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What causes ED?

ED usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED.

Because an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases-such as diabetes, high blood pressure, nerve disease or nerve damage, multiple sclerosis, atherosclerosis, and heart disease-account for the majority of ED cases. Patients should be thoroughly evaluated for these conditions before they begin any form of treatment for ED.

Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of ED. Smoking, drinking alcohol excessively, being overweight, and not exercising are possible causes of ED.

Surgery-especially radical prostate and bladder surgery for cancer-can also injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and the fibrous tissues of the corpora cavernosa.

In addition, ED can be a side effect of many common medicines such as blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine, an ulcer drug.

Psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure can also cause ED. Even when ED has a physical cause, psychological factors may make the condition worse.

Hormonal abnormalities, such as low levels of testosterone, are a less frequent cause of ED.

Co-Occurring Drug Abuse and Mental Health

Offenders with co-occurring drug abuse and mental health problems often require an integrated treatment approach. High rates of mental health problems are present in offender populations and in those with substance abuse problems. Drug abuse treatment can sometimes address depression, anxiety and other mental health problems. Personality, cognitive and other serious mental disorders can be difficult to treat and may disrupt drug treatment. The presence of co-occurring disorders may require an integrated approach that combines drug abuse treatment with psychiatric treatment, including the use of medication. A physician should assess Individuals with either a substance abuse or mental health problem for the presence of the other.

Medications for Drug Abuse

Medications are important parts of treatment for many drug abusing offenders. For heroin addiction, medicines such as methadone and buprenorphine help normalize brain function and individuals who may benefit from them should take them. Effective use of medications can be instrumental in enabling people with co-occurring mental health problems to function successfully in society. Behavioral strategies can increase adherence to medication regimens.

Chronic Conditions Prevention

Treatment planning for drug abusing offenders who are living in or returning the community should include strategies to prevent and treat serious, chronic medical conditions, such as HIV/AIDS, hepatitis B and C and tuberculosis.
The rates of infectious diseases, such as hepatitis, tuberculosis and HIV/AIDS, are higher in drug abusers, incarcerated offenders and offenders under community supervision than in the general population. Infectious diseases affect not just the offender, but also the criminal justice system and the wider community. Consistent with federal and state laws, offenders who have abused drugs should be tested for infectious diseases and receive counseling on health practices and on ways to modify risky behaviors. Probation and parole officers who monitor offenders with serious medical conditions should link them with appropriate healthcare services, encourage compliance with medical treatment and re-establish eligibility of the offender for public health services like Medicaid.