Mixed causes of erectile dysfunction include a combination of both organic and psychogenic nature of the pathology. This is a fairly common etiology of the disease's formation since no process in the human body can occur in isolation, without influencing other organs and tissues. Most often, such a variant of the pathology is encountered against the background of long-standing chronic pathologies of the cardiovascular, endocrine, and nervous systems, and, undoubtedly, upon the detection of a malignant tumor.

Cardiovascular Diseases

Several pathologies of the cardiovascular system can simultaneously lead to erectile dysfunction as well as depressive and anxious states, further worsening the quality of erection. Among them are:

  • Arterial hypertension;
  • Chronic heart failure;
  • Ischemic heart disease;
  • Previously experienced stroke or heart attack.

Acute conditions (heart attack, stroke) besides severe neurological or vascular damage are associated with severe stress and persistent fear of death for some time. Patients are worried, anxious about their condition, and often try to avoid increased physical exertion and stress, fearing a recurrence of the ischemic episode.

Chronic pathologies and the state of rehabilitation after acute situations require the intake of a large number of medications to prevent further deterioration of the condition. Both the fact of taking a large number of pills and their active substances also negatively affect the level of self-esteem and the adequacy of erection. Additionally, patients may be fitted with a pacemaker – the presence of an implant in the body intensifies stress patterns, worsening the patient's condition.

Moreover, in patients with chronic heart failure and ischemic heart disease, an increase in somatic symptoms of depression over a year is associated with an increased risk of death from cardiovascular disease and other incidents. Thus, a pathological vicious circle is formed.

Neurological Diseases

Among the neurological diseases that can lead to erectile dysfunction and the formation of depressive or anxiety disorders, it is worth noting:

  • Parkinson's disease;
  • Alzheimer's disease;
  • Multiple sclerosis;
  • Stroke;
  • Spinal or cranial trauma.

Many nuclei of the brain are involved in the mechanism of emotional reactions, which can be damaged in the formation of brain pathology. Particular importance is given to the consequences of vascular ischemia, disrupting neural connections and leading not only to depressive episodes but also to lethargy, apathy, emotional indifference.

Patients also need to take a large number of medications, but one of the most important aspects leading to a deterioration of the condition is the impossibility of being cured. Most neurological diseases are still incurable, their progression can be slowed down but not stopped. The fear of death (even with a favorable prognosis with high survival in the next decade) exacerbates the condition of patients, prevents them from enjoying life and sexual activity.

Endocrine Diseases

Disruption of the hormonal background itself can negatively affect the maintenance of erection. However, even if the disease does not directly affect sex hormones, it can lead to erectile dysfunction:

  • Diabetes;
  • Thyroid diseases;
  • Gigantism or dwarfism (enhanced or diminished growth factor function).

Besides the direct organic effect on the vascular bed of arteries and veins, as well as on the fibers of nerve tissue, this pathology is associated with constant, mandatory intake of medications as replacement therapy for missing hormones, and sometimes – surgical intervention.

Diabetes further binds the patient to constant insulin injections, counting carbohydrates both during meals and during physical exertion. Sexual activity is physical activity – accordingly, after it, patients require another calculation of the insulin dose.

Additionally, hormonal changes often lead to external changes – weight gain, the formation of toxic goiter (enlargement of the front surface of the neck due to an enlarged thyroid gland). Negative self-image, feelings of awkwardness and shame, fear of showing one's body to a partner, low self-esteem – all this leads to the formation of erectile dysfunction. The patient cannot focus on pleasure, gets distracted, and loses erection.

Malignant Neoplasms

Neoplasms themselves, if they are not related to the genital organs, do not affect sexual activity in the early stages. On severe, long-term stages, muscle weakness and rapid fatigue develop, which do not allow completing sexual intercourse and maintaining erectile function.

The formation of erectile dysfunction is ensured by medications used during chemotherapy, as well as by the fear of death, mood decline, and excessive focus on one's own condition. Oncological diseases are the most common pathology leading to depressive and anxiety disorders in patients.

Patients are concerned about the lack of strength, the potential possibility of a fatal outcome, deterioration of appearance due to the disease itself or its treatment. Such strong stress, experienced at any age, negatively affects the ability to maintain sexual activity during therapy and does not allow returning to the previous life even after achieving complete remission.