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Aetiology of erectile dysfunction can be:

  • psychogenic
    • history of sexual abuse, marital or  relationship stress
    • performance anxiety
    • overt psychological disorders, such as depression or schizophrenia
    • drugs prescribed to treat psychological disorders
  • organic
    • vascular
      • cardiovascular disease
      • artherosclerosis
      • hypertension
      • diabetes
      • hyperlipidaemia
      • smoking
      • major surgery or radiotherapy (pelvis or retroperitoneum)
    • neurogenic
      • central causes
        • degenerative disorders (multiple sclerosis, Parkinson’s disease, multiple atrophy etc.)
        • spinal cord trauma or diseases
        • stroke
        • CNS tumors
      • peripheral causes
        • type 1 and 2 diabetes mellitus
        • chronic renal failure’
        • polyneuropathy
        • surgery e.g - pelvis or retroperitoneum, radical prostatectomy, colorectal surgery, etc.)
    • anatomical or structural
      • foreskin problems (phimosis, lichen sclerosus)
      • penile curvature (congenital curvature or Peyronie’s disease)
      • benign and malignant genital dermatoses.
    • hormonal
      • hypogonadism
      • hyperprolactinemia
      • hyper- and hypothyroidism
      • hyper- and hypocortisolism (Cushing’s disease etc.)
    • drug induced
      • antihypertensives (diuretics are the most common medication causing ED)
      • antidepressants (selective serotonin reuptake inhibitors, tricyclics)
      • antipsychotics (incl. neuroleptics)
      • antiandrogens; GnRH analogues and antagonists
      • recreational drugs (alcohol, heroin, cocaine, marijuana, methadone)

However, in most patients both factors probably contribute to the failure to achieve an adequate erection.


  • head injury and gonadotropin deficiency (3)
    • marked changes of the hypothalamo-pituitary axis have been documented in the acute phase of traumatic brain injury(TBI)
      • following TBI as many as 80% of patients showing evidence of gonadotropin deficiency, 18% of growth hormone deficiency, 16% of corticotrophin deficiency and 40% of patients demonstrating vasopressin abnormalities leading to diabetes insipidus or the syndrome of inappropriate anti-diuresis
      • longitudinal prospective studies have shown that some of the early abnormalities are transient, whereas new endocrine dysfunctions become apparent in the post-acute phase. There remains a high frequency of hypothalamic-pituitary hormone deficiencies among long-term survivors of TBI, with approximately 25% patients showing one or more pituitary hormone deficiencies


Last reviewed 09/2020