Erectile
Dysfunction: |
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In organic ED, the man is usually over 40 years of age and the ED is more likely to be progressive in
its presentation. There is usually loss of early morning erections and masturbation is not possible.
As the majority of these men are usually in stable, long term relationships, the ED is not situational.
A man under the age of 40 years with anxiety related ED may have early morning erections or
be able to masturbate without difficulty. The ED may have come on suddenly, be episodic, and
occur in some situations and not in others. Naturally, these generalisations are simplifications,
and organic and psychological causes are often both present.
Organic causes account for the vast majority of
cases of ED and these are primarily vascular in origin, particularly associated with hypertension,
ischaemic heart disease and diabetes mellitus.(1) Long standing diabetes is also associated with neuropathy and this is important as oral agents are less efficacious in the treatment of ED in these patients. Saenz de Tejada et al. (4) suggest that 75% of men will develop ED within 10 years of onset of diabetes and that ED may not only be a presenting symptom of diabetes mellitus, but that it is significantly predictive of neuropathic symptoms and poor glycaemic control. Severe depression like any severe chronic illness will be associated with ED, in part because of general malaise, poor circulation and associated reduced desire exacerbated by antidepressants. Performance anxiety and other anxiety related circumstances are also worthy of discussion, as they are not uncommon. While these may contribute to the organically based ED of a middle aged man, they are the usual cause in men under the age of 40 years. |
More severe psychiatric disorders, such as entrenched body image problems may require psychiatric
referral.
Identifying the problem |
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