In view of the known cardiovascular effects of smoking it is perhaps surprising that there is little evidence that smoking itself increases the risk of ED. For example, in MMAS the overall incidence of erectile dysfunction was 11% in smokers, not significantly different from the 9.5% incidence in non-smokers. In some sub-groups, however, smoking had a definite harmful effect. Smoking increases the risk of Erectile Dysfunction

Malignancies affecting either partner may adversely affect male erectile function ( Fig. 1.31 ). This may be directly due to physical, often neurological, problems following extensive pelvic surgery, or to psychosexual problems arising from changes in self image and esteem. The latter problems are often seen in patients with stomas or in women who have undergone mastectomy or hysterectomy. Pelvic radiotherapy and chemotherapy may also reduce sexual function.

1.31 Malignancies associated with ED

It is a well-known adage that alcohol “increases the desire but lessens the ability”. Acute alcohol intoxication commonly results in erectile failure, but the incidences of E.D. in chronic alcoholics has been variously estimated at between 8 and 63%. These large differences arise because of different methods of assessment.

The incidence of ED in men with chronic renal failure is approximately 40%. There is evidence that men on haemodialysis are more likely to have problems than those who have had a transplant, and also that a significant number (approximately 75%) of these men will experience improvement in their erections following transplantation.
Arthritis, HIV, endocrine diseases causing ED…

There is a strong association between a variety of neurological diseases and ED. Hollowing spinal injury, erections are often very unpredictable in frequency and nature. Reflex erections persist if the sacral segments of the cord are intact, but these may be poorly maintained. Voluntary erections may still occur, especially in men with incomplete and lower level lesions.

Cardiovascular disease can affect potency by a variety of mechanisms. Erectile dysfunction occurs in up to 45% of men following myocardial infarction, but there is evidence that a similarly high incidence exists in men before they suffer heart attacks. Psychological factors may play a significant role in this type of erectile failure, the men and their partners being afraid of the exertion of sexual activity. 85% of men with vascular accidents develop impotence

Many studies have shown a strong association between diabetes and ED. In MMAS, the prevalence was 28%. in treated diabetics, and in men attending diabetes clinics the prevalence varies from 27 to 59%. Overall, the risk of HO in diabetics appears to be about three times as great as that of the population as a whole. There is a strong connection between Diabetes and Impotence…

Broadly speaking, ED can be defined as being the consequence of either organic or inorganic (i.e. psychogenic) disease. Although 30 years ago it was thought that the majority of cases were psychogenic in nature, in the 1970s and 1980s many experts believed that ED always had an organic cause. Today experts say that impotence is caused both by psychological and physical problems…

In a questionnaire survey, Brecher found that although 59% of men over the age of 70 years were still having regular coitus with their wives, 81% claimed to be sexually active. This suggests that as men become older the frequency of coitus declines more rapidly than does stated erectile ability and that masturbation becomes relatively more frequent

There is now abundant evidence that sexual function declines with increasing age even though interest in sexual activity may remain. This decline in function was described by Kinsey et al. in 19488, who found a steady decrease in the frequency of coitus with increasing age. Their data of the effect of age on sexual function are shown in Fig. 1.1. These data, however, have been criticized for being obtained from a very select population. The study included relatively few men over the age of 55 years…