Erectile Dysfunction (Impotence)
Erectile
Dysfunction (ED) is defined as the inability to achieve or maintain
an erection sufficient for mutually satisfying intercourse.
ED 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 ED increases with
age, it is not an inevitable result of aging. ED is a secondary
condition linked to many medical conditions.
The
first step in treating ED 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 than we can better understand the factors that are responsible
for ED 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,
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 become engorged with blood expanding and lengthening
the penis.
The
expanding tissue then exerts a positive pressure compressing the
veins that normally empty the blood from the penis, maintaining
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 ED 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 ED.
Physicians now understand that approximately eighty-five percent
of ED is attributable to physical/organic conditions while only
fifteen percent is due to psychological or mixed origin (both psychological
and organic). Some important causes of physiological ED are
as follows:
Vascular
Disease is the leading cause of ED. Vascular disorders
including arteriosclerosis (hardening of the arteries), hypertension,
hypercholestremia and other conditions which interfere with the
blood flow to the penis. Additionally, "venous leakage"
also contributes to poor erections. This condition occurs
when the penile veins are unable to constrict efficiently during
an erection. When these veins "leak" blood escapes
to the periphery resulting in a poor erection
Diabetes
is another common cause of ED. Approximately fifty percent
of men with diabetes (insulin dependent) experience some degree
of ED after the age of fifty-five. 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 ED develops.
Prescription
medications often cause ED as a side effect. Some
two hundred known medications fall into this category including:
- Antihypertensives
medications significantly:
- beta-blockers
e.g. Atenolol, Propanolol and Tenorium.
- Diuretics
medications e.g. HydroDiuril and Lasix.
- Ace
Inhibitors/Calcium Channel Blockers medications e.g.
Vasotec, Lotension, Cardizem, Norvasc periodically cause ED,
however, they are generally represent an excellent alternative
medication for individuals with drug induced ED.
- Antidepressant/Antipsychotic
medications of almost any label can also result in
ED e.g. Prozac, Elavil, Zoloft, Thorazine, Haldol. Note: Many
other medications in a variety of classes can periodically cause
ED. If you are taking a prescription medication or over-the-counter
medication, regularly, please consult with your physician.
However, never alter a dosage or discontinue a medication without
the advice of your physician.
- LH-RH
Analogs/Antiandrogen medications e.g. Lupron Depot®,
Eulexin, Nilandron®, Casodex®, etc. These medications
are used in the treatment of prostate cancer. They function
by decreasing the production of testosterone in the testes and
adrennal glands. The decrease in testosterone often results
in ED.
- Chemotherapy/Radiation
therapy are also significant contributors to ED. 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 ED, as well as a decrease in desire. Excessive
tobacco use can also attribute to ED by accentuating the effects
of other risk factor such as vascular disease or hypertension.
Radical
Pelvic Surgery also result in ED. 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.
Neurological
diseases such as multiple sclerosis, Parkinson's disease,
spinal cord injuries, long term effects of diabetes can also result
in the disruption of the normal sequence of events necessary for
an erection to occur.
Deficiencies
in the Endocrine System are another source of ED. 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.
Psychological ED is usually diagnosed when no physical
causes can be defined. Pure psychological ED usually occurs
suddenly without warning as opposed to physical ED that may gradually
develop over years. Some common causes of psychological ED
are as follows:
-
Performance
anxiety is one of the most common causes of psychological
ED. 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 ED. 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, Peyronies Disease, may also
cause ED. 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.
Treatment
of Erectile Dysfunction
Until
recently, individuals who sought medical treatment for ED were told
"It's all in your head". Physicians labeled these
individuals with a psychological disorder and they were referred
to counseling. Today, there are many treatment options available,
the treatment option you choose should be specific and responsive
to your needs and expectations as well as your partners. The
following is a summary ofthe more popular treatment options available
today:
Oral
Medications one in particular Viagra® (Sildenafil
Citrate) has change the course of treatment for
ED. Never has so much enthusiasm surrounded a prescription medication.
In the first six months alone, Pfizer's sales of the blue diamond
shaped tablet topped 50 million. Viagra® is dispensed as a pill
and ingested orally. Approximately 30-60 minutes later the
drug is absorbed into the bloodstream. Viagra® then functions
as an inhibitor to an enzyme found mainly in the penis. By
inhibiting this enzyme a series of natural occurring events, take
place resulting in increased blood flow to the penis thus generating
a fuller erection. Since the medication increases the levels
of a naturally occurring, process spontaneous erections do not occur.
Viagra® is essentially changing the way we treat ED. The medication
is manufactured by Pfizer pharmaceuticals.
ORDER
YOUR VIAGRA® ONLINE NOW!!!
Penile
Injection Therapy uses a hypodermic needle to inject medication
(mixture of papaverine, phentolamine and prostoglandin) into the
side of the penis.
The
drugrelaxes
the smooth muscle tissue of the penis allowing for an erection.
These injections can be painful, result in scare tissue formation
at the injection site and cause priapism (prolonged and painful
engorgement of the penis). The product is available through Pharmacia
and Upjohn (Caverjet) and Scharz Pharma, Inc (EDEX) at approximately
\\$18.00 per dose.
Urethral
Inserts consists of a disposable applicator, small
enough to fit into the urethra. The applicator is inserted
into the urethra approximately one inch and the medication (prostaglandin
E-1) is released. As a result, an erection occurs lasting
30-60 minutes. Patient acceptance is still an issue secondary
to expense and the low success rate as compared to other treatments
for ED. The inserts are available through the pharmaceutical company
Vivus Inc.
Vacuum
Therapy works by placing a cylinder with an attached
pump over the penis. The pump creates a vacuum in the cylinder,
which pulls blood into the penis tocreate an erection. The
cylinder is then removed while simultaneously a constriction band
is placed at the base of the penis. This will usually keep
the penis erect for up to thirty minutes, These devices range from
\\$150.00-400.00 and can be purchased through Mentor Urology, POST-T-VAC,
Inc., American Med Tech, Inc.
Hormonal
Therapy is used to treat the small percentage of individuals
who have abnormally low levels of testosterone. During the initial
consultation a physician will likely order hormone tests (LH and
Prolactin) first to exclude other causes of low testosterone levels.
If appropriate, testosterone is available in a transdermal adhesive
patch. The patch is available through Androderm (SmithKline
Beecham) and Testroderm (Alza Pharmaceuticals), at a cost
of \\$20.00 per patch.
Vascular
Surgery may involve both the arterial and venous
systems. Venous ligation has been reported to be effective
in patients with venous leakage. However, it is often difficult
to diagnose individuals with this condition given are current testing
capabilities; therefore, it is difficult to predict their outcome
prior to surgery. Arterial revasculation procedures are limited
to congenital or traumatic vascular abnormalities. Similar
to venous testing, complete standardization diagnostic testing has
not been established, so difficulties persists in predicting surgical
results.
Penile
Implants requires surgical insertion of a prosthetic device.
Three forms of penile prosthesis are currently available flexible,
malleable and inflatable.
Flexible
or Malleable rods consist of two semi-rigid, flexible rods which
make the penis firm enough for intercourse. There are also
inflatable prosthetic devices that produce a more natural erection.
When an erection is desired the pump (located in the scrotum) is
squeezed, this in turn inflates a cylinder creating an erection.
Following intercourse, the pump is released and the penis returns
too normal. These devices have been associated with postoperative
infections, mechanical failure, silicon particle shedding and the
risk of the initial surgery. These prosthetics are available
through American Medical Systems and Mentor Urology.
Herbal
Approaches are not currently regulated by the FDA
so it is difficult to ascertain whether their hype is warranted.
Furthermore, these products tend to suggest an aphrodisiac effect
(help with the loss of sexual desire) rather than improvement wit
ED.
Psychotherapy
and/or Behavioral Therapy have been found to be
beneficial in treating ED. Although the majority of causes
of ED are physical, there are quite frequently underlying psychosocial
factors involved as well. Psychotherapy and/or behavioral
therapy may be helpful in individuals whom no organic cause for
ED has been detected. Therapy often focuses on complications
surrounding performance anxiety, dysfunctional relationships, loss
of a partner, psychotic disorders, substance abuse, etc.
Partners
can provide support for individuals with ED. The condition
affects the relationships of more than 50 million Americans.
If you are a partner, you can make a difference through support
and education. For a list of Impotence Anonymous (IA®)
and I-ANON® chapters, call 1-800-669-1603 or email to.
Note:
All of the above mentioned treatments only treat ED, they do
not treat the underlying illnesses or disorders responsible for
the ED. The prolonged use of some these treatments in individuals
who have conditions such as those listed under causes of ED is inappropriate.
Please be responsible with your health. Schedule regular appointments
with your family physician and/or your urologist so they may address
and treat the underlying conditions responsible for your ED.
|
