Erectile Dysfunction: A Deeper Look
Erectile dysfunction,
which is commonly known as impotence, is the inability to achieve
or maintain an erection hard enough to engage in sexual intercourse.
There are two types of erectile dysfunction, primary and secondary.
Primary erectile dysfunction occurs when a man has never been able
to engage in sexual intercourse. Secondary erectile dysfunction
is more common, occurring when a man once had the ability to have
an erection and engage in sexual intercourse, but lost it.
If a man wonders how to resolve this
problem, sensate focus
is worth exploring first. The following information
may also be helpful. Remember this information is here simply as
a guide to some facts regarding erectile dysfunction and possible
avenues of treatment. We cannot diagnose anyone's unique sexual
problems. If you have a serious problem, we recommend that you see
a doctor for professional help.
Erectile dysfunction can be the result
of organic factors, psychological factors, or both. Organic causes
can be divided into five subcategories: neurological, vascular,
postsurgical, drugs, and hormonal. Under each of the categories
is a list of some possible causes of erectile dysfunction.
Diabetes
Pelvic or Spinal Cord Trauma
Pelvic surgery
Pelvic surgery or trauma
Arteriosclerosis (abnormal thickening and loss of elasticity in the arterial walls)
Prostatectomy (excision of part or all of the prostate gland)
Radical cystectomy (the surgical removal of a cyst or urinary bladder)
Alcohol
Tranquilizers
Antidepressants
Hormonal
Low serum testosterone level
High serum estrogen level
Among the psychological causes of erectile dysfunction are depression, anxiety, relationship problems, and stress.
When men have both organic causes and psychological
problems, erectile dysfunction can be especially hard to overcome.
For a more complete look at the psychological effects on erectile
dysfunction, look at the psychology section of erectile dysfunction
to see how men respond to erectile failures, performance anxiety,
or even falling into to spectator roles.
To better understand the organic
causes of erectile problems, we need to realize that proper blood
flow to the penis is required to have a rigid and erect penis.
At the time of erection, blood flows into the cavernous and spongy
bodies of the penis, or more precisely the corpora cavernosa and
the corpus spongiosum. As blood pressure rises, there is an increase
in blood inflow and erection. Nitric oxide plays an important
role in this process by relaxing the arteries that enter the cavernous
and spongy bodies so they can swell and fill with blood, resulting
in a firm erection. Diabetics, smokers, and men with low testosterone
are most prone to have defects in several of the biological system
needed for erection.
Biking, alcoholism, and smoking,
are other causes of erectile dysfunction that can be controlled.
Men who bicycle frequently compress the penile arteries between
the pubic bone and bike seat. This pressure lowers the penile
oxygen partial pressure, which relates with the blood flow to
the penis. Males who over consume alcohol have a decreased sexual
response, but alcohol in small amounts may enhance sexual arousal
slightly. Smoking causes erectile dysfunction by producing a buildup
of fatty deposits in delicate blood vessels which blocks blood
supply to the penis. The drug nicotine can also damage certain
valve mechanism involved in the trapping of blood in the penis.
There is a battery of tests that
can be performed to diagnose a man's erectile problems. These
tests include evaluating a man's life history, doing a physical
examination, measuring serum testosterone levels, making psychological
evaluations, monitoring nocturnal penile tumescence (swelling),
and conducting vascular or neurologic examinations. Each evaluation
needs to be custom designed to best suit each man's unique problem.
There are numerous methods and
cures for relieving erectile dysfunction. Many men benefit from
trying sensate
focus to remedy the milder forms of impotence. Viagra can
help with more serious cases. The following paragraphs discuss
other technologies and treatments used for erectile dysfunction.
There are numerous external mechanical aids that are approved by the FDA to aid in erectile dysfunction. Most of the devices require a prescription, so an evaluation by a doctor is necessary. The basic principle of vacuum constriction devices is that a vacuum chamber is placed over the penis. A pump provides negative pressure in the chamber, inducing an erection, and a rubber band is placed at the base of the penis to trap the blood in the penis. Vacuum constriction devices include ErecAid system, distributed by Osbon Medical Systems Ltd., and Vacuum Erection Device, distributed by Mission Pharmacal Co. Users of vacuum constriction devices need to be cautioned that there is a chance of painful ejaculation, due to the constriction of the rubber band. Users also need to be patient while relying on these devices, since they can diminish spontaneity of sexual intercourse. Men can integrate the device into foreplay, thereby including their partner. Men who use the device regularly usually find they can achieve an erection more quickly as they gain experience with the procedure.
In cases of complete impotence, penile implants may be the method of choice. The surgery needed to insert these implants is usually performed on men ranging from 40 to 70 years, since older men are most likely to have complete impotence, and due to irreversible tissue damage done by the surgery. This tissue damage will prevent the use of other treatments such as any oral medicine or any external vacuum constricting devices. There are two types of implants, inflatable and non-inflatable. Some possible complications due to this procedure are infection, which can cause penile erosion and reduced penile sensation.
Intracavernosal injection, or ICI, is best used when the cause of erectile dysfunction is neurological. The drugs used in the injection are called vasoactive drugs. These drugs facilitate erection by relaxing the smooth muscle tissues in the penis. Three common drugs used for this technique are Papaverine, Alprostadil and Phentolamine. There is a high success rate with this form of treatment with men who cannot take oral medication, men with diabetes, spinal cord injury, or radical prostatectomy. It is important to note that most men find this treatment nerve racking because it involves inserting a hypodermic needle into the penis. Side-effects include penile pain, priapism (continuous, usually non-sexual erection) and fibrosis (development of excess fibrous connective tissues in an organ).
The drug Alprostadil, or other prostaglandin drugs, can also be inserted in the penis in pellet form via the urethra. This method is often called MUSE, short for medicated urethral system for erection; it's easy and fast, producing erections after 15 minutes. Some side-effects include hypotension (decreased or lowered blood pressure), priapism, urethral burning, syncope (brief loss of consciousness associated with an inadequate flow of oxygented blood to the brain), penile pain, and men with pregnant partners should not use this method.
Sildenafil, also known as Viagra, has been the latest trend in the treatment of erectile dysfunction. Essentially what this drug does is increase nitric oxide by suppressing the breaking down of cGMP (cyclic guanosine monophosphate). Some side-effects of Sildenafil are: lightheadedness, dizziness, facial flushing, nasal congestion, dyspepsia (indigestion), and some even see a bluish tint in their sight. There are serious side effects when Sildenfil is combined with certain drugs, such as nitroglycerin, and other nitrates that are taken to treat heart disease. Another downfall of taking Sildenafil is that it reduces romantic spontaneity. For more detailed information regarding Sildenafil, refer to the Viagra section.
This chemical is found in the bark of the West African yohimbe tree. The drug yohimbine increases penile firmness enough to help with milder forms of impotence. The drug increases the blood flow to the penis. It indirectly increases parasympathetic activity in the autonomic nervous system. The FDA has approved this drug and it is available by prescription under such names as Yocon, Erex, and Yohimex. There are over the counter products containing yohimbine, but a study conducted by the FDA concluded that the concentration of yohimbine in these products is negligible and has little or no effect. Some side-effects of this drug are anxiety and insomnia.
Low testosterone is the cause of impotence in a small fraction of men. Treatment may involve injection of testosterone or wearing testosterone patches on the skin.
There are new and exciting cures already in the works for treating erectile dysfunction. Although Viagra has become quite popular, it has a reputation of not being spontaneous, and has bad side-effects for people with heart problems. A new drug called Uprima claims to preserve spontaneity, and does not have to be taken orally. This drug is placed under the tongue, and takes effect in approximately twenty minutes.
Another new and exciting treatment being developed is gene therapy. Still in its preliminary tests, gene therapy offers a treatment for erectile dysfunction that is quick, convenient, and has little side-effects. Researchers are hoping to have the treatment administered via an injection only once or twice a year! Others hope to effectively create a cream that will produce the same results, a natural erection, but without the use of hypodermic needles. Some gene therapy methods under study directly target smooth muscle tissue in the penis, while others are designed to increase the production of nitric oxide.
Here are some steps that one can take to help prevent serious or even situational erectile dysfunction.
*Avoid smoking
*Exercise daily to maintain good blood flow
*Eat a well-balanced diet.
*Drink alcohol in moderation or abstain
*Avoid being too anxious before sexual activity
*Have safe sex on a regular basis