Erectile dysfunction, or ED, is a common form of sexual dysfunction that affects about 30 million men in the United States alone.
If you have erectile dysfunction, you may find it difficult to develop or maintain an erection that’s firm enough for sex.
Alternatively, you might be able to get an erection, but not on a consistent enough basis to have sex when you want to.
Sometimes, problems in your nervous system can affect your sexual function and either cause or worsen erectile dysfunction.
This type of erectile dysfunction is referred to as neurogenic, or neurological ED.
Below, we’ve discussed how ED develops, as well as how neurological factors may affect your erectile function and sexual performance.
We’ve also explored the treatment options that are currently available for erectile dysfunction, including ED that’s caused by or linked to neurological factors.
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Neurological erectile dysfunction, or neurological ED, is any form of erectile dysfunction that’s caused by impairment to your nervous system.
Your nervous system plays a significant role in the process of develooping and maintaining an erection before and during sex.
Erections start with stimulation and arousal. When you feel aroused due to physical contact or sexual imagery, nerves in your brain and pelvic area send impulses to the erectile tissue inside your penis.
These impulses cause the blood vessels that supply your erectile tissue to expand, increasing the amount of blood that flows into your penis.
It’s this blood that gives an erection its size and firmness. As blood continues to flow into your penis, a fibrous membrane called the tunica albuginea contracts, holding the blood inside the tissue and sustaining your erection, allowing you to have sex.
This process depends on a few things. Most importantly:
Consistent blood flow
A functional nervous system
When your nervous system is impaired, this process may be interrupted, preventing you from being able to get and/or sustain an erection.
Several issues can cause neurological erectile dysfunction, including damage to your nervous system from injuries or surgery and neurological conditions that damage the nerves in certain parts of your body.
Common causes of neurological ED include:
Injuries that affect your nervous system. Injuries that cause nervous system damage, such as spinal cord injuries, often lead to sexual issues like erectile dysfunction and anejaculation (inability to ejaculate).These issues are often temporary. For example, research has found that most men with spinal cord injury recover some erectile function after two years.
Surgery to the prostate or bladder. Some surgical procedures for prostate or bladder cancer can damage the nerves and blood vessels around the penis, which may lead to erectile dysfunction. Many men find that their erection quality and sexual performance improves over time as they recover from this type of surgery.
Diabetic neuropathy (nerve damage due to diabetes). Diabetes can cause a form of damage to your nerves known as diabetic neuropathy, especially when it’s uncontrolled or inconsistently treated. Research has found a clear link between poorly controlled diabetes and severe erectile dysfunction. In fact, approximately 40 percent to 50 percent of men with diabetes are affected by neuropathy-induced erectile dysfunction.
Multiple sclerosis. Multiple sclerosis, or MS, damages the central nervous system and eventually causes permanent nerve damage. This nerve damage can eventually cause erectile dysfunction to develop. In certain cases, medications used to treat the symptoms of MS may also contribute to ED.
Parkinson’s disease. Erectile dysfunction is a known symptom of Parkinson’s disease, a progressive nervous system disorder. Men with Parkinson’s disease also often face other sexual issues, including reduced sexual feeling and difficulty reaching orgasm.
Epilepsy. Some men with epilepsy develop erectile dysfunction. Experts believe that this may be caused by epileptic discharges that affect the levels of sex hormones, such as testosterone and prolactin, which are involved in sex drive and erections.
Other neurological causes. Other potential causes of neurological ED include heavy metal poisoning and alcoholism, both of which can affect the nerve tissue throughout your body.Research shows that these causes can overlap, meaning more than one factor may contribute to your neurological ED symptoms if you’re affected.
Although neurological issues can cause or worsen erectile dysfunction, they aren’t always the only factor. Other common causes of ED include:
Cardiovascular health issues. ED is often linked to atherosclerosis (clogged arteries), high blood pressure, heart and blood vessel disease and other common cardiovascular health issues.
Physical injuries and/or scarring. ED can often occur after physical injuries that affect the penis or pelvis. Scarring conditions, such as Peyronie’s disease, can also cause or worsen erectile dysfunction.
Medications. Some medications, such as medications for depression, anxiety, difficulty sleeping, high blood pressure and androgen-related health issues, can cause or worsen erectile dysfunction.
Psychological issues. ED often occurs as a result of mental health issues, such as fear or anxiety regarding sexual contact, depression, chronic stress and persistent feelings of guilt or low self-esteem.
Habits and lifestyle factors. You may have a higher risk of developing ED if you drink a large amount of alcohol on a regular basis, smoke, are overweight or physically inactive or if you use illicit drugs.
Treatment for ED can vary based on its cause. If you have erectile dysfunction, it’s important to talk to your healthcare provider to learn what could be causing it, as well as what options you have for treating your symptoms and improving your sexual performance.
Just like ED caused by poor cardiovascular health or psychological issues, neurological erectile dysfunction can vary in severity.
If you have neurological erectile dysfunction, you may:
Find it difficult or impossible to get an erection at any time
Be able to get an erection, but find it difficult to sustain it for long enough to have sex
Be able to get an erection, but not consistently enough to have sex when you want to
The symptoms of neurological ED mirror the symptoms of cardiovascular ED.
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Most cases of neurological ED improve with treatment, although some — particularly those that involve complex, major injuries — can be challenging to treat.
When it comes to treating neurological erectile dysfunction, the general principle is that it’s best to start with the least invasive forms of treatment, then explore other options.
We’ve listed the current treatment options for neurological ED below, with additional information on how each treatment option works, its effects and more.
Many cases of neurological ED can be treated with medication. Common ED medications, such as sildenafil (the active ingredient in Viagra®, AKA generic Viagra), tadalafil (Cialis®) and others are often prescribed for men with ED caused by multiple sclerosis, Parkinson’s disease and other conditions.
These medications, which are called PDE5 inhibitors, work by increasing the level of blood flow to the erectile tissue inside your penis.
Most PDE5 inhibitors work quickly, meaning you can take them approximately one hour before you plan to have sex.
Some, such as tadalafil, provide long-lasting effects and work for a couple days at a time.
Currently, all PDE5 inhibitors require a prescription, meaning you’ll need to talk to a healthcare provider before you can purchase and use them.
Hims offers several brand name and generic ED medications online, including sildenafil, tadalafil and others, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.
When oral ED medications aren’t effective at treating neurological ED, other medications may be used instead.
In some cases, neurological ED may be treated using injectable medications, such as Trimix®, which contains alprostadil papaverine and phentolamine.
These medications require some preparation and aren’t as easy to use as drugs like sildenafil, but they’re often effective.
We’ve discussed these medications and their effectiveness in more detail in our full guide to ED injections.
Unfortunately, medications like sildenafil and tadalafil aren’t always fully effective for men with neurological ED.
When medication doesn’t work on its own, your healthcare provider may recommend using a vacuum constriction device (VCD, or penis pump).
These devices, which consist of a cylinder, manual or electric pump and constriction ring, are designed to draw blood into your penis.
Used correctly, they can improve the quality of your erections and help you to enjoy more satisfying, fulfilling sex.
Research shows that VCDs work well.
One review published in the International Journal of Impotence Research noted high satisfaction rates among men who use these devices.
Vacuum constriction devices can cause certain side effects, and need to be used with care. We’ve discussed these devices, their effects and the evidence to support their use in our guide to penis pumps for erectile dysfunction.
If other treatments for neurological ED aren’t effective, your healthcare provider may suggest a penile implant.
Penile implants are usually reserved as a last option for treating ED. They’re usually effective, but they require surgical intervention and, as such, aren’t as convenient as using medication or a vacuum constriction device to improve your sexual function.
Currently, two types of penile implants are available — inflatable implants that feature a hydraulic system to produce erections, and rigid prostheses.
Erectile dysfunction often occurs as a result of damage to your nervous system, whether due to an injury, surgery or a medical condition that affects your nerve function.
While some forms of neurological ED improve with the passage of time, others require ongoing treatment and management.
Several treatment options are available for neurological ED, medications, devices and surgical procedures.
Although these aren’t effective for everyone, many men find that they can produce real, noticeable improvements in their erections and sexual performance.
Hims offers a selection of ED treatments online, including medications such as sildenafil, tadalafil and avanafil (sold under the brand name Stendra®).
These medications require an online consultation with a licensed healthcare provider, who will determine if a prescription is appropriate.
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Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership.
She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH.
Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare.
Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.