Patient's question:
The scrotum feels cold, and there is difficulty and weakness in erection. How could I have ED if I never masturbate?Doctor's answer:
Erectile dysfunction is mostly functional, with a minority being organic. The common causes can be categorized into the following aspects:1. Psychological and Neurological Factors: Such as psychological trauma during childhood sexual development, lack of sexual knowledge during the early stages of marriage, tension and anxiety, marital conflicts, or harmonious family relationships; or unhealthy habits like excessive masturbation, which can lead to reduced sensitivity in the penis, mental tension, excessive psychological burden, and ultimately erectile dysfunction. Overexertion in mental or physical activities, or adverse psychological stimuli such as excessive depression, sadness, or fear, as well as indulgence in sexual activity or excessive sexual life, can all disrupt the function of the cerebral cortex and result in erectile dysfunction.
2. Neurological Disorders: Hypothalamic-pituitary tumors or tumors in other parts of the body, localized brain damage such as partial epilepsy, encephalitis, or cerebral hemorrhage compression, spinal cord injuries, spinal cord tumors, chronic alcoholism, multiple sclerosis, or pelvic surgery that damages peripheral autonomic nerves can all lead to erectile dysfunction.
3. Endocrine Disorders: Conditions such as diabetes, hypopituitarism, testicular damage or dysfunction, hypothyroidism, hyperthyroidism, or insufficient adrenal function can all cause erectile dysfunction.
4. Urological and Genital Organ Disorders: Conditions like prostatitis, benign prostatic hyperplasia, epididymitis, or varicocele are common causes of erectile dysfunction. Some middle-aged and elderly patients develop erectile dysfunction due to prostatitis and benign prostatic hyperplasia.
5. Medication Effects: Many medications can suppress sexual function, such as reserpine, guanethidine, digoxin, diazepam, furosemide, or metoclopramide, all of which can lead to erectile dysfunction.
6. Chronic Fatigue: Fatigue can cause erectile dysfunction because excessive muscle fatigue or psychological fatigue resulting from overthinking, depression, or tension interferes with sexual arousal. This includes reduced brain function inhibiting sexual interest, decreased excitability of the limbic system's emotional centers, and reduced secretion of gonadotropin-releasing hormones from the pituitary gland and testosterone from the testes, which lowers sexual excitement.