Erectile Dysfunction (ED), is a repeated inability to achieve or keep an erection firm enough for sexual intercourse. The word impotence may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as a lack of sexual desires and problems with ejaculation and orgasm but the term Erectile Dysfunction is more precise because it refers only to erection problems. Men with erection problems often retain other sexual functions. For example, they may have sexual desire and may still be able to have orgasms and ejaculate semen.
It is estimated that about thirty million men in the United States experience chronic erectile dysfunction. Studies show that about half of the men between the ages of 40 and 70 have ED to some degree. Until recently, there was only a little choice of treatment in cases of diminished erection or impotence. Fortunately, times have changed. Due to the fact that research has been successful over the years, men may now be treated for this problem. Possible therapies include medications, injections, sexual counseling and surgery. Most erection disorders are caused by a combination of physical and psychological problems. Urologists who have traditionally treated erectile dysfunction.
ANATOMY OF THE PENIS
The penis contains two chambers called the corpora cavernosa, which run the length of the organ. A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissue, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa.
HOW IS THE PENILE ERECTION ACHIEVED?
The physiological process of an erection begins in the brain and involves the nervous and vascular systems. The brain, for example, is where sensation of sexual arousal is experienced. The brain sends its arousal signal to the penile nerves. Nerves play and important role in achieving erections. Nerves are the pathways from the brain and spinal cord to the penis and are involved in releasing chemicals called neurotransmitters. The nerve impulses go to the two erection chambers, the corpora cavernosa. The corpora cavernosa are two cylinders side by side in the penis. Covering them is a dense, elastic fibrous envelope called the tunica albuginea. There, the nerve impulses cause relaxation of penile tissue and expanding of arterial blood supplies. As the penile tissue relaxes and penile arteries expand, the blood flow into the erection chambers increases. The penis then swells in size. Veins that drain the blood are compressed against the inner wall of the tunica albuginea. The blood is thus trapped, making the penis hard and erect. Continued stimulation keeps the process going and maintains an erection. When stimulation ends or following ejaculation, pressure in the penis decreases, blood is released, and the penis resumes its normal shape.
TYPES OF ERECTILE DYSFUNCTION
There are different levels of erectile dysfunction. One is when the penis does not harden enough or at all. The second type is when the penis does get somewhat erect, but not hard enough to allow intercourse. The third possibility is that the penis does not get erect normally, but then softens again too quickly.
WHAT CAUSES ERECTILE DYSFUNCTION?
Since an erection is caused by a precise sequence of events, erectile dysfunction can occur when any of the events is disrupted. Very often, an erectile problem will have more than one cause. The causes may be psychological or physical, or a combination of both. Distinguishing between psychological and physical causes is helpful because treatment may differ depending on the cause. Today, experts believe that 80-90% of all erectile dysfunction cases may be due to physical conditions with psychological factors accounting for the remaining 10-20%. In many cases, however, there are both psychological and physical reasons for the condition.
There are many classification systems for the causes of ED. The easiest is to categorize the causes as physical, psychological, neurological, vascular and other. Reduced blood flow to the penis and nerve damage is the most common causes of erectile dysfunction. Underlying causes include the following: vascular disease, diabetes, drugs, hormone imbalance, neurological causes, pelvic trauma in surgery, Peyronie’s disease, and venous leak.
- Vascular Disease: Vascular disease is the predominant cause of erection problems. Low blood flow in and around the heart may cause a cardiac infarct, the same problem in the brain may cause a stroke, and in the penis it causes erection problems. Another cause of erection trouble may be the venous leak. If the veins that drain blood from the cavernous bodies in the penis do not sufficiently close during erection, it causes blood and pressure to leak out of the penis, which in turn will make it impossible to build up enough blood pressure in the cavernous bodies for sufficient erection.
- Diabetes: Diabetes is a major cause of erection problem. Between 35 and 50% of men with diabetes experience erectile dysfunction and 50% of all diabetic men become impotent after age 50. The disease can damage blood vessels and nerve tissues. Both may have an effect on erection. High levels of blood sugar associated with diabetes often damage small blood vessels and nerves throughout the body, which can impair nerve impulses and blood flow necessary for erection.
- Other: Drugs and vices, like drinking alcohol or smoking, may damage the nerves and blood supply needed for normal erection. There are over 200 prescription drugs that may cause or contribute to impotence, including drugs for high blood pressure, heart medication, antidepressants, tranquilizers and sedatives.
- Hormonal Imbalance: Testosterone deficiency can result in a loss of libido (sexual desire) and a loss of erection. Low testosterone account for 1% of ED. High production of prolactin and high or low thyroid hormone levels (hyperthyroidism or hypothyroidism, may add to a low testosterone production and thus, cause a lower libido. Hormonal imbalances can also occur as a result of kidney or liver disease.
- Neurological Causes: Multiple sclerosis, Parkinson’s disease, and spinal cord injuries are among those that may lead to loss of potency. Spinal cord and brain injuries can cause impotence because they interrupt the transfer of nerve impulses from the brain to the penis.
- Pelvic Trauma in Surgery: Surgery of the colon, prostate, bladder, or rectum, may damage the nerves and blood vessels involved in erection. Surgeries, especially the radical prostate surgery for cancer, can injure nerves and arteries near the penis, causing erectile dysfunction. Injury to the penis, spinal cord, prostate, bladder, and pelvis, can lead to erectile dysfunction by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa. Removal of the prostate or bladder often results in impotence. There are some new nerve-sparing techniques aimed at lowering the incidence of impotence from 40% to 60% are now being developed and used in these surgeries. Read more about the da Vinci Robotic surgery for prostate cancer removal.
- Peyronie’s Disease: Peyronie’s disease is an inflammatory condition that causes scarring of the erectile tissue. The French surgeon Francois de la Peyronie first described it in 1743. It is estimated that up to 1-4% of all men may have some form of it. The scar tissue, or Peyronie’s plaque, forms in the wall of the tissue that surrounds the corpus cavernosum. This is the structure that fills with blood to create a normal erection. When the plaque is large enough it may interfere with the ability of the muscles within the corpora to compress the veins that drain the penis during an erection. Therefore blood leaks from the penis back into the general circulation, making it impossible to maintain an erection. The penis is curved. Most cases occur between 40-70 years of age but it can develop at any time. The cause of Peyronie’s disease is unknown, although trauma to the penis has been implicated. This curvature can be so severe that it prevents intercourse.
- Psychological Causes: Though the physical reasons for ED are many, once a man has difficulty with erections, psychological factors often become a factor. Men who experience a sudden loss of erectile capability often have a psychological origin to their condition. Just as an erection can result from thinking about sex, negative thoughts can prevent an erection from occurring. In addition, depression and other psychological problems can affect both erections and sexual drive. Typically, patients whose erectile dysfunction is primarily psychological in nature continue to have erections while they sleep or when they get up in the morning. Psychological causes of impotence can include stress or anxiety from home or work, worry about poor sexual performance, marital problems, unresolved sexual orientation and depression. Psychological factors in impotence are often secondary to physical causes, but they magnify their significance.
THE BOTTOM LINE
A satisfactory treatment for some patients may be unsatisfactory for others. It has its own set of advantages and disadvantages. In addition, each patient has his own preferences. On the basis of individual preferences, patients may weigh treatment advantages and disadvantages quite differently in making a choice. In addition to the advantages and disadvantages, cost and loss of time from work or other activities may be considerations in choosing a treatment. There is hope through research. Advances in oral medication, suppositories, injectable medications, and implants have expanded the options for men seeking treatment for erectile dysfunction. These advantages have also helped to increase the number of men seeking treatment. The good news for many men and their partners is that erectile dysfunction can be treated safely and effectively. In light of recent medical advances, men no longer need to suffer from erectile dysfunction in silence. Most importantly, couples can now fully enjoy the enriching and exhilarating joy of intimate sexual contact. The key to regaining long-term sexual function is to trust and open communication between the motivated man and his supportive partner. Success also requires the knowledgeable and caring healthcare professional; one who understands both the physical and psychological impact of the condition on both the patient and his partner. With teamwork, communication, and a mutual commitment to regaining sexual function, many couples can experience renewed passion and excitement in their physical and emotional relationship.
Reprinted with permission from the Urology Team, P.A., a professional association of Board Certified Urologists in:
You can visit The Urology Team at https://www.urologyteam.com/
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