Erectile Dysfunction Information
Erectile Dysfunction is defined as the inability to achieve or maintain
an erection sufficient for mutually satisfying intercourse. Per the
adjacent diagram one can see that the incidence of Erectile Dysfunction
correlates with an individual's age and affects some 67% of men by
the age of 70 years old.
Erectile Dysfunction 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 Erectile
Dysfunction increases with age, it is not an inevitable result of
aging. Erectile Dysfunction is a secondary condition linked to many
medical conditions.
The first step in treating Erectile Dysfunction 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 then we can better understand the factors that are responsible
for Erectile Dysfunction 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, be it
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 becomes engorged with blood which
expands and lengthens the penis.
- The expanding tissue then exerts a positive pressure
that compresses the veins that normally empty the blood from the penis,
which maintains 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 Erectile Dysfunction 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 Erectile Dysfunction.
Physicians now understand that approximately 85% of Erectile
Dysfunction is attributable to physical/organic conditions while
only 15% is due to psychological or mixed origin (both psychological
and organic). Some important causes of physiological Erectile
Dysfunction are as follows:
Vascular Disease is
the leading cause of Erectile Dysfunction. Vascular disorders
include arteriosclerosis (hardening of the arteries), hypertension,
hyper-cholestremia and other conditions which interfere with
the blood flow to the penis. Additionally, "venous leakage",
a condition occurring when the penile veins are unable to constrict
efficiently during an erection, also contributes to poor erections.
When these veins "leak", blood escapes to the periphery
resulting in a poor erection.
Diabetes is another common
cause of Erectile Dysfunction. Approximately 50% of men with insulin
dependent diabetes experience some degree of Erectile Dysfunction
after the age of 55 years old. 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
Erectile Dysfunction develops.
Neurological diseases such
as multiple sclerosis, Parkinson's disease, spinal cord injuries,
and
long term effects of diabetes can also disrupt the normal sequence
of events necessary for an erection to occur.
Deficiencies
in the Endocrine System are
another source of Erectile Dysfunction. 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.
Prescription medications often cause Erectile Dysfunction as
a side effect. About two hundred known medications fall into this category
including:
Antihypertensives medications specifically:
- Beta-blockers e.g. Atenolol,
Propanolol and Tenorium.
- Diuretics medications e.g. HydroDiuril
and Lasix. empty the blood from the penis, which maintains the blood
in the penile tissue.
- Ace Inhibitors/Calcium Channel
Blockers medications e.g. Vasotec®, Lotension®, Cardizem®,
and Norvasc®. These generally represent an excellent alternative
medication for individuals with drug induced Erectile Dysfunction
.
Antidepressant/Antipsychotic
medications of almost any label can result in Erectile Dysfunction
e.g. Prozac®, Elavil®, Zoloft®, Thorazine®, and Haldol®.
Note: many other medications in a variety of classes can periodically
cause Erectile Dysfunction. If you take a prescription medication
or an over-the-counter medication, regularly, please consult with
your physician. Never alter a dosage or discontinue a medication without
the advice of your physician.
Smoking has been
linked to Erectile Dysfunction in numerous clinical studies.
The most common causes of the organic
component in erectile dysfunction or impotence are vascular abnormalities
associated with atherosclerosis and diabetes mellitus. Atherosclerosis
causes 40% of cases of erectile dysfunction, and in cases of diabetes
mellitus the prevalence of erectile dysfunction is 50%. Smoking is significantly
associated with the development of both atherosclerosis and diabetes
mellitus. The Epidemiology and Pathophysiology of Erectile Dysfunction.
The Journal of Urology 1999 Jan; 161(1):5-11
After smoking two cigarettes, the diameter of the internal pudendal
artery narrows and the penile arteries almost completely closed. This
evidence suggests that smoking can cause an acute vasospastic constriction
of the arteries in the penis. These observations are supported by physiological
evidence that nicotine causes acute peripheral vasoconstriction. Acute
Vasospasm of Penile Arteries in Response to Cigarette Smoking. Urology
1990; 36(1):99-100
Researchers at Wake Forest University
in Winston Salem, North Carolina concluded that male smokers who suffer
from long standing hypertension are 26 times more likely to be impotent
than those individuals who do not smoke. The Journal of Family Practice.
January 2000, Aside from impotence,smoking as also been linked to the
following negative effect concerning male sexual health:
- Reduced
volume of ejaculation
- Lowered sperm
count
- Abnormal sperm
shape
- Impaired sperm motility
LH-RH Analogs/Antiandrogen medications e.g. Lupron
Depot®, Eulexin®, Nilandron®, Casodex®, etc. are medications
used in the treatment of prostate cancer. They function by decreasing
the production of testosterone in the testes and adrenal glands, which
often results in Erectile Dysfunction
Chemotherapy/Radiation
therapy are also a significant contributor to Erectile Dysfunction.
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 Erectile
Dysfunction, as well as a decrease in desire. Excessive tobacco use
can also attribute to Erectile Dysfunction by accentuating the effects
of other risk factor such as vascular disease or hypertension.
Radical
Pelvic Surgery also result in Erectile Dysfunction. 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.
Psychological Erectile Dysfunction
is usually diagnosed when no physical causes can be defined. Pure psychological
Erectile Dysfunction usually occurs suddenly without warning as opposed
to physical Erectile Dysfunction that may gradually develop over the
years.
Some common causes of psychological Erectile Dysfunction are
as follows:
Performance anxiety
is one of the most common causes of psychological Erectile Dysfunction.
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 Erectile Dysfunction. 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, Peyronie's Disease, may also
cause Erectile Dysfunction . 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.
Male
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