Erectile Dysfunction
Introduction
Erectile dysfunction (ED) affects the lives of many middle-aged men and their partners to one degree or another. The term erectile dysfunction covers a range of disorders, but usually refers to the inability to obtain an adequate erection for satisfactory sexual activity.
Although erectile dysfunction, formerly called impotence, is more common in men older than 65, it can occur at any age. An occasional episode of erectile dysfunction happens to most men and is normal. As men age, it's also normal to experience changes in erectile function. Erections may take longer to develop, may not be as rigid or may require more direct stimulation to be achieved. Men may also notice that orgasms are less intense, the volume of ejaculate is reduced and recovery time increases between erections.
When erectile dysfunction proves to be a pattern or a persistent problem, it can interfere with a man's self-image as well as his and his partner's sexual life. Erectile dysfunction may also be a sign of a physical or emotional problem that requires treatment.
Erectile dysfunction was once a taboo subject, but more men are seeking help. Doctors are gaining a better understanding of what causes erectile dysfunction and are finding new and better treatments.
Signs and symptoms
Patterns of erectile dysfunction include:
- Occasional inability to obtain a full erection
- Inability to maintain an erection throughout intercourse
- Complete inability to achieve an erection
The penis contains two cylindrical, sponge-like structures that run along its length, parallel to the tube that carries semen and urine (urethra). When a man becomes sexually aroused, nerve impulses cause the blood flow to the cylinders to increase about seven times the normal amount. This sudden influx of blood expands the sponge-like structures and produces an erection by straightening and stiffening the penis. Continued sexual arousal or excitation maintains the higher rate of blood flow, keeping the erection firm. After ejaculation, or when the sexual excitation passes, the excess blood drains out of the spongy tissue, and the penis returns to its nonerect size and shape.
Specific steps take place to produce and sustain an erection:
- Arousal. The first step is sexual arousal, which men obtain from the senses of sight, touch, hearing and smell, and from thoughts.
- Nervous system response. The brain communicates the sexual excitation to the body's nervous system, which activates increased blood flow to the penis.
- Blood vessel response. A relaxing action occurs in the blood vessels that supply the penis, allowing more blood to flow into the shafts that produce the erection.
If something affects any of these factors or the delicate balance among them, erectile dysfunction can result.
Nonphysical causes
Nonphysical causes may account for impotence. They may include:
- Psychological problems. The most common nonphysical causes are stress, anxiety and fatigue. Impotence is also an occasional side effect of psychological problems such as depression.
- Negative feelings. Feelings that you express toward your sexual partner — or that are expressed by your sexual partner — such as resentment, hostility or lack of interest also can be a factor in erectile dysfunction.
Physical causes account for many cases of erectile dysfunction and may include:
- Nerve damage from longstanding diabetes (diabetic neuropathy)
- Cardiovascular disorders affecting the blood supply to the pelvis
- Certain prescription medications
- Operations for cancer of the prostate
- Fractures that injure the spinal cord
- Multiple sclerosis
- Hormonal disorders
- Alcoholism and other forms of drug abuse
The physical and nonphysical causes of erectile dysfunction commonly interact. For instance, a minor physical problem that slows sexual response may cause anxiety about attaining an erection. Then the anxiety can worsen your erectile dysfunction.
Treatment
A wide variety of options exist for treating erectile dysfunction. They include everything from medications and simple mechanical devices to surgery and psychological counseling. The cause and severity of your condition are important factors in determining the best treatment or combination of treatments for you. You and your doctor may also want to consider how much money you're willing to spend and the personal preferences of you and your partner. If erectile dysfunction is the result of a medical condition, the cost of treatment may be covered by insurance.
Oral medications
Oral medications available to treat ED include:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
Viagra, Levitra and Cialis work in much the same way. Chemically known as phosphodiesterase inhibitors, these drugs enhance the effects of nitric oxide, a chemical messenger that relaxes smooth muscles in the penis. This increases the amount of blood and allows a natural sequence to occur — an erection in response to sexual stimulation. These medications don't automatically produce an erection. Instead they allow an erection to occur after physical and psychological stimulation. Many men experience improvement in erectile function after taking these medications regardless of the cause of their impotence.
These medications share many similarities, but they have differences as well. They vary in dosage, duration of effectiveness and possible side effects. Other distinctions — for example, which drug is best for certain types of men — aren't yet known. No study has directly compared these three medications.
Hormone replacement therapy
For the small number of men who have testosterone deficiency, testosterone replacement therapy may be an option.
Vacuum devices
This treatment involves the use of an external vacuum and one or more rubber bands (tension rings). To begin you place a hollow plastic tube, available by prescription, over your penis. You then use a hand pump to create a vacuum in the tube and pull blood into the penis. Once you achieve an adequate erection, you slip a tension ring around the base of your penis to maintain the erection. You then remove the vacuum device. The erection typically lasts long enough for a couple to have adequate sexual relations. You remove the tension ring after intercourse.
Vascular surgery
This treatment is usually reserved for men whose blood flow has been blocked by an injury to the penis or pelvic area. Surgery may also be used to correct erectile dysfunction caused by vascular blockages. The goal of this treatment is to correct a blockage of blood flow to the penis so that erections can occur naturally. But the long-term success of this surgery is unclear.
Penile implants
This treatment involves surgically placing a device into the two sides of the penis, allowing erection to occur as often and for as long as desired. These implants consist of either an inflatable device or semirigid rods made from silicone or polyurethane. This treatment is often expensive and is usually not recommended until other methods have been considered or tried first. As with any surgery, there is a small risk of complications such as infection.
Psychological counseling
If stress, anxiety or depression is the cause of your erectile dysfunction, your doctor may suggest that you, or you and your partner, visit a psychologist or psychiatrist with experience in treating sexual problems.
Prevention
Although most men experience episodes of erectile dysfunction from time to time, you can take these steps to decrease the likelihood of occurrences:
- Limit or avoid the use of alcohol and other similar drugs.
- Stop smoking.
- Exercise regularly.
- Reduce stress.
- Get enough sleep.
- Deal with anxiety or depression.
- See your doctor for regular checkups and medical screening tests.
Informations obtained from National Institute of Health.