Erectile Dysfunction Overview
Erectile dysfunction, also known as ED or male impotence, is one of the most commonly untreated medical conditions with profound psychological consequences and may interfere with a man’s overall self-esteem, well-being and intimate relationships.
Approximately 50% of men over the age of 40 experiences ED or having problems achieving or maintaining an erection. The frequency of ED increases with age particularly among men with a history of neurological disease, cardiovascular disease and type 2 diabetes. Such diseases are more common in the elderly, which may partially explain the elevated prevalence of inadequate erection in men over 60 years of age.
But according to the latest study, published in The Journal of Sexual Medicine, indicates that one in four men at an outpatient clinic who sought help for erectile dysfunction was actually under the age of 40.
Most of men are often embarrassed and distress about being impotent, and prefer to avoid sex rather than seek help. Without treatment, ED can make sexual intercourse difficult and can be frustrating. The increasing awareness of ED as well as the availability of devices, prescription drugs, noninvasive treatments and natural cures may result in a greater proportion of men seeking treatment, and eventually regaining satisfaction with their sex life.
How Does a Man Get an Erection?
An understanding of the basic mechanism of erection (how an erection works) will allow men to understand not only the causes of erectile dysfunction but also lay the foundation for the understanding of ED treatment options.
The penis is made up of spongy erectile tissue (corporal sinusoids) paired in three erection chambers called the corpora cavernosa, and the corpus spongiosum. When an erection occurs, these chambers are primarily filled with soft tissue composed of smooth muscle fibres, connective tissues and erectile tissues which allow increased blood flow into the chambers leading to an increase in pressure and the development of rigidity or hardness of the penis.
Usually, erection is initiated by an erotic cognitions and sexual stimulus including:
- touch (stimulation of the genitalia)
When a man becomes sexually excited, chemicals are released in to the brain that cause signals to pass down the spinal cord and outward through special nerves as a result of tactile stimulation of the penis. These neurotransmitter nerves release another chemical called Nitric Oxide that causes the aforementioned smooth muscle to relax and blood rushes into the erectile bodies, causing erection.
Chronic medical conditions such as diabetes, heart problems, hypertension, prostate enlargement can block the erectile arteries or cause scarring of the spongy erectile tissue and prevent proper blood flow, therefore, limiting the frigidity of erection.
Depression and anger can also prevent the brain signals from reaching the level required to induce erection.
In a nutshell, the erection is much like a tire; a firm tire is dependent upon a hose that can deliver air in adequate amounts in a speedy fashion and a valve mechanism that holds the air in place. In the penis the hose is represented by the erection arteries, which rapidly carry blood into the erectile bodies and the valve mechanism, while complicated in its structure, ensures that the blood is trapped inside the erectile tissues until ejaculation occurs or the sexual stimulus has passed.
History of Erectile Dysfunction
Impotence has been a condition affecting men since ancient times. During the late 17th centuries in France, male impotence was considered a crime, as well as legal grounds for a divorce. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677.
In the medieval Islamic world by the Muslim, physicians and pharmacists prescribed a combination of a drug therapy and diet to treat erectile dysfunction. Aside from oral medication they also tried local the application of medication via the urethra – this was the earliest attempts at treating Erectile Dysfunction.
While in ancient Greece and Rome, animal genitalia such as snakes, roosters, goats and lizards were used not only cure male impotence but also consumed as a powerful aphrodisiac.
In the nineteenth century, Frederick Hollick used cannabis to cure impotence as well as to restore sexual power and desire. Like Hollick, most doctors recommended tonics and stimulants as the natural cures for ED. William Acton prescribed strychnine and phosphoric acid with either syrup of orange-peel or syrup of ginger. W. Frank Glenn claimed damiana to be the most effective treatment for impotence. In cases of complete inability to produce an erection, he employed a combination of phosphide of zinc, damiana, aresenious acide, and cocaine.
Vincent Marie Mondat—a distinguished French physician—was credited with the most outlandish of the various external devices. He invented the “congestor,” a vacuum pump or “exhausting apparatus,” which in drawing blood into the penis was designed to promote erection.
In 1998, Viagra (Sildenafil) by Pfizer became the first drug of choice approved by the FDA to treat erectile dysfunction. Viagra immediately became the fastest selling pharmaceutical in history to treat ED. Other big pharmaceutical companies developed their own version of erectile dysfunction drugs: Cialis, made by Eli Lilly; Levitra, by Bayer AG and GlaxoSmithKline.
What is Erectile Dysfunction (ED)
Erectile dysfunction or ED is the preferred term rather than “impotence”. The National Institutes of Health (NIH) Consensus Development Conference on Impotence defined impotence as “male erectile dysfunction, that is, the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.”
There are no universally agreed criteria for how consistent the problem has to be and for what duration it needs to be present to fulfill the definition. A period of persistence of longer than 3 months has been suggested as a reasonable clinical guideline.
Signs & Symptoms of Male Impotence
The early signs and symptoms of erectile dsyfunction may include:
- Unable to get hard at any time
- Difficulty in keeping an erection and does not last long enough for sexual intercourse
- Lack of sexual desire
If you experience “signs and symptoms of ED” or recurrent symptoms of impotence listed above, it’s important to seek prompt health care provider before pursuing any sort of treatment.
Different Types & Causes Erectile Dysfunction (ED)
There are many causes and types of impotence. A combination of physical (physiological) and psychological (emotional) causes disrupt the normal blood flow to the penis which causes ED. Understanding the specific types and the underlying causes of ED can help a person identify the condition and which therapies may respond better than the others.
The following are some of the different types and potential causes of erectile dysfunction:
1. Physical or Organic ED – Physical is the most common type of ED which include damage to the nerves, arteries, smooth muscles, and fibrous tissues in the penis. Chronic diseases and disorders also contributes the elevated rates of erectile dysfunction in men over the age of 60. Diseases and disorders include:
- Atherosclerosis (clogged blood vessels)
- Diabetes (Type 1, 2 & 3 diabetes)
- Cardio vascular disease
- High Cholesterol
- Hypertension or elevated blood pressure
- Kidney disease (renal failure)
- Prostate enlargement
2. Psychological or Emotional ED – Psychological is another cause of ED. The human brain is the largest sex organ, so anything that disrupts the normal functioning of the brain or sexual feelings can cause or worsen erectile dysfunction. Psychological causes of ED include:
- Anxiety also known as “performance anxiety” or fear of sexual failure
- Low self-esteem
- Relationship problems
3. Neurological or Nerve ED – There are many neurological or nerve problems causes of erectile dysfunction that interferes brain’s ability to communicate with the reproductive system. Anything that interrupts with this pathway, such as disease or injury of the blood vessels and nerves, can lead to erectile dysfunction.
Neurological disorders associated with impotence include:
- Alzheimer’s disease
- Brain or spinal tumours
- Chronic alcoholism
- Heavy metal poisoning
- Multiple sclerosis
- Nerve injuries
- Parkinson’s disease
- Pelvic surgery
- Peripheral neuropathy – commonly seen in people with diabetes
- Spinal cord injury
- Temporal lobe epilepsy
4. Endocrinological and Hormonal ED – Erectile dysfunction is just one of the potential problem that may caused by hormonal imbalance. Also abnormalities of the pituitary gland may cause high levels of the hormone called “prolactin“, a hormone that causes ED and breast enlargement (man’s boob).
Having a normal levels of testosterone, low levels of estrogen as well as normal thyroid levels is required for normal erections. Your doctor can check your hormone levels with a simple blood test.
On the other hand, endocrine system produces hormones that regulate metabolism, sexual function, reproduction, mood, and more. One of the endocrine disease is diabetes and one of the side effects associated with chronic diabetes is nerve damage that can cause a person problem with erection.
Other hormonal and endocrinological causes of erectile dysfunction include:
5. Drug-induced ED – Erection dysfunction is a very common side effect of the many prescription medications. If you think that your medication causes your ED, talk to your doctor for an alternative medications.
Examples of common drugs known to cause erectile dysfunction include:
- Alpha-adrenergic blockers: tamsulosin (Flomax)
- Antacid or Gastroesophagelal reflux disorder (GERD): rantidine (Zantac) and cimetidine (Tagamet)
- Antipsychotic: Phenothiazines (Compazine) and butyrophenones (haloperidol)
- Beta-blockers:Carvedilol (Coreg) and Metoprolol (Lopressor)
- Calcium-Channel Blockers: Amlodipine
- Chemotherapy drugs: Methotrexate, Ciplatin or Vincristine
- Diuretics: Furosemide (Lasix) and Spironolactone (Aldactone)
- Heart or cholesterol: digoxin, Gemfibrozil, or Clofibrate
- Depressants: alprazolam (Xanax), diazepam (Valium), and codeine
- Stimulants: Cocaine or Amphetamines
- Selective Serotonin Reuptake Inhibitors or SSRIs: (Prozac, Paxil)
- Synthetic hormones: such as estrogens, corticosteroids, and 5-alpha reductase inhibitors; Leuprolide (Eligard)
6. Venogenic Erectile Dysfunction – also known as “Venous Leak” inflicting young men as much as 30-70 percent of all impotence where the veins of the penis leak blood and prevent the development of a rigid or hard erection. Venogenic impotence is extremely common in younger men from birth (primary). Others develop ED after years of normal sexuality (secondary).
7. Penile ED – Diseases such as Peyronie’s disease (development of scar tissue inside the penis) and priapism can affect the structures in the penis including the spongy erectile tissue and small veins which serve as a drainage system.
8. Other types of erectile dysfunction:
- Peyronie’s disease is a form of erectile dysfunction caused by a scar tissue inside the penis, called plaque. It can make the penis to bend upward or to the side and make an erection quite painful.
- Priapism – Prolonged painful erection that may lasts for several hours. If left untreated, it can damage the spongy erectile tissue and scarring.
- Premature ejaculation is uncontrolled ejaculation which occurs prior to or within after sexual activity in less than one minute.
Complications of Erectile Dysfunction
Complications of untreated impotence include:
- Poor sex life
- Depression or anxiety
- Failure to start a family
- Embarrassment or low self-esteem
- Marital or relationship difficulties
What Are The Risk Factors of ED
It is a given that as you get older, erections might take longer to achieve and might not be as rigid as before as the years goes by. An approximately 50% of men ages from 40 to 70 experience difficulty in achieving erection at some point or another, that’s according to The Merck Manual. Some men needs more direct penis stimulation to get and maintain the erection.
ED is always related to both physical and psychological or emotional factors. Among the contributing factors that may increase your risk of developing erectile dysfunction, include:
- Advancing Age
- Medical conditions – Specifically diabetes, heart disease, prostate problems, multiple sclerosis, atherosclerosis, high blood pressure, and high levels of cholesterol are major risk factors for ED.
- Lifestyle factors – Lifestyle choices, such as smoking, drinking too much alcohol, using illegal drugs, being overweight, and not exercising, can lead to ED.
- Smoking – Smoking is the number one contributing factors of ED because it increases the effects of other blood vessel disorders, including high blood pressure and atherosclerosis.
- Alcohol Consumption– Heavy drinking can cause erectile dysfunction. Alcohol is depressant that affects the central nervous system and impairs sexual function.
- Substance Abuse – Illicit drugs such as heroin, cocaine, methamphetamines, and bath salts can affect sexual function.
- Over Weight and Sedentary Lifestyle – Obesity is a risk factor for erectile dysfunction. Lack of exercise and a sedentary lifestyle can lead to obesity and other health problems associated with erectile dysfunction.
- Certain medical treatments – Such as prostate surgery or radiation treatment for cancer
- Injuries or physical trauma – Such as venous leak or arteries that control erections; spinal cord injury or tumor.
- Prescription drugs – including antidepressants, antihistamines, tranquilizers, appetite suppressants, ulcer medications and medications to treat high blood pressure, pain or prostate conditions
- Psychological conditions – such as anxiety or depression, stress, fear of sexual failure, low self-esteem and guilt may make the ED worse.
- Prolonged bicycling or bicycling accident – which can compress nerves and affect blood flow to the penis, may lead to temporary or permanent erectile dysfunction
- Endocrinological conditions – abnormally low testosterone, hypogonadism
- Peyronie’s disease – distortion or curvature of the penis
- Chronic diseases – especially renal failure and dialysis and cancer
- Priapism – inflammation of the penis
- Sleep disorder such as sleep apnea
- Long-standing illnesses like chronic liver disease or renal failure often have ED
Test and Diagnosis
In order to determine the various causes and types of erectile dysfunction, physical exam, laboratory test and answering some questions (medical history) can help the doctor diagnose erectile dysfunction and recommend appropriate treatment. Like for instance, breast enlargement in men or man’s boob can indicate low testosterone or hormonal imbalance.
To accurately diagnose the cause of impotence, the doctor may order some tests that include:
- Physical exam. A thorough examination of the following:
- status of the penis and the prostate
- size and texture of the testicles
- presence of the epididymis and vas deferens
- checking the nerves for sensation and peripheral pulses
- checking for abnormalities of the penis such as Peyronie’s disease, hypospadias
- Psychological or mental health exam. Your doctor may look for signs of depression or anxiety during the interview process. Your doctor will ask about:
- past and present medical illnesses, surgeries and medications
- history of psychological problems such as depression or anxiety, stress, guilt
- lifestyle including illicit drug use, alcohol, sleep problem
- details of sexual technique
- specific circumstances when ED occurs
- frequency, erection quality (EQ), duration – during sleep or awakening
- Complete Blood Count (CBC) . To check for signs of: heart disease; glucose levels; high cholesterol levels; low testosterone levels and other health conditions.
- Urine tests (urinalysis). To measure protein, testosterone level and blood sugar.
- Duplex ultrasound. It involves using a high-frequency sound waves to take video images of the body’s tissue.
- Nocturnal Penile Tumescence (NPT). This test involves wrapping a special device around the penis to measure involuntary of erection during sleep.
Treatments: Drugs, Devices, Surgery, & Counselling
There are treatments available to help patients restore and maintain erections. Each type of treatment has its own advantages, disadvantages and side effects. If you are experiencing erectile dysfunction, you should discuss the pros and cons of each treatment option available to determine if the treatment is appropriate for you.
These treatments may include the following:
- Pills. These prescription medications include Sildenafil (Viagra®), Talafadil (Cialis®), and Vardenafil (Levitra®), (Staxyn®). All three work by acting on the chemical nitric oxide (NO). These drugs for impotence help increase blood flow to the penis and maintain erection during sexual stimulation. These ED drugs can cause a variety of side effects such as nausea, blurred vision, hearing loss, dizziness, flushes, headaches, nasal congestion, etc.
- Topical Medications: Because oral ED can cause a lot of side effects and it’s not advisable to take ED medications if you have heart problems or have diabetes. Recent developments in treatments for erectile dysfunction alternative include topical medications including:
- Vitaros – The first prescription cream to treat erectile dysfunction, giving hope to those unable to take Viagra and other ED treatments. It comes in a single use with disposable applicator. The cream is applied directly to the tip of the penis to produce an erection within 5 to 30 minutes once absorbed into the skin.
- AndroGel – Low levels of testosterone is always associated with ED for some men. AndroGel is a synthetic testosterone replacement therapy that is applied to the skin daily for 24-hour delivery into the body. Common side effects including headache, acne, dizziness, prostate enlargement, lower sperm count and emotional instability.
- TriMix-gel®– is an easy to apply gel directly into the penis to achieve an erection before sexual intercourse.
- Vacuum Constrictive Devices (VCDs) also known as “the pump“: It is a plastic cylindrical tube that you place over the penis. As air is pumped out of the cylinder with a hand- or battery-operated pump, blood is drawn into the penis helping it to attain an erection. Then a constriction device or a tension ring is placed around the base of the penis to keep the blood tissue maintain an erection until sexual intercourse is finished.
- Penile Injections/Suppository Therapy: Medications may be injected into the side of the penis, which promote blood flow. The most common drug used for injection are:
- Prostaglandin/Aprostadil (Caverject® and and Edex®) – can be injected into the base or side of the penis prior to sexual intercourse.
- Alprostadil penis suppository or Muse System – can be inserted with a special applicator about 2 inches into the urethra. Side effects can include pain, minor bleeding, dizziness or fibrous tissue formation inside the penis. Side effects include: priapism; pain, bleeding, and scarring.
- Hormone Replacement Therapy: For men with low testosterone levels and hypogonadism, testosterone therapy is available in the form of:
- intramuscular injections
- transdermal patches or skin patches
- tablets placed between the cheek and gums
- topical ointments
- Discover how you can increase your testosterone here>> Male Libido Booster
- Surgery: Helps repair arteries carrying blood to the penis or veins that allow blood to leave the penis.
- Penile Prosthesis (Implants): This is the las resort of ED treatment. It involves the implantation of malleable rods into each of the penis’ two erection chambers called the corpora cavernosa. The inflatable prostheses can be inflated and deflated as needed. Implants are expensive and can lead to infection. Side effects include infection, bleeding and malfunction.
- Sex Therapy or Counselling: This is recommended for patients with emotional or anxiety problems. Typically the patient and his partner are both involved in the therapy sessions.
- Cognitive Behavioural Therapy (CBT)
- Psychosexual Counselling
- Sensate Focus
- Lifestyle interventions: such as weight loss, exercise, and alcohol and smoking cessation.
Natural Remedies or Alternative Supplements for ED
Some natural or alternative remedies for erectile dysfunction include:
- Panax Gensing
- Pomegranate juice
- Watermelon juice
- Beetroot juice
How to Prevent Erectile Dysfunction/Male Impotence?
To prevent erection problems, a lifestyle change is necessary to achieve healthy sexual function. You can engage in healthy lifestyle behaviour in lowering your risk of impotence by:
- Controlling your blood pressure if you have high blood pressure
- Controlling your blood sugar if you have diabetes
- Controlling your cholesterol if you have high cholesterol
- Discontinue using illicit drug
- Discontinue smoking cigarette
- Decreasing or eliminating alcohol use
- Getting plenty of rest and relaxation
- Maintaining a healthy diet
- Keeping a balance well
- Increasing physical activity
- Maintaining a healthy weight
- Talking with your partner about sexual issues
- Participating in counseling to address emotional or psychological issues
- Quitting smoking
- Performing penis exercises as a regular regimen
- http://www.auanet.org — American Urologic Association
- www.urologyhealth.org — Urology Health