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What are the Causes of Erectile Dysfunction? A Comprehensive Analysis by a Malaysian Urologist
阳痿，医学上称为勃起功能障碍（Erectile Dysfunction, ED），指男性持续无法获得或维持足够硬度的勃起以完成满意的性生活。它是许多马来西亚男性可能面临的常见健康问题，而非个人失败或羞耻之事。重要的是认识到：ED几乎总是有潜在的生理或心理原因，并且绝大多数情况是可治疗、可管理的。 了解其病因是迈向有效治疗的第一步。本文将从医学角度，系统梳理导致阳痿的各类病因，帮助您科学认识这一状况。 | Erectile Dysfunction (ED) refers to the persistent inability of a man to achieve or maintain an erection sufficient for satisfactory sexual performance. It is a common health issue that many Malaysian men may face, not a personal failure or a matter of shame. It is crucial to understand: ED almost always has underlying physical or psychological causes, and the vast majority of cases are treatable and manageable. Understanding its causes is the first step towards effective treatment. This article will systematically outline the various causes of ED from a medical perspective to help you understand this condition scientifically.
Click to buy核心认知：ED是症状，而非疾病本身 | Core Understanding: ED is a Symptom, Not a Disease Itself
ED本身通常是一种症状，它提示身体其他方面可能出现了问题。其病因复杂，往往是多因素交织的结果，可分为以下几大类： | ED itself is usually a symptom, indicating that something else may be wrong in the body. Its causes are complex and often multifactorial, falling into the following main categories:
一、血管性原因 (Vascular Causes) – 最常见的原因
勃起本质上是一个血管事件，依赖于充足的血液涌入阴茎。因此，任何损害血管或血流的疾病都是ED的主要风险因素。 | An erection is essentially a vascular event, relying on adequate blood flow into the penis. Therefore, any disease that damages blood vessels or blood flow is a major risk factor for ED.
- 心血管疾病 (Cardiovascular Diseases):
- 动脉粥样硬化 (Atherosclerosis): 即“血管硬化”。胆固醇斑块在动脉内壁沉积，导致血管狭窄、硬化，减少流向阴茎的血液。这是ED最常见的基础病因。阴茎动脉比心脏冠状动脉更细，因此ED往往是全身血管疾病的早期预警信号，可能比心脏病发作早2-5年出现。 | Cholesterol plaques build up inside artery walls, causing narrowing and hardening of vessels, reducing blood flow to the penis. This is the most common underlying cause of ED. Penile arteries are narrower than coronary arteries, so ED is often an early warning sign of systemic vascular disease, potentially appearing 2-5 years before a heart attack.
- 高血压 (Hypertension): 长期高血压会损害血管内皮功能，影响血管正常舒张能力。 | Chronic high blood pressure damages vascular endothelial function, affecting the ability of blood vessels to dilate properly.
- 高胆固醇 (High Cholesterol): contribute to atherosclerosis.
- 糖尿病 (Diabetes Mellitus):
- 是导致ED的强风险因素。 长期高血糖会同时损害血管和神经（糖尿病神经病变）。它可导致微小血管病变，影响阴茎供血，并损害控制勃起的神经。 | A strong risk factor for ED. Long-term high blood sugar damages both blood vessels and nerves (diabetic neuropathy). It can cause microvascular disease, affecting blood supply to the penis, and damage nerves controlling erection.
二、神经性原因 (Neurological Causes) – “信号传导”故障
勃起需要大脑、脊髓、神经之间复杂的信号传递。任何环节的神经损伤都可能中断这个过程。 | Erection requires complex signal transmission between the brain, spinal cord, and nerves. Nerve damage at any point can interrupt this process.
- 脊髓损伤 (Spinal Cord Injury)
- 多发性硬化症 (Multiple Sclerosis)
- 帕金森病 (Parkinson’s Disease)
- 中风 (Stroke)
- 盆腔手术 (Pelvic Surgery): 如前列腺癌根治术、直肠癌手术，可能损伤支配阴茎的神经。 | e.g., Radical prostatectomy for prostate cancer, rectal cancer surgery – may damage nerves supplying the penis.
- 糖尿病神经病变 (Diabetic Neuropathy): 如上所述。 | As mentioned above.
三、内分泌性原因 (Endocrine/Hormonal Causes) – “化学信使”失调
激素在调节性欲和勃起中起着关键作用。 | Hormones play a key role in regulating libido and erection.
- 低睾酮症 (Low Testosterone / Hypogonadism):
- 睾酮是男性主要的性激素，对维持性欲（性冲动） 和促进勃起起重要作用。水平低下会直接导致性欲显著减退，从而难以引发勃起，或使勃起不坚挺。 | Testosterone is the primary male sex hormone, crucial for maintaining libido (sex drive) and facilitating erection. Low levels directly lead to significantly reduced libido, making it difficult to initiate erections or resulting in less rigid erections.
- 原因包括：年龄增长（自然下降）、睾丸损伤或疾病、肥胖（脂肪细胞将睾酮转化为雌激素）、垂体疾病等。 | Causes include: aging (natural decline), testicular injury or disease, obesity (fat cells convert testosterone to estrogen), pituitary disorders, etc.
- 甲状腺疾病 (Thyroid Disorders):
- 甲状腺功能亢进（甲亢）(Hyperthyroidism): 可能导致焦虑、震颤、心悸，有时影响勃起。 | May cause anxiety, tremors, palpitations, and sometimes affect erection.
- 甲状腺功能减退（甲减）(Hypothyroidism): 可能导致疲劳、性欲减退、ED。 | May cause fatigue, low libido, ED.
- 高泌乳素血症 (Hyperprolactinemia): 泌乳素水平异常升高（可能由垂体瘤、某些药物引起），会抑制睾酮产生，导致性欲减退和ED。 | Abnormally high prolactin levels (caused by pituitary tumors, certain medications) suppress testosterone production, leading to low libido and ED.
四、药物性原因 (Medication-Induced Causes) – 常见且易被忽视
许多药物可能将ED作为其副作用。 | Many medications can list ED as a side effect.
- 降压药 (Blood Pressure Medications):
- 利尿剂 (Diuretics): 如氢氯噻嗪 (Hydrochlorothiazide)。
- β-受体阻滞剂 (Beta-Blockers): 如普萘洛尔 (Propranolol)、美托洛尔 (Metoprolol) – 影响较为明显。
- 抗抑郁药 (Antidepressants):
- 选择性血清素再摄取抑制剂（SSRIs）: 如氟西汀 (Fluoxetine)、帕罗西汀 (Paroxetine)、舍曲林 (Sertraline) – 常导致性欲减退、ED、射精延迟。
- 三环类抗抑郁药 (Tricyclic Antidepressants)。
- 抗精神病药 (Antipsychotics)
- 激素类药物 (Hormonal Agents):
- 用于前列腺癌的雄激素剥夺疗法 (Androgen Deprivation Therapy for Prostate Cancer): 显著降低睾酮。
- 非那雄胺/度他雄胺 (Finasteride/Dutasteride) （治疗脱发/前列腺增生）: 可能引起性欲减退、ED（较少见但可能发生）。
- 其他 (Others): H2受体阻滞剂（如西咪替丁）、某些抗惊厥药等。 | H2 Receptor Blockers (e.g., Cimetidine), some anticonvulsants, etc.
重要提示：如果怀疑药物导致ED，切勿自行停药！ 请咨询您的医生，他们可能会调整剂量、更换药物或提供其他解决方案。 | Important: If you suspect a medication is causing ED, do not stop taking it yourself! Consult your doctor; they may adjust the dose, switch medications, or offer other solutions.
五、心理性原因 (Psychological Causes) – “软件”问题
即使身体“硬件”正常，心理和情绪状态也能直接引发或加重ED。 | Even if the physical “hardware” is normal, psychological and emotional states can directly cause or worsen ED.
- 表现焦虑 (Performance Anxiety): 最常见的心理原因。 对勃起表现（硬度、持续时间）的过度担忧和恐惧。这种焦虑本身会形成恶性循环：越担心 -> 越紧张 -> 越难勃起 -> 更担心。 | The most common psychological cause. Excessive worry and fear about erection performance (hardness, duration). This anxiety creates a vicious cycle: more worry -> more tension -> more difficulty achieving erection -> more worry.
- 抑郁 (Depression): 性欲减退是核心症状之一。 情绪低落、快感缺失、精力不足、疲劳、自卑感均可直接损害性欲和勃起功能。 | Low libido is one of the core symptoms. Low mood, anhedonia (loss of pleasure), lack of energy, fatigue, low self-esteem can directly impair libido and erectile function.
- 压力 (Stress): 工作、经济、家庭、人际关系等带来的慢性压力。
- 关系问题 (Relationship Problems): 与伴侣沟通不良、情感疏离、冲突、缺乏信任、愤怒或不满。
- 身体意象问题与自卑 (Body Image Issues and Low Self-Esteem)
六、生活方式与行为因素 (Lifestyle & Behavioral Factors) – 可改变的风险
- 吸烟 (Smoking): 是ED的独立危险因素。 尼古丁和有害物质严重损害血管内皮功能，导致血管收缩和动脉硬化加速。 | An independent risk factor for ED. Nicotine and toxins severely damage vascular endothelial function, causing vasoconstriction and accelerated atherosclerosis.
- 过量饮酒 (Excessive Alcohol Consumption): 短期抑制神经系统，可能导致暂时性ED；长期损害肝脏、神经和血管，抑制睾酮产生，导致慢性ED。
- 物质滥用 (Substance Abuse): 如大麻、海洛因、甲基苯丙胺等可严重干扰神经系统和荷尔蒙平衡。
- 肥胖 (Obesity): 尤其腹部肥胖。增加心血管风险，降低睾酮水平（脂肪组织将睾酮转化为雌激素），增加胰岛素抵抗（与糖尿病相关）。
- 缺乏运动 (Sedentary Lifestyle / Lack of Exercise): 导致肥胖、心血管健康下降、血液循环不良。
- 睡眠不足与睡眠呼吸暂停 (Poor Sleep & Sleep Apnea): 影响睾酮分泌和整体健康。
七、其他原因 (Other Causes)
- 盆腔创伤 (Pelvic Trauma): 损伤血管或神经。
- Peyronie’s病 (Peyronie’s Disease): 阴茎海绵体形成疤痕组织（斑块），导致阴茎弯曲和疼痛，可能伴有ED。
- 慢性疾病 (Chronic Diseases): 如肝肾功能衰竭。
给马来西亚男性的重要建议 | Important Advice for Malaysian Men
- 克服尴尬，寻求专业诊断 (Overcome Embarrassment, Seek Professional Diagnosis): ED是一种医学状况，请像对待其他健康问题一样对待它。 第一步是咨询医生！前往政府诊所（Klinik Kesihatan）、您的家庭医生（GP）或医院泌尿科。 | ED is a medical condition; please treat it like any other health issue. The first step is to consult a doctor! Visit a Government Clinic (Klinik Kesihatan), your GP, or a hospital Urology Department.
- 坦诚沟通 (Communicate Openly with Your Doctor): 详细描述您的症状、病史、用药史、生活习惯和心理状态。这有助于医生准确判断病因。 | Describe your symptoms, medical history, medication history, lifestyle, and psychological state in detail. This helps the doctor accurately determine the cause.
- 关注整体健康 (Focus on Overall Health): 治疗ED往往从管理其根本原因开始（如控制血糖、血压、血脂）。优化生活方式（戒烟、健康饮食、规律运动、管理压力）是治疗的基石。 | Treating ED often starts with managing its root causes (e.g., controlling blood sugar, pressure, cholesterol). Optimizing lifestyle (quitting smoking, healthy diet, regular exercise, stress management) is the foundation of treatment.
- 善用本地资源 (Utilize Local Resources):
- 政府诊所 (Klinik Kesihatan): 提供基础医疗和转诊。
- 马来西亚卫生部 (MOH) MyHealth 门户: 提供可靠的健康信息。
结语：病因明晰，希望在前 | Conclusion: Causes Clarified, Hope Ahead
导致阳痿的病因涵盖血管、神经、内分泌、药物、心理及生活方式等多个层面，且常相互影响。了解这些原因，有助于破除迷思，减少不必要的焦虑，并认识到：ED绝非不治之症！ 绝大多数情况是可识别、可治疗或可有效管理的。在马来西亚完善的医疗体系下，通过专业医生的诊断和个体化治疗方案的制定，您完全有能力克服ED困扰，重获满意的性福生活与自信。请勇敢迈出寻求帮助的第一步！ | The causes of ED span vascular, neurological, endocrine, medication, psychological, and lifestyle factors, often interacting. Understanding these causes helps dispel myths, reduce unnecessary anxiety, and recognize that ED is by no means incurable! The vast majority of cases are identifiable, treatable, or manageable. Within Malaysia’s healthcare system, through professional diagnosis and personalized treatment plans, you have the full ability to overcome ED and regain satisfying sexual well-being and confidence. Please bravely take the first step to seek help!
重要健康提示 | Important Health Note: 本文提供的信息仅供参考，不能替代专业医疗建议、诊断或治疗。如果您有健康方面的疑虑，请务必咨询合格的医疗保健提供者。切勿因本文信息而延迟寻求专业医疗建议。 | The information provided in this article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. If you have any health concerns, please consult a qualified healthcare provider. Do not disregard professional medical advice or delay seeking it because of something you have read here.