List of high-risk drugs for drug-induced erectile dysfunction and five underlying causes of psychogenic erectile dysfunction.

Erectile dysfunction is generally caused by psychological and organic factors, and can also be caused by various drugs. In recent years, there has been a significant increase in drug-induced erectile dysfunction, which should not be ignored. In order to make both doctors and patients pay sufficient attention to the possibility of drugs causing erectile dysfunction, reduce unnecessary misunderstandings and strengthen prevention, the following are some commonly used drugs that have a certain impact on male sexual function: (1) Antihypertensive drugs that act on the central nervous system: The inhibitory effect of methyldopa on sexual function is directly proportional to the dosage. For example, if the daily dose is less than 0.1 grams, 10% to 15% of male patients will experience erectile dysfunction; if the daily dose is 1 to 1.5 grams, 20% to 25% of patients will experience sexual dysfunction; if the daily dose is greater than 2 grams, 50% of patients may experience significant sexual dysfunction. (2) Anti-adrenergic drugs: mainly reserpine and guanethidine drugs. Among hypertensive patients who use reserpine for a long time, 30% to 40% of patients develop impotence; among patients who take more than 25 mg of guanethidine daily, 50% to 60% of men experience delayed ejaculation or inability to ejaculate, and about 25% of male patients have impotence. The effects of similar drugs to guanethidine, such as benzylguanidine, isoquinolineguanidine, guanethidine, and guanethidine chlorophen, on sexual function are similar to those of guanethidine. (3) β-blockers: When the daily oral dose of propranolol is 320 mg, 13.8% of hypertensive patients develop impotence. Indolol, atenolol, labetalol, etc., have all been reported to cause impotence. (4) Antihypertensive drugs that act on vascular smooth muscle: Hydralazine, when the daily oral dose is more than 20 mg, 5% to 10% of patients develop impotence. (5) Antipsychotic drugs: Chlorpromazine, thioridazine, fluphenazine, and haloperidol can all cause impotence. (6) Anti-manic and antidepressant drugs: Potassium carbonate, mirtamine, amitriptyline, clomipramine, etc. can cause impotence. (7) Antihistamines: Long-term use of cimetidine and ranitidine can cause impotence, with cimetidine users having a higher incidence. (8) Anticholinergic drugs: Atropine, anisodamine, propranolol, and trihexyphenidyl (Artane) can all cause impotence when used in high doses. (9) Cardiac glycosides: Long-term use of digitalis and digoxin can cause impotence. (10) Hormonal drugs: Long-term use of estrogens such as estradiol, ethinylestradiol, and chlormadinone in men can cause impotence; glucocorticoids can directly or indirectly lower serum testosterone levels, leading to impotence. (11) Antipyretic analgesics: Long-term use of indomethacin (anti-inflammatory pain) may occasionally cause impotence; long-term use of phenacetin and phenylbutazone at high doses may cause testicular atrophy, inhibition of sperm formation, and male infertility. (12) Antitumor drugs: Currently, most antitumor drugs can cause progressive impotence, and it is now confirmed that antitumor drugs can directly damage the structure and function of the testes.

Five major causes of psychogenic erectile dysfunction: (1) Negative feelings about sex: mostly due to negative influences and psychological trauma during development. In the process of socialization and accumulation of life experience, they often accept a lot of feudal traditional views from their family or society, so they hold a negative and negative attitude towards sex; early homosexual or incestuous experiences; confusion of gender identity or identification; cold and lacking physical affection parental role models; punishment from parents for their healthy interest in sex during childhood; excessive authoritarianism of the mother, which damages the male's self-image; heavy psychological pressure brought about by the failure of the first sexual intercourse attempt. All of these factors make them regard sex as dirty, sinful or dangerous. Therefore, any success in sex will seriously conflict with their sexual concepts. Primary erectile dysfunction is more often caused by fear of sexual success, followed by fear of sexual failure. Secondary erectile dysfunction is more often caused by fear of sexual failure, always worrying that they cannot react normally as in the past, such as anxiety or depression caused by premature ejaculation. In fact, more than half of patients with erectile dysfunction have a history of premature ejaculation. (2) Negative feelings about themselves: They often lack self-esteem and self-confidence, and are filled with feelings of inferiority, depression, or poor body image. (3) Negative feelings about their partners: Lack of communication between partners; resentment; fear of their partners and fear of women; lack of trust in their partners, or even hostility; asynchronous sexual desire with their partners; disharmonious sexual values ​​and interests; weakened physical attractiveness of their partners. (4) Extramarital affair-related impotence: This refers to the phenomenon of impotence in men when having sexual relations with women other than their wives. Because extramarital sex is an improper sexual relationship between men and women conducted in a secretive and fearful situation, men often feel guilty and remorseful, and fear social condemnation. Although they may have an erection when flirting with the other party, they may be unable to complete the sexual intercourse due to a sense of inexplicable guilt when their sexual organs actually come into contact. This extramarital affair-related impotence is purely caused by psychological factors and is not a true loss of sexual ability. Therefore, as long as a person who has had extramarital sexual behavior reforms and reconciles with his wife, his ability will be restored. (5) Other negative feelings: sexual ignorance or incorrect sexual knowledge; excessively high expectations; obsessive contemplation; excessive attention to sexual performance, even to the point of taking an observer or scrutinizing attitude instead of fully engaging; iatrogenic influences, such as inappropriate comments from doctors during male vasectomy that make patients doubt their sexual ability; fatigue, excessive work tension and too much pressure; widower syndrome, which refers to impotence that occurs after a spouse has been ill for a long time, died or divorced.