Erectile
Dysfunction (Impotence)
Erectile
Dysfunction (ED) is defined as the inability to achieve or maintain
an erection sufficient for mutually satisfying intercourse. ED
impacts more than a man's sexual activity. The emotions and
uncertainties that coincide with this condition often have a
significant effect on a man's self-esteem, as well as, his
relationship with his partner. Although the incidence of ED
increases with age, it is not an inevitable result of aging.
ED is a secondary condition linked to many medical
conditions.
The first step in
treating ED is that the individual understands the psychology,
physiology and anatomy responsible for the ability to achieve and
maintain an erection. If we can comprehend these events than
we can better understand the factors that are responsible for ED and
address the questions concerning treatment.
Normal
Erectile Function
For something that
appears so natural, an erection is a rather complicated process
involving the coordination of the psychological, neurological and
cardiovascular systems. The penis becomes erect following a
series of events. First, the nerves are stimulated, a
sensation known as arousal. No matter what the nature of the
stimulus, visual, mental or physical the brain coordinates the
following series of events:
Nerve impulses
transverse the length of the spinal cord to the pudendal nerve and
on to the penis. Smooth muscle within the walls of the penile
arteries respond by relaxing.
Subsequently, the penile
arteries dilate allowing up to eight times more blood to flow into
the corpora cavernosum, (two parallel cylinders that transverse the
length of the penis).
The cavernosum become
engorged with blood expanding and lengthening the penis.
The expanding tissue
then exerts a positive pressure compressing the veins that normally
empty the blood from the penis, maintaining the blood in the penile
tissue.
When ejaculation occurs
or when arousal is discontinued the penis returns to its non-erect
state.
Causes of Erectile Dysfunction
Historically, when an
individual consulted his physician concerning ED he was usually
informed there were no known physiological answers concerning his
condition. Today, a generation of research has resulted in
significant advances in both the diagnosis and treatment of ED.
Physicians now understand that approximately eighty-five percent of
ED is attributable to physical/organic conditions while only fifteen
percent is due to psychological or mixed origin (both psychological
and organic). Some important causes of physiological ED are as
follows:
Vascular
Disease is the leading cause of ED. Vascular
disorders including arteriosclerosis (hardening of the arteries),
hypertension, hypercholestremia and other conditions which interfere
with the blood flow to the penis. Additionally, "venous
leakage" also contributes to poor erections. This condition
occurs when the penile veins are unable to constrict efficiently
during an erection. When these veins "leak" blood escapes to
the periphery resulting in a poor erection
Diabetes
is another common cause of ED. Approximately fifty percent
of men with diabetes (insulin dependent) experience some degree of
ED after the age of fifty-five. Diabetes results in poor
circulation and/or peripheral neuropathy. When the nerves are
involved sexual stimuli are not transmitted appropriately to or from
the brain and ED develops.
Prescription
medications often cause ED as a side effect. Some two
hundred known medications fall into this category including:
- Antihypertensives
medications significantly:
- beta-blockers e.g.
Atenolol, Propanolol and Tenorium.
- Diuretics
medications e.g. HydroDiuril and Lasix.
- Ace
Inhibitors/Calcium Channel Blockers medications e.g.
Vasotec, Lotension, Cardizem, Norvasc periodically cause ED,
however, they are generally represent an excellent alternative
medication for individuals with drug induced ED.
- Antidepressant/Antipsychotic
medications of almost any label can also result in ED
e.g. Prozac, Elavil, Zoloft, Thorazine, Haldol. Note: Many other
medications in a variety of classes can periodically cause
ED. If you are taking a prescription medication or
over-the-counter medication, regularly, please consult with your
physician. However, never alter a dosage or discontinue a
medication without the advice of your physician.
- LH-RH
Analogs/Antiandrogen medications e.g. Lupron Depot®, Eulexin,
Nilandron®, Casodex®, etc. These medications are used in the
treatment of prostate cancer. They function by decreasing
the production of testosterone in the testes and adrennal
glands. The decrease in testosterone often results in
ED.
- Chemotherapy/Radiation
therapy are also significant contributors to ED. These
drugs/treatments are used in the treatment of cancer.
Substance
Abuse can also negatively effect male potency.
The chronic use of cocaine, marijuana, alcohol, steroids etc. often
results in ED, as well as a decrease in desire. Excessive
tobacco use can also attribute to ED by accentuating the effects of
other risk factor such as vascular disease or
hypertension.
Radical Pelvic
Surgery also result in ED. Surgical procedures
involving the prostate gland, bladder or colon may interfere with
the nerves involved in the erectile response. Radiation
therapy for cancer may also effect the erectile process.
Neurological
diseases such as multiple sclerosis, Parkinson's disease,
spinal cord injuries, long term effects of diabetes can also result
in the disruption of the normal sequence of events necessary for an
erection to occur.
Deficiencies in
the Endocrine System are another source of ED. Low levels of
testosterone or thyroid hormone can interfere with the stimulation
process necessary in the erection sequence. Excessive
production of prolactin by the pituitary gland may contribute to
decreased levels of testosterone resulting in a lack of
desire. Diabetes once again enters the scenario as it is
classified as an endocrine disorder.
Psychological
ED is usually diagnosed when no physical causes can be
defined. Pure psychological ED usually occurs suddenly without
warning as opposed to physical ED that may gradually develop over
years. Some common causes of psychological ED are as follows:
-
Performance
anxiety is one of the most common causes of psychological
ED. When a man feels pressured to achieve or maintain an
erection, he will commonly become anxious and nervous when in a
sexually demanding situation. Stress increases the body's
production of catecholamines such as adrenaline and nor-
adrenaline, which act as erection inhibitors. The release of
these inhibitors further contributes to failure resulting in more
anxiety. Therefore, the cycle begins, increased stress
resulting in increased catecholomines that further inhibits the
erectile process.
-
Depression is
another cause of psychogenic ED. Unfortunately, many of the
popular antidepressant medications (for a list see prescription
medications in the next section) have side effects which include
erectile failure.
Anatomical
Deviation of the Penis, Peyronies Disease, may also
cause ED. This condition usually develops from an inflammatory
process and results in fibrous scaring of the penis. (The
cause of this process is not yet understood) However, when an
erection does occur, there is a bending of the penis secondary to
the scar tissue. This curvature may interfere with erectile
capacity and/or ejaculation.
Treatment of Erectile
Dysfunction
Until recently,
individuals who sought medical treatment for ED were told "It's all
in your head". Physicians labeled these individuals with a
psychological disorder and they were referred to counseling.
Today, there are many treatment options available, the treatment
option you choose should be specific and responsive to your needs
and expectations as well as your partners. The following is a
summary ofthe more popular treatment options available
today:
Oral
Medications one in particular Viagra® (Sildenafil
Citrate) has change the course of treatment for ED.
Never has so much enthusiasm surrounded a prescription
medication. In the first six months alone, Pfizer's sales of
the blue diamond shaped tablet topped 50 million. Viagra® is
dispensed as a pill and ingested orally. Approximately 30-60
minutes later the drug is absorbed into the bloodstream. Viagra®
then functions as an inhibitor to an enzyme found mainly in the
penis. By inhibiting this enzyme a series of natural occurring
events, take place resulting in increased blood flow to the penis
thus generating a fuller erection. Since the medication
increases the levels of a naturally occurring, process spontaneous
erections do not occur. Viagra® is essentially changing the
way we treat ED. The medication is manufactured by Pfizer
pharmaceuticals.
ORDER YOUR VIAGRA® ONLINE NOW!!!
Penile Injection
Therapy uses a hypodermic needle to inject medication
(mixture of papaverine, phentolamine and prostoglandin) into the
side of the penis.
The drugrelaxes
the smooth muscle tissue of the penis allowing for an
erection. These injections can be painful, result in scare
tissue formation at the injection site and cause priapism (prolonged
and painful engorgement of the penis). The product is available
through Pharmacia and Upjohn (Caverjet) and Scharz Pharma, Inc
(EDEX) at approximately $18.00 per dose.
Urethral
Inserts consists of a disposable applicator, small
enough to fit into the urethra. The applicator is inserted
into the urethra approximately one inch and the medication
(prostaglandin E-1) is released. As a result, an erection
occurs lasting 30-60 minutes. Patient acceptance is still an
issue secondary to expense and the low success rate as compared to
other treatments for ED. The inserts are available through the
pharmaceutical company Vivus Inc.
Vacuum
Therapy works by placing a cylinder with an attached
pump over the penis. The pump creates a vacuum in the
cylinder, which pulls blood into the penis tocreate an
erection. The cylinder is then removed while simultaneously a
constriction band is placed at the base of the penis. This
will usually keep the penis erect for up to thirty minutes, These
devices range from $150.00-400.00 and can be purchased through
Mentor Urology, POST-T-VAC, Inc., American Med Tech, Inc.
Hormonal
Therapy is used to treat the small percentage of individuals
who have abnormally low levels of testosterone. During the initial
consultation a physician will likely order hormone tests (LH and
Prolactin) first to exclude other causes of low testosterone
levels. If appropriate, testosterone is available in a
transdermal adhesive patch. The patch is available through
Androderm (SmithKline Beecham) and Testroderm (Alza
Pharmaceuticals), at a cost of $20.00 per patch.
Vascular
Surgery may involve both the arterial and venous
systems. Venous ligation has been reported to be effective in
patients with venous leakage. However, it is often difficult
to diagnose individuals with this condition given are current
testing capabilities; therefore, it is difficult to predict their
outcome prior to surgery. Arterial revasculation procedures
are limited to congenital or traumatic vascular abnormalities.
Similar to venous testing, complete standardization diagnostic
testing has not been established, so difficulties persists in
predicting surgical results.
Penile
Implants requires surgical insertion of a prosthetic
device. Three forms of penile prosthesis are currently
available flexible, malleable and inflatable.
Flexible or Malleable
rods consist of two semi-rigid, flexible rods which make the penis
firm enough for intercourse. There are also inflatable
prosthetic devices that produce a more natural erection. When
an erection is desired the pump (located in the scrotum) is
squeezed, this in turn inflates a cylinder creating an
erection. Following intercourse, the pump is released and the
penis returns too normal. These devices have been associated
with postoperative infections, mechanical failure, silicon particle
shedding and the risk of the initial surgery. These
prosthetics are available through American Medical Systems and
Mentor Urology.
Herbal
Approaches are not currently regulated by the FDA so
it is difficult to ascertain whether their hype is warranted.
Furthermore, these products tend to suggest an aphrodisiac effect
(help with the loss of sexual desire) rather than improvement wit
ED.
Psychotherapy
and/or Behavioral Therapy have been found to be
beneficial in treating ED. Although the majority of causes of
ED are physical, there are quite frequently underlying psychosocial
factors involved as well. Psychotherapy and/or behavioral
therapy may be helpful in individuals whom no organic cause for ED
has been detected. Therapy often focuses on complications
surrounding performance anxiety, dysfunctional relationships, loss
of a partner, psychotic disorders, substance abuse, etc.
Partners
can provide support for individuals with ED. The condition
affects the relationships of more than 50 million Americans.
If you are a partner, you can make a difference through support and
education. For a list of Impotence Anonymous (IA®) and I-ANON®
chapters, call 1-800-669-1603 or email to.
Note: All of the above mentioned treatments only
treat ED, they do not treat the underlying illnesses or disorders
responsible for the ED. The prolonged use of some these
treatments in individuals who have conditions such as those listed
under causes of ED is inappropriate. Please be responsible
with your health. Schedule regular appointments with your
family physician and/or your urologist so they may address and treat
the underlying conditions responsible for your ED.
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