Erectile dysfunction (ED), also called impotence, is defined as man’s inability to have an erection hard enough to have sex or to keep an erection long enough to finish having sex. ED is a very common problem, associated with many causes and affects the lived=s of many men and their partners worldwide.

Although erectile dysfunction is more common in men over age 65, it can occur at any age. Still, it’s important to realize that an occasional episode of erectile dysfunction happens to most men and is perfectly normal. In fact, in most cases it’s nothing to worry about. As men age, it’s also normal for them 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 ejaculations is reduced and recovery time increases between erections.

When erectile dysfunction proves to be a pattern or a persistent problem, however, it can harm a man’s self-image as well as his sexual life. It can also be a sign of a physical or emotional problem that requires treatment. Erectile dysfunction was once a taboo subject for most men to discuss with their doctor. More men are seeking help for this problem, and doctors are gaining a better understanding of what causes erectile dysfunction and are finding new and better ways to treat it.

Causes of Erectile Dysfunction

Atherosclerosis, which causes narrowing and hardening of the blood vessels, causes a reduction in blood flow throughout the body and in particular to the arteries in the penis, as these are very small and they are amongst the first vessels to be affected in the body. This can lead to ED. Several studies have shown that in some cases ED is also associated with cardiac problems. Atherosclerosis is associated with age and accounts for 50% to 60% of impotence in men over 60.

Risk factors for atherosclerosis include:

Diabetes Mellitus

High Blood Pressure

High Cholesterol level

Smoking, which can lead to any of the above risk factors, is perhaps the most significant risk factor for impotence related to arteriosclerosis.

Medication,such as over 200 commonly prescribed drugs, which are known to cause or contribute to impotence, including drugs for high blood pressure, heart medications, antidepressants, tranquilizers, and sedatives. A number of over-the-counter medications also can lead to impotence.

Long-term use of alcohol and illicit drugs may affect the vascular and nervous systems and are associated with erectile dysfunction.

Hormonal dysfunction, in rare cases

Neurological trauma or certain disorders, such as MS, Parkinson’s Disease, Alzheimer’s

Surgery in the pelvis (Radical Prostatectomy, Radical Cystectomy, Colectomy)

Radiation therapy for the treatment of cancer in the pelvis

Diagnosis of Erectile Dysfunction

Specialized tests include:

Doppler Ultrasonography in order to assess the flow of blood in the penile arteries.

Cavernosography involves injecting a dye into your blood vessels to permit your doctor to view any possible abnormalities in blood flow into and out of your penis.

Complete neurological examination and assessment for any possible neurologival deficit, that may cause ED.

Measurement of Nocturnal Penile Tumescence, which involves the measurement of nocturnal involuntary episodes of erections.

Available treatment options

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. If erectile dysfunction is the result of a medical condition, the cost of treatment may be covered by insurance.

Oral medication

Sildenafil (Viagra)

Vardenafil (Levitra)

Tadalafil (Cialis)

These oral medications are taken prior to intercourse and a prerequisite for them to work is for the man to be sexually aroused. Their main effect is to cause relaxation of the smooth muscle in blood vessels thus allowing more blood to flow through them and achieving erection.

Second line treatments

Penile injection therapy

Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring.

A system for inserting a pellet of alprostadil into the urethra is marketed as Muse. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness from increased blood flow to the penis; and minor urethral bleeding or spotting.

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. The vacuum device is then removed. The erection typically lasts long enough for a couple to have adequate sexual relations. It has been suggested that this type of device mainly suits couples in a stable relation, who want a more conservative treatment approach.

Revascularization procedures

In patients where there is proven arterial blockage revascularization procedures are needed. This treatment applies to a limited number of patients. In certain instances, when it appears that erectile dysfunction stems from the leak of blood from the venous system, ligation of these vessels is required to correct the problem. This is a highly complex procedure with moderate results.

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