Definition, etiological classification, and susceptible populations of erectile dysfunction

**I. Erectile Dysfunction**

Erectile Dysfunction (ED) is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse. ED is a more accurate term than the previously used "impotence." ED can be classified into three degrees: mild, moderate, and severe.

With scientific development and social progress, people's understanding of erectile dysfunction has also deepened. It was not until the 1970s, due to the progress in research on erectile physiology and pathology, that people realized that erectile dysfunction is related to many diseases (hypertension, diabetes, cardiovascular disease), drugs, trauma, and surgery.

Generally, the causes of erectile dysfunction can be divided into:

(1) Psychogenic erectile dysfunction: refers to erectile dysfunction caused by mental and psychological factors such as tension, stress, depression, anxiety and marital discord.

(2) Organic erectile dysfunction: ① Vascular causes: including any disease that may reduce blood flow to the penile cavernous arteries, such as: arteriosclerosis, arterial injury, arterial stenosis, pudendal artery shunt and abnormal cardiac function, or penile venous leakage caused by a reduction in the smooth muscle of the tunica albuginea or cavernous sinus that impairs the venous return closure mechanism. ② Neurological causes: diseases or injuries to the central and peripheral nerves can all lead to erectile dysfunction.

③ Surgery and trauma: Major vascular surgery, radical prostatectomy, abdominoperineal radical resection for rectal cancer, and other surgeries, as well as pelvic fractures, lumbar compression fractures, or straddle injuries, can cause damage to penile blood vessels and nerves, leading to erectile dysfunction.

[People prone to erectile dysfunction] (1) The elderly: As age increases, the likelihood of developing erectile dysfunction increases, but it is not inevitable in the process of aging.

(2) Patients with multiple physical illnesses: ① Cardiovascular disease.

② Diabetes mellitus.

③ Chronic renal insufficiency.

④ Hyperlipidemia.

⑤ Multiple sclerosis, stroke, demyelinating diseases, Alzheimer's disease, etc.

⑥ Endocrine disorders such as hypopituitarism, hypogonadism, hyperprolactinemia, adrenal gland disorders, hyperthyroidism, and hypothyroidism.

⑦ Prostate and penile diseases.

⑧ Ulcers, arthritis, allergies, alcoholic cirrhosis, chronic obstructive pulmonary disease, etc.

(3) Patients with mental illness: Mental illnesses such as schizophrenia, depression and drugs for treating depression are all related to erectile dysfunction.

50% to 90% of patients with depression experience a lack of libido; on the other hand, sexual dysfunction often leads to mental abnormalities such as depression and anxiety.

(4) Patients: Diuretics, antihypertensive drugs, drugs for treating heart disease, tranquilizers, antidepressants, hormones, anticholinergics, and drugs for treating peptic ulcers can all cause erectile dysfunction.

(5) Smokers: The prevalence of complete erectile dysfunction in smokers and non-smokers with heart disease was 56% and 21%, respectively; the prevalence of complete erectile dysfunction in smokers and non-smokers with hypertension was 20% and 8.5%, respectively.

(6) Alcoholics: Alcohol is said to "increase libido and decrease sexual ability".

Studies have shown that the prevalence of erectile dysfunction is 70% in alcoholics and 25% in non-alcoholic liver disease patients.

Moreover, half of them still failed to regain erectile function even after years of abstinence from alcohol.

(7) Drug users: The prevalence of erectile dysfunction among heroin users is 32.2%.

(8) Trauma or surgery: Spinal cord injury or surgery, pelvic fracture combined with urethral trauma, abdominoperineal radical resection of rectal cancer, retroperitoneal lymph node dissection, aortic reconstruction, pelvic radiotherapy for prostate cancer, and any trauma or surgery that damages the nerve supply and blood supply to the penis can easily cause erectile dysfunction.

Therefore, surgeons should continuously improve surgical techniques and skills to prevent iatrogenic erectile dysfunction.