Injury erectile dysfunction: Erectile dysfunction and nerve damage: Symptoms and more

27.08.202311.06.2023 by alexxlab

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Erectile dysfunction and nerve damage: Symptoms and more

Nerve damage can cause erectile dysfunction. This may occur from medical conditions, such as diabetes, injuries, such as spinal cord injury, or pelvic surgery.

Nerve damage is not the most common cause of erectile dysfunction (ED), but it can be a cause.

Other effects of nerve damage-induced ED may include urinary incontinence or being unable to urinate.

Finding the underlying cause of ED and treating it may help people manage the condition.

This article examines the link between nerve damage and ED, possible causes, and treatment options.

Certain health conditions, injuries, or pelvic surgery may cause damage to nerves in the penis. This may prevent nerve signals from the spinal cord from reaching the penis.

Sexual arousal causes nerves to release certain chemicals that increase blood flow into erection chambers within the penis.

As the blood pressure within these chambers increases, the penis becomes firm and causes an erection. Nerve damage can have an impact on this process, leading to ED.

People may have ED if they are consistently unable to achieve or maintain an erection sufficient for sex.

If nerve damage is causing ED, people may have additional symptoms, depending on what type of nerve damage is causing ED.

Autonomic nerve damage is a type of nerve damage that affects the sex organs and other organs and can cause ED.

Autonomic nerve damage that causes ED can also cause problems with the bladder and bowels, such as:

urinary incontinence
diarrhea
constipation

If injury or surgery to the pelvic area causes ED, people may experience:

a burning pain, tingling, or numbness in the buttocks and genital area
pain during sex
urinary urgency
a frequent need to urinate

Various conditions or injuries may lead to nerve damage, such as:

diabetes
multiple sclerosis
chronic alcohol use
heavy metal poisoning
nerve damage from surgery, such as from a pelvic operation
nerve and spinal cord injuries

To diagnose ED and nerve damage, a doctor may perform a physical examination to determine what is causing ED.

A doctor may also use blood tests, questionnaires, or ultrasound scans to check for other physical or psychological causes.

Various treatments may be effective in treating nerve damage-induced ED.

They may include:

phosphodiesterase 5 (PDE5) inhibitors, usually a first-line treatment
fampridine, which may have severe side effects
apomorphine
alprostadil
vacuum devices
penile injections
penile implants, if other treatments are not successful

Research suggests that PDE5 inhibitors are a safe and effective first-line treatment for nerve-related ED.

Second-line treatments include penile injections of prostaglandin E1, papaverine, or phentolamine, and vacuum devices. If these treatments are not effective, penile implants may be an effective option.

How long ED will last and whether nerve-related ED is reversible or curable may depend on the underlying cause and extent of nerve damage.

In some cases, nerve damage may be irreversible, but in other cases, surgery may be an effective option.

This section answers some frequently asked questions about erectile dysfunction and nerve damage.

What nerve damage can cause erectile dysfunction?

Various conditions may cause nerve damage that could lead to ED, such as:

multiple sclerosis
spinal cord injury
diabetes
injury to the pelvic area
alcohol-related neuropathy
heavy metal poisoning
tumors in the pelvic region or spinal cord

What is neurological erectile dysfunction?

Neurological ED is the term for ED that is due to neurological impairment.

This can include nerve damage, which can affect erectile function. This may be due to injury, surgery, or conditions such as diabetes.

However, nerve damage is only one type of neurological impairment.

Aside from nerve damage, other neurological causes of ED include:

stroke
Parkinson’s disease
medications that affect the brain’s neurotransmitters, such as some antidepressants

What is the biggest cause of erectile dysfunction?

Abnormalities with the penile arteries or veins are the most common cause of ED, particularly in older adults.

However, this is different than nerve damage, with which there is no link.

If problems with the arteries are causing ED, it is usually due to arteriosclerosis.

Risk factors for arteriosclerosis include:

smoking
having high cholesterol levels
having excess weight
having high blood pressure
having a lack of exercise

ED can be an early warning sign of vascular disease. Other causes include:

diabetes
depression or other mental health issues
hormonal imbalances
side effects of certain medications, such as blood pressure medications

Nerve damage can affect erectile function and cause ED. Nerve damage may occur due to factors such as:

a medical condition such as diabetes or multiple sclerosis
injury to the nerves or spinal cord
surgery to the pelvic area

There are many treatments for nerve-related ED. Depending on the underlying cause, some cases of ED may be reversible.

In other cases, treatments, such as medications or devices, can help manage symptoms.

Post-traumatic erectile dysfunction: doppler US findings

Review

. 2006 Sep-Oct;31(5):598-609.

doi: 10.1007/s00261-005-0217-8.

Sun Ho Kim¹, Seung Hyup Kim

Affiliations

Affiliation

¹ Department of Radiology, Seoul National University Hospital, Chongno-Gu, Seoul, Korea. [email protected]

PMID:
16314991
DOI:
10.1007/s00261-005-0217-8

Review

Sun Ho Kim et al.

Abdom Imaging.

2006 Sep-Oct.

. 2006 Sep-Oct;31(5):598-609.

doi: 10.1007/s00261-005-0217-8.

Authors

Sun Ho Kim¹, Seung Hyup Kim

Affiliation

¹ Department of Radiology, Seoul National University Hospital, Chongno-Gu, Seoul, Korea. [email protected]

PMID:
16314991
DOI:
10.1007/s00261-005-0217-8

Abstract

Erectile dysfunction can happen after trauma, particularly with vertebral, pelvic, or perineal injuries. Penile Doppler ultrasonographic (US) findings in these patients are various, from normal to serious arterial impairment, according to the severity and type of injury. With neurogenic causes, Doppler US findings are usually normal, but decreased flow in cavernosal arteries may also be encountered due to combined vascular injury. With arteriogenic causes, relatively or absolutely decreased peak velocity in cavernosal arteries can be encountered. Alterations of penile arterial anatomy are frequently found in these patients and can be secondary changes due to proximal arterial insufficiency. After trauma in the penis or perineum, distortion or reconstruction of vascular anatomy in addition to traumatic sequelae in the erectile tissue can be directly visualized on Doppler US. Venogenic impotence can also be a result of trauma, and Doppler US findings are the same as nontraumatic venous leak. High-flow priapism is another category of post-traumatic erectile dysfunction, which can be diagnosed conclusively by Doppler US. It can be managed by angiographic embolization, and Doppler US is useful in evaluating recurrence and erectile dysfunction after embolization.

Cited by

High-flow post-traumatic priapism: diagnostic and therapeutic workup.
Acampora C, Borzelli A, Di Serafino M, Iacobellis F, Barbuto L, D’errico C, Ponticiello G, Romano L.
Acampora C, et al.
J Ultrasound. 2021 Dec;24(4):539-545. doi: 10.1007/s40477-020-00449-8. Epub 2020 Mar 20.
J Ultrasound. 2021.
PMID: 32198630
Free PMC article.
The Risk of Erectile Dysfunction Following Pelvic Angiographic Embolization in Pelvic Fracture Patients: A Nationwide Population-Based Cohort Study in Taiwan.
Hsu SD, Chen CJ, Wang ID, Lin KT, Wang CC, Chien WC, Chung CH, Chang WK.
Hsu SD, et al.
World J Surg. 2019 Feb;43(2):476-485. doi: 10.1007/s00268-018-4803-7.
World J Surg. 2019.
PMID: 30242456
Successful management of cavernosal artery pseudoaneurysm using microcoil embolization.
Masterson JM, Savio LF, Softness K, Masterson TA, Perez JB, Bhatia S, Ramasamy R.
Masterson JM, et al.
Transl Androl Urol. 2017 Oct;6(5):973-977. doi: 10.21037/tau.2017.08.16.
Transl Androl Urol. 2017.
PMID: 29184798
Free PMC article.
Evaluation and management of priapism: 2009 update.
Huang YC, Harraz AM, Shindel AW, Lue TF.
Huang YC, et al.
Nat Rev Urol. 2009 May;6(5):262-71. doi: 10.1038/nrurol.2009.50.
Nat Rev Urol. 2009.
PMID: 19424174
Free PMC article.
Review.

Publication types

MeSH terms

5 dangerous injuries that can lead to impotence

Erectile dysfunction – a serious disorder of the reproductive system, which can be organic, psychogenic or mixed. Impotence is an unpleasant disease that brings only discomfort, affects the quality of life, sexual activity and emotional state of a man, and the treatment process itself takes time and effort.

However, sometimes the cause of impotence is physical injury due to an accident or blow, as well as surgery. What should be feared and what should you pay attention to so as not to ruin your men’s health?

General information

According to experts, contusions and injuries account for 13% of all organic erectile dysfunction. With a general spinal cord injury, the risk of erectile dysfunction is much higher than with a partial injury. Penile injuries can also be caused by cycling or pelvic surgery.

Injuries that may cause erectile dysfunction in the future include:

spinal cord injuries,
pelvic injury associated with damage to the nerve and arterial vessels,
penile injury,
postoperative trauma in the pelvic area.

Most popular injuries and their consequences for men

Cycling

cause of impotence due to traumatic effects on the vessels and nerves around the perineum. The pressure causes a temporary slowdown in blood flow in this area, which is manifested in a slight tingling or partial numbness in the groin area.

Researchers at Harvard Medical School have found that the risk of developing erectile dysfunction is increased by cycling for more than three hours per week.

Currently, special bicycle saddles are designed to reduce perineal injury during cycling. In addition, it is recommended to use special cycling suits that have a softening tab in the groin area and have thermoregulation.

Injuries to the penis

Injuries to the penis can have a different origin and type of injury:

industrial injury,
car accident,
burn or chemical exposure,
gunshot or knife wound,
hit during a fight or sports game
excessive sexual activity

The most common type of injury that many men have experienced at least once in their lives is penis incarceration trouser zip lock. No less often trauma to the penis occurs due to excessive friction during sexual activity. Such injuries are found in very passionate lovers, as well as in men who are just beginning sexual activity, and are characterized by skin lesions and chafing of the folds in the foreskin. Men who are born with a short frenulum may get a torn frenulum of the penis during intercourse.

Penile contusion is quite common – such an injury accounts for more than 50% of all cases of damage to the penis. Other types of trauma are infringements and fractures. Since 2001, 1331 cases of penile fracture have been counted. Other penile injuries include the very rare amputation of the penis or penetrating trauma, most commonly during a fight or assault.

Signs of penile injury are: pain, swelling, bruising, bleeding, difficulty urinating and blood in the urine, urinary retention and acute pain during erection.

An obligatory action in case of any damage to the penis is immediate contact with a specialized doctor: urologist, andrologist or surgeon. Delaying a trip to a specialist can threaten the development of purulent infections in the penis or urethra, the formation of scars at the site of wounds that will impede blood flow to the penis, curvature of the penis, and the absence of a normal erection. More complex injuries and injuries may require surgery to remove blood clots or dead tissue.

Pelvic injuries

Erectile dysfunction caused by pelvic injuries most often results from fractured pelvic bones or bruises caused during traffic accidents and car accidents. A person after such an injury may be left with damaged nerves or vessels (mainly arteries) that cannot deliver enough blood to the penis to cause an erection.

Spinal injuries

Spinal cord injuries in most cases lead to erectile dysfunction. Operations on the spinal cord or trauma affect the loss of control over erection. Medical experts estimate that half of the major injuries are caused by road traffic accidents. For an erection to occur, it is important to correctly transmit the sexual stimulus in the form of a nerve impulse from the head through the spinal cord to the penis. Under the influence of this impulse, vasodilators (NO) are released, which causes blood flow to the penis and an erection. Therefore, every malfunction of the parasympathetic nervous system can cause erectile dysfunction. Depending on the type and location of the injury, 8 to 100% of all patients with spinal injuries suffer from impotence, and from 80 to 9 from ejaculatory disorders.7%.

Vascular and nerve injuries during pelvic surgery

During operations in the area of the bladder, colon, rectum, prostate, complications may occur due to damaged vessels and nerves necessary for erection of the penis. Nowadays, thanks to the use of new nerve-sparing techniques, it is possible to reduce the incidence of erectile dysfunction by 40-60% after nerve damage during the procedure. The return of full sexual activity usually occurs 6-18 months after surgery.

Helpful hints: the essentials in a nutshell

Basically, injuries that can lead to impotence are received in the course of random incidents and accidents from which no one is insured. You can minimize the use of a bike for long distances or buy a modern saddle to ensure sufficient blood flow to the genitals and avoid excessive penis squeezing. It is worth being more careful during sports, training and competition – quite often bruises of the penis occur during sports, team games or wrestling.

An equally important part is correct rehabilitation after an injury or in the postoperative period – the correct approach to treatment can reduce the risk of complications and speed up the recovery process.

No one is immune from injuries, bruises or malfunctions of organs – we are people, not machines. It is important to see a doctor in a timely manner to prevent the risk of complications, a properly selected treatment regimen and a recovery period, which will largely determine whether the injury will affect health in the future.

Erectile dysfunction

Russian synonyms

Impotence, erectile dysfunction, sexual impotence, ED.

Synonyms English

Erectile dysfunction, Impotence, ED, Male erecticle dysfunction.

Symptoms

Problems with erection and its maintenance.
Decreased sexual desire (libido).

General information about the disease

Erectile dysfunction is the inability to achieve and/or maintain an erection sufficient for satisfactory sexual activity. This problem is widespread throughout the world. The likelihood of this deviation increases with age. Almost 50% of men aged 40-70 have erection problems.

Normally, an erection occurs when sexual arousal occurs in the brain or when mechanical irritation of the penis or scrotum occurs. This is mediated through a nerve center located in the lumbar region of the spinal cord, which sends impulses to the vessels and muscles of the penis. As a result, blood flows to the penis through the arteries. The muscles of the corpora cavernosa (cavernous spongy bodies that make up the penis) relax, blood fills them, as a result, the member increases and becomes hard. After filling the penis with blood, its outflow from it is blocked due to contraction of the muscles of the small pelvis.

Erection is closely related to testosterone, the male sex hormone. It is a complex process implemented by the coordinated work of the central and peripheral nervous system, various hormones, blood arteries, blood vessels and muscles. Violation of the functioning of any part of the system can significantly affect the ability of a man to experience an erection, ejaculate (secrete) and experience an orgasm. Erectile dysfunction can be caused by the following factors (or a combination of them).

Organic factors. As a rule, they (about 80% of cases) cause erectile dysfunction:

Vascular diseases (atherosclerosis of peripheral vessels, myocardial infarction, arterial hypertension (high blood pressure).
High blood cholesterol, obesity.
Metabolic syndrome is a condition characterized by high blood pressure, high levels of insulin and cholesterol, and fat around the waist.
Systemic diseases (diabetes, scleroderma, renal failure, cirrhosis of the liver, hemochromatosis, cancer and its treatment).
Neurological causes (epilepsy, stroke, multiple sclerosis, Guillain-Barré syndrome, Alzheimer’s disease).
Parkinson’s disease.
Hormonal disorders (dysfunction of the thyroid gland, low testosterone levels).
Peyronie’s disease is the development of scar tissue inside the penis.
Priapism (a disease in which there is a prolonged painful erection, not associated with sexual arousal), more often with sickle cell anemia, can irreversibly damage the cavernous bodies and vessels of the penis and lead to severe erectile dysfunction.
Smoking. It slows down blood flow in the veins and arteries, causes various chronic diseases, which can lead to erectile dysfunction.
Alcoholism, drug addiction.
Surgery or injury to the pelvis or spinal cord.
Taking certain medications (antidepressants, antihistamines, drugs to treat high blood pressure, adenoma or prostate cancer).

Often (about 50% of cases) the cause of erectile dysfunction is vascular disease, usually atherosclerosis of the pelvic arteries – the formation of atherosclerotic plaques (fatty deposits in the walls of blood vessels) that interfere with blood flow to the penis. Diseases of the nervous system prevent the transmission of nerve impulses to the brain.

Psychological causes of erectile dysfunction:

Depression, anxiety, mental disorders.
Stress.

In addition, erectile dysfunction is situational and sometimes depends on a particular place, circumstances, partner.

Erectile dysfunction can cause the following complications:

dissatisfaction with sexual life;
stress;
decreased self-esteem;
problems in relations with a partner, problems in the family;
inability to have children.

With the development of this disorder, it is extremely important not only to immediately consult a doctor, but also to explain the situation to your partner. Silence is the worst strategy. Sincerity will prevent a misinterpretation of a man’s behavior and help maintain a full-fledged harmonious relationship.

Who is at risk?

Men over 40. The risk of developing erectile dysfunction increases with age.
Smokers.
Obese and overweight persons.
Alcohol abusers or drug users.
People subject to stress.
Cycling for a long time. The saddle of a bicycle can put pressure on the prostate, which in some cases leads to temporary erectile dysfunction.
Taking certain medications regularly.
Patients with diabetes, renal failure, liver cirrhosis, hemochromatosis, cancer, diabetes, Peyronie’s disease, Parkinson’s disease.
Suffering from vascular diseases (atherosclerosis, myocardial infarction, arterial hypertension).
Suffering from neurological diseases (epilepsy, stroke, multiple sclerosis, Guillain-Barré syndrome, Alzheimer’s disease).
Patients with thyroid disease, low testosterone levels.

Diagnosis

The diagnosis of “erectile dysfunction” is made after a thorough examination and questioning of the patient. After that, it is extremely important to determine its cause. For this, the following studies can be carried out.

Laboratory tests

Of particular importance in determining the causes of erectile dysfunction is the measurement of hormone levels.

Testosterone. The level of total and bound testosterone in erectile dysfunction can be reduced, which will indicate a decrease in the function of the gonads.
Luteinizing hormone (LH). Produced by the pituitary gland, which regulates the production of testosterone in the body. A decrease in LH levels with a reduced level of testosterone indicates a pathology that has arisen in the central nervous system. Elevated levels of LH in combination with low levels of testosterone indicate a primary violation of testosterone production by the testicles.
Thyroid stimulating hormone (TSH). A change in the level of TSH (a hormone produced in the pituitary gland that regulates the functioning of the thyroid gland) may indicate a malfunction of the thyroid gland as the cause of erectile dysfunction.

Other tests are also ordered.

Complete blood count. Allows you to detect a decrease in hemoglobin and red blood cells, which may indicate the development of anemia. When examining a blood smear under a microscope, a change in the shape of red blood cells, characteristic of sickle cell anemia, is revealed.
Urinalysis

Leukocytes. An increase in the level of leukocytes may indicate an inflammatory process in the genitourinary system.
Erythrocytes. Normally, urine does not contain red blood cells. Their appearance is usually a sign of disease of the kidneys, prostate and bladder.
Glucose. An increase in the level of glucose (sugar) in the urine is characteristic of diabetes mellitus.

Cholesterol and its fractions. A significant increase in cholesterol levels (especially low-density lipoprotein (LDL) cholesterol means an increased risk of deposition of fat in the walls of blood vessels, including the arteries of the penis and pelvis.
Blood glucose and glycated hemoglobin (HbA1c). An increase in glucose and glycated hemoglobin (a parameter that reflects the average sugar level over the past three months) indicates the presence of diabetes.
Creatinine and urea. Their level can be increased in chronic renal failure.
Bilirubin is a breakdown product of hemoglobin that undergoes transformation in the liver. With cirrhosis of the liver, its concentration will be exceeded.
Prostate-specific antigen (PSA). It is elevated in cancer and prostate adenoma.

Other research methods

The introduction of a vasodilator drug (prostaglandin E-1) into the penis allows you to assess the ability of blood vessels to expand and distinguish between physiological and psychological causes of erectile dysfunction.
Ultrasound scanning. With it, you can evaluate the function of the vessels of the penis and the flow of blood to it. Ultrasound is used in the absence of penile erection after prostaglandin injection, then the results are compared. Violation of the filling of blood vessels of the penis may indicate the presence of plaques in the vessels of the penis and small pelvis (atherosclerosis of the vessels).
Testing the innervation of the penis. To assess the innervation of the penis, the state of the bulbocavernosus reflex is examined, which consists in the immediate contraction of the anus when pressing on the head of the penis. During the study, the doctor observes or palpates the anus.
Biothesiometry of the penis. This study is aimed at determining the sensitivity of the penis and its innervation using vibration. Decreased sensitivity may indicate the presence of a neurological disease.
Study of nocturnal erection. Normally, a man gets an erection several times during sleep. The absence of nocturnal erections indicates an organic cause of erectile dysfunction, the presence of a nocturnal erection indicates the psychological causes of problems. To study nocturnal erection, a special system consisting of tapes is attached to the penis. A nocturnal erection causes the tape to break. A special sensor can also be used.

Treatment

Treatment of erectile dysfunction depends on the underlying causes.

In case of psychological erectile dysfunction, the patient is referred to a sex therapist or psychotherapist. In addition, erectile dysfunction itself may necessitate the need to consult a psychologist. If the disease is caused by medication, you should stop using them and look for other options. If any disease has led to dysfunction, it is treated.

Various drugs may be used. The drug and its dosage are determined solely by the doctor. Some medications are contraindicated in patients with stroke, heart and vascular disease, low or high blood pressure, and diabetes. They may be in the form of tablets or suppositories injected into the urethra.

Hormone replacement therapy with testosterone or other hormones, depending on the disease, can be carried out for pathologies of the glands that produce hormones.

Various mechanical methods should be tried before medical treatment:

For men who have an erection but are not maintained for a sufficient time, a constrictive ring is recommended. After an erection occurs, a leather or metal ring with a clasp is put on the base of the penis. Thus, venous outflow of blood and premature cessation of erection are prevented.
If a man does not have an erection, a vacuum pump may be used to draw blood into the penis, after which the erection is maintained by a constrictive ring.

In difficult cases where other treatments fail, the surgical insertion of inflatable devices into the penis, fixed with semi-rigid rods, can be used to induce and control the duration of an erection.

Treatment of erectile dysfunction usually becomes more effective with lifestyle changes (weight loss, exercise, healthy eating).

Prevention

A healthy lifestyle is the best way to prevent erectile dysfunction.

Smoking and alcohol cessation is recommended.
For early detection and treatment of various diseases, regular examinations are necessary. If a disease is detected, treatment should be started immediately, strictly following the plan developed by the doctor.
Regular exercise will keep you fit.
A healthy diet rich in fruits, vegetables, and whole grains will help prevent many diseases.

Recommended tests

CBC
Urinalysis
Testosterone
Testosterone free
Luteinizing hormone (LH)
Thyroid Stimulating Hormone (TSH)
Prolactin
Follicle stimulating hormone (FSH)
Cholesterol – low density lipoprotein (LDL)
Cholesterol, total
Glycated hemoglobin (HbA 1c)
Plasma glucose
Serum creatinine
Serum urea
Bilirubin total
General prostate-specific antigen (PSA total), hypersensitive

Literature

Dan L.

Injury erectile dysfunction: Erectile dysfunction and nerve damage: Symptoms and more

Erectile dysfunction and nerve damage: Symptoms and more

What nerve damage can cause erectile dysfunction?

What is neurological erectile dysfunction?

What is the biggest cause of erectile dysfunction?

Post-traumatic erectile dysfunction: doppler US findings

Affiliation

Authors

Affiliation

Abstract

Similar articles

Cited by

Publication types

MeSH terms

5 dangerous injuries that can lead to impotence

General information

Most popular injuries and their consequences for men

Helpful hints: the essentials in a nutshell

Erectile dysfunction

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