Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.
Erectile dysfunction used to be known more widely as ‘impotence’ before the causes became better understood and successful treatments came into use. Impotence is a term that is still in use, however.
Erectile dysfunction (ED) is a common type of male sexual dysfunction. It is when a man has trouble getting or keeping an erection. ED becomes more common as you get older. But it’s not a natural part of aging.
Some people have trouble speaking with their doctors about sex. But if you have ED, you should tell your doctor. ED can be a sign of health problems. It may mean your blood vessels are clogged. It may mean you have nerve damage from diabetes. If you don’t see your doctor, these problems will go untreated.
Your doctor can offer several new treatments for ED. For many men, the answer is as simple as taking a pill. Getting more exercise, losing weight, or stopping smoking may also help.
- Penile erection occurs but it is not maintained for the length of sexual activity
- Penile erection that is not firm enough to penetrate the vagina
- Inability to obtain a penile erection.
The ability to achieve and sustain erections requires the following:
- A healthy nervous system that conducts nerve impulses in the brain, spinal column, and penis
- Healthy arteries in and near the corpora cavernosa
- Healthy smooth muscles and fibrous tissues within the corpora cavernosa
- Adequate levels of nitric oxide in the penis
- Erectile dysfunction can occur if one or more of these requirements are not met.
The following are causes of erectile dysfunction, and many men have more than one potential cause:
There are two reasons why older men are more likely to experience erectile dysfunction than younger men. First, older men are more likely to develop diseases (such as heart attacks, angina, cardiovascular disease, strokes, diabetes mellitus, and high blood pressure) that are associated with erectile dysfunction. Second, the aging process alone can cause erectile dysfunction in some men, primarily by decreasing the compliance of the tissues in the corpora cavernosa, although it has been suggested, but not proven, that there is also decreased production of nitric oxide in the nerves that supply the corporal smooth muscle within the penis.
Erectile dysfunction tends to develop 10-15 years earlier in diabetic men than among nondiabetic men. In a population study of men with type I diabetes for more than 10 years, erectile dysfunction was reported by 55% of men 50-60 years of age. The increased risk of erectile dysfunction among men with diabetes mellitus may be due to the earlier onset and greater severity of atherosclerosis that narrows the arteries and thereby reduces the delivery of blood to the penis. When insufficient blood is delivered to the penis, it is not possible to achieve an erection. Diabetes mellitus also causes erectile dysfunction by damaging both sensory and autonomic nerves, a condition called diabetic neuropathy. Smoking cigarettes, obesity, poor control of blood glucose levels, and having diabetes mellitus for a long time further increase the risk of erectile dysfunction in people with diabetes. In addition to atherosclerosis and/or neuropathy causing ED in diabetes, many men with diabetes also develop a myopathy (muscle disease) as their cause of ED in which the compliance of the muscles in the corpora cavernosa is decreased, and clinically this presents as an inability to maintain the erection.
Hypertension (high blood pressure):
People with essential hypertension or arteriosclerosis have an increased risk of developing erectile dysfunction. Essential hypertension is the most common form of hypertension; it is called essential hypertension because it is not caused by another disease (for example, by kidney disease). It is not clearly known how essential hypertension causes erectile dysfunction; however, those with essential hypertension have been found to have low production of nitric oxide by the arteries of the body, including the arteries in the penis. High blood pressure also accelerates the progression of atherosclerosis, which in turn can contribute to erectile dysfunction. Scientists now suspect that the decreased levels of nitric oxide in patients with essential hypertension may contribute to erectile dysfunction.
The most common cause of cardiovascular diseases in the United States is atherosclerosis, the narrowing and hardening of arteries that reduces blood flow. Atherosclerosis typically affects arteries throughout the body and is aggravated by hypertension, high blood cholesterol levels, cigarette smoking, and diabetes mellitus. When coronary arteries (arteries that supply blood to the heart muscle) are narrowed by atherosclerosis, heart attacks and angina occur. When cerebral arteries (arteries that supply blood to the brain) are narrowed by atherosclerosis, strokes occur. Similarly, when arteries to the penis and the pelvic organs are narrowed by atherosclerosis, insufficient blood is delivered to the penis to achieve an erection. There is a close correlation between the severity of atherosclerosis in the coronary arteries and erectile dysfunction. For example, men with more severe coronary artery atherosclerosis also tend to have more erectile dysfunction than men with mild or no coronary artery atherosclerosis. Some doctors suggest that men with new onset erectile dysfunction should be evaluated for silent coronary artery diseases (advanced coronary artery atherosclerosis that has not yet caused angina or heart attacks).
Cigarette smoking aggravates atherosclerosis and thereby increases the risk for erectile dysfunction.
Nerve or spinal cord damage: Damage to the spinal cord and nerves in the pelvis can cause erectile dysfunction. Nerve damage can be due to disease, trauma, or surgical procedures. Examples include injury to the spinal cord from automobile accidents, injury to the pelvic nerves from prostate surgery for cancer (prostatectomy), radiation to the prostate, surgery for benign prostatic enlargement, multiple sclerosis (a neurological disease with the potential to cause widespread damage to nerves), and long-term diabetes mellitus.
Marijuana, heroin, cocaine, methamphetamines, crystal meth, and alcohol abuse contribute to erectile dysfunction. Alcoholism, in addition to causing nerve damage, can lead to atrophy (shrinking) of the testicles and lower testosterone levels.
Low testosterone levels:
Testosterone (the primary sex hormone in men) is not only necessary for sex drive (libido) but also is necessary to maintain nitric oxide levels in the penis. Therefore, men with hypogonadism (diminished function of the testes resulting in low testosterone production) can have low sex drive and erectile dysfunction.
Many common medicines produce erectile dysfunction as a side effect. Medicines that can cause erectile dysfunction include many used to treat high blood pressure, antihistamines, antidepressants, tranquilizers, and appetite suppressants. Examples of common medicines that can cause erectile dysfunction include propranolol (Inderal) or other beta-blockers, hydrochlorothiazide, digoxin (Lanoxin), amitriptyline (Elavil), famotidine (Pepcid), cimetidine (Tagamet), metoclopramide (Reglan), indomethacin (Indocin), lithium (Eskalith, Lithobid), verapamil (Calan, Verelan, Isoptin), phenytoin (Dilantin), gemfibrozil (Lopid), amphetamine/dextroamphetamine (Adderall), and phentermine.
Depression and anxiety: Psychological factors may be responsible for erectile dysfunction. These factors include stress, anxiety, guilt, depression, widower syndrome, low self-esteem, posttraumatic stress disorder, and fear of sexual failure (performance anxiety). It is also worth noting that many medications used for treatment of depression and other psychiatric disorders may cause erectile dysfunction or ejaculatory problems.
A man has erectile dysfunction when his penis has regularly failed to give an erection that has been good enough to achieve or maintain sexual penetration.
Most men at some point experience some difficulty with their penis becoming hard, or with maintaining an erection, but this is not erectile dysfunction, which is considered a disorder only if satisfactory sexual performance has been impossible on a persistent number of occasions for some time.
Doctors may look for symptoms to have persisted for at least three months before investigating them further and considering a diagnosis of erectile dysfunction needing treatment.
There is a simple test to offer some suggestion that the problem may have a medical cause rather than a psychological one – men with psychogenic erectile dysfunction usually have normal erections during sleep and as they wake up in the morning, whereas an organic cause will often prevent these erections.
Known as the ‘postage stamp test,’ it checks for the presence of nighttime erections – of which men usually have three to five a night – by seeing if postage stamps applied around the penis before sleep have snapped off overnight.
Other tests of nocturnal erection are the Poten test and Snap-Gauge test. These methods provide limited information, however, and simply lead the doctor in a diagnostic direction.
It is always worth talking to your doctor about problems with erection because they can be the earliest signal of atherosclerotic disease – narrowing of the arteries, which can lead to heart disease.
Erectile Dysfunction Treatment
Erectile dysfunction can be treated at any age. Treatment depends on your overall health and the underlying cause of the problem.
Discussing Erectile Dysfunction With Your Doctor
Unfortunately, some men are reluctant or embarrassed to discuss sexual matters with their doctor. As a result, they don’t get the help that could resolve their problem with ED.
Treatment for Erectile Dysfunction: Lifestyle Change
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Erectile Dysfunction Vacuums
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Erectile Dysfunction Surgery
Surgery can improve the blood flow to the penis, thus improving erections.
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Yohimbe Bark Supplements
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Alprostadil is a type of medicine that causes blood vessels to expand, increasing blood flow throughout the body. By increasing blood flow to the penis, alprostadil helps facilitate an erection.
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Hormonal Therapy for Erection Problems
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Testosterone Replacement Therapy
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Horny Goat Weed (Epimedium)
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Sexual Pleasure with Impotence
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