Erectile Dysfunction: Information

Erectile dysfunction, sometimes called "impotence," is the repeated inability to get 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 lack of sexual desire and problems with ejaculation or orgasm. Using the term erectile dysfunction makes it clear that those other problems are not involved.

Most men experience this at some point in their lives, usually by age 40, and are not psychologically affected by it. Some men, however, experience chronic, complete erectile dysfunction (impotence), and others, partial or brief erections. Frequent erectile dysfunction can cause emotional and relationship problems, and often leads to diminished self-esteem. Erectile Dysfunction has many causes, most of which are treatable, and is not an inevitable consequence of aging.

Incidence of the disorder increases with age. Chronic Erectile Dysfunction affects about 5% of men in their 40s and 15-25% of men by the age of 65. Transient ED and inadequate erection affect as many as 50% of men between the ages of 40 and 70.

Diseases (e.g., diabetes, kidney disease, alcoholism, atherosclerosis) account for as many as 70% of chronic Erectile Dysfunction cases and psychological factors (e.g., stress, anxiety, depression) may account for 10-20% of cases. Between 35 and 50% of men with diabetes experience ED.

Causes of Erectile Dysfunction

• Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.
• Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases-such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease-account for about 70 percent of ED cases. Between 35 and 50 percent of men with diabetes experience ED.
• Also, surgery (especially radical prostate and bladder surgery for cancer) can injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.
• In addition, many common medicines-blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and Cimetidine (an ulcer drug)-can produce ED as a side effect.
• Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20 percent of ED cases. Men with a physical cause for ED frequently experience the same sort of psychological reactions (stress, anxiety, guilt, depression).
• Spinal cord and brain injuries (e.g., paraplegia, stroke) can cause impotence when they interrupt the transfer of nerve impulses from the brain to the penis. Other nerve disorders, such as multiple sclerosis, Parkinson's disease, and Alzheimer's disease, may also result in impotence.
• Trauma to the pelvic region or spinal cord can damage veins and nerves needed for erection. Surgery of the colon, prostate, bladder, or rectum may damage the nerves and blood vessels involved in erection. Prostate and bladder cancer surgery often require removing tissue and nerves surrounding a tumor, which increases the risk for impotence.
• Radical cystectomy (for bladder cancer) and prostatectomy (for prostate cancer) require cutting or removing nerves that control penile blood flow. These nerves do not control sensation in the penis and are not responsible for orgasms; only erection is affected by these procedures.
• Radiation therapy for prostate or bladder cancer also can permanently damage these nerves.
• Hormone disorders account for fewer than 5% of cases of impotence. Testosterone deficiency, which occurs rarely, can result in a loss of libido (sexual desire) and loss of erection. Among other conditions, an excess of the hormone prolactin, caused by pituitary gland tumor, reduces levels of testosterone. Hormone imbalances can also result from kidney or liver disease.
• Peyronie's disease is a rare inflammatory condition that causes scarring of erectile tissue. Scarring produces curvature of the penis that can interfere with sexual function and cause painful erections.
• If the veins in the penis cannot prevent blood from leaving the penis during erection, erection cannot be maintained. Venous leak can be a result of injury, disease, or damage to the veins in the penis.
• Other possible causes are smoking, which affects blood flow in veins and arteries.

Treatment of Erectile Dysfunction: Non- Surgical Treatment

Sex Therapy

A significant number of men develop impotence from psychological causes that can be overcome. When a physiological cause is treated, subsequent self-esteem problems may continue to impair normal function and performance. Qualified therapists (e.g., sex counselors, psychotherapists) work with couples to reduce tension, improve sexual communication, and create realistic expectations for sex, all of which can improve erectile function.

Psychological therapy may be effective in conjunction with medical or surgical treatment. Sex therapists emphasize the need for men and their partners to be motivated and willing to adapt to psychological and behavioral modifications, including those that result from medical or surgical treatment.

Medical Treatment

Oral Medication

Oral medications used to treat erectile dysfunction include selective enzyme inhibitors (e.g., sildenafil [Sildenafil Citrate tablets], vardenafil HCl [Levitra], tadalafil [Tadalafil]) and yohimbine (Yohimbine, Yocon).

Selective enzyme inhibitors are available by prescription and may be taken up to once a day to treat ED. They improve partial erections by inhibiting the enzyme that facilitates their reduction and increase levels of cyclic guanosine monophosphate (cGMP, a chemical factor in metabolism), which causes the smooth muscles of the penis to relax, enabling blood to flow into the corpora cavernosa.

Patients taking nitrate drugs (used to treat chest pain) and those taking alpha-blockers (used to treat high blood pressure and benign prostatic hyperplasia) should not take selective enzyme inhibitors.

Men who have had a heart attack or stroke within the past 6 months and those with certain medical conditions (e.g., uncontrolled high blood pressure, severe low blood pressure or liver disease, unstable angina) that make sexual activity inadvisable should not take Tadalafil. Dosages of the drug should be limited in patients with kidney or liver disorders.

Sildenafil Citrate tablets is absorbed and processed rapidly by the body and is usually taken 30 minutes to 1 hour before intercourse. Results vary depending on the cause of erectile dysfunction, but studies have shown that Sildenafil Citrate tablets is effective in 75% of cases. It helps men with erectile dysfunction associated with diabetes mellitus (57%), spinal cord injuries (83%), and radical prostatectomy (43%).

In clinical studies, Levitra has been shown to work quickly, provide consistent results, and improve sexual function in most men the first time they take the drug. It also has shown to be effective in men of all ages, in patients with diabetes mellitus, and in men who have undergone radical prostatectomy.

Generic Tadalafil has been shown in clinical trials to stay in the body longer than the other selective enzyme inhibitors. Generic Tadalafil promotes erection within 30 minutes and enhances the ability to achieve erection for up to 36 hours.

Yohimbine improves erections for a small percentage of men. It stimulates the parasympathetic nervous system, which is linked to erection, and may increase libido. It is necessary to take the medication for 6 to 8 weeks before determining whether it will work or not.

Ease of administration makes oral medication advantageous. Some drugs, however, are suitable for only a relatively small group of men, and in many cases, oral medications may by less effective than other treatments.

Self-Injection

Self-injection involves using a short needle to inject medication through the side of the penis directly into the corpus cavernosum, which produces an erection that lasts from 30 minutes to several hours. Prostaglandin (alprostadil, Caverject, Edex), and phentolamine (Regitine) produce results similar to Generic Sildenafil Citrate tablets but are localized in the penis after injection. They cause vascular dilation and a relaxation of smooth muscle. Prostaglandin is the only substance currently approved for erectile dysfunction treatment. Phentolamine is a heart medicine with similar effects used by some physicians to treat impotence.

All these drugs have been shown to produce erections in 80% of men who inject them. Some men claim that they produce erections that feel natural and improve sex. The injections are relatively painless and create an erection that begins about 5 to 15 minutes after the injection. It is recommended that self-injection be performed no more than once every 4 to 7 days.

Urethral suppositories

Urethral suppositories containing prostaglandin (aprostadil), like Muse (Medicated Urethral System for Erections), may be an alternative to injection. Using a hand-held delivery device, a man inserts a prostaglandin pellet through the meatus (penis opening) into the urethra. Prostaglandin is absorbed through the urethral mucosa and into the surrounding erectile tissue. It is available with a prescription, is well tolerated, and may improve erections in 60% of men who use it.

In addition to the side effects associated with injecting aprostadil, pain in the penis and perineum (area between scrotum and rectum) may occur with suppository use.

Penis: Information

The internal structure of the penis consists of two cylinder-shaped vascular tissue chambers (corpora cavernosa) that run throughout the penis. A spongy tissue fills the chambers. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The Corpora cavernosa are surrounded by a membrane, called the tunica albuginea.

The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa and is surrounded by the corpus spongiosum. The longest part of the penis is the shaft, at the end of which is the head, or glans penis. The opening at the tip of the glans, which allows for urination and ejaculation, is the meatus.

Anatomy of the Penis. Explanation: Arteries and veins penetrate the long, filled cavities running the length of the penis-the corpora cavernosa and the corpous sponglosum. Erection occurs when relaxed muscles allow the corpora cavernosa to fill with excess blood fed by the arteries, while drainage of blood through the veins is blocked.

Side effects of Anti-Impotency Drugs

Common side effects of selective enzyme inhibitors include headache, reddening of the face and neck (flushing), indigestion, and nasal congestion. Tadalafil may cause muscle aches and back pain, which usually resolve on their own within 48 hours.

Yohimbine has a stimulatory effect and side effects include elevated heart rate and blood pressure, mild dizziness, nervousness, and irritability. Yohimbine's effects have not been studied thoroughly, but some studies suggest that 10% to 20% of men respond to treatment with the drug.

Side effects of self-injection include infection, bleeding, and bruising at the injection site, dizziness, heart palpitations, and flushing. There is a small risk for priapism (an erection that lasts for more than 6 hours and requires medical relief). Repeated injection may cause scarring of erectile tissue, which can further impair erection.