well-being. Maintain a cheerful mood, a calm and balanced lifestyle, and engage in regular physical exercise to strengthen the body and improve immunity. When erectile dysfunction occurs, inform the doctor about all underlying medical conditions and their progression to facilitate early treatment; never conceal your condition.