The term erectile dysfunction has replaced the outdated term impotence. The word “impotence” is no longer used, because it does not give a clear explanation of the problem. Moreover, the use of this term led to an incorrect understanding of this condition. Men suffering from erectile dysfunction are not sterile and they retain the ability to ejaculation and orgasm, as all other men. They also have all the normal male sex characteristics. Erectile dysfunction (ED) can be defined as “inability to achieve and (or) to maintain an erection sufficient for satisfactory sexual activity.”
Most men have problems with achieving and maintaining an erection at some time in their lives, possibly due to excessive stress, receiving large amounts of alcohol, or simply fatigue. However, if this problem persists, it most likely is associated with erectile dysfunction. ED affects 100 million men worldwide and 30 million men in the United States. The study of men’s health showed the overall prevalence of ED, equal to 39% in the United Kingdom, Germany, France, Canada, Italy and Spain.
Study IMSM (Massachusetts study on issues of aging men) found that 52% of men aged 40 to 70 years in varying degrees, suffered from erectile dysfunction. A lot of men with erectile dysfunction suffer in silence because they believe that it is artificial problem that they have to put up with her because they grow old or because this problem cannot be resolved.
About erectile dysfunction (ED)?
Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. It’s also sometimes referred to as impotence. Erectile dysfunction (ED) occurs when a man has consistent and repeated problems sustaining an erection. Without treatment, ED can make sexual intercourse difficult. The problem is reported by 1 in 5 men and that number increases with age. Occasional ED isn’t uncommon. Many men experience it during times of stress. Frequent ED can be a sign of health problems that need treatment. It can also be a sign of emotional or relationship difficulties that may need to be addressed by a professional. A man is considered to have erectile dysfunction if he regularly finds it difficult getting or keeping a firm enough erection to be able to have sex, or if it interferes with other sexual activity. Most men have occasionally experienced some difficulty with their penis becoming hard or staying firm. However, erectile dysfunction is only considered a concern if satisfactory sexual performance has been impossible on a number of occasions for some time.
Broadly, two forms of erectile dysfunction can affect men’s sex lives – the main cause is either medical or psychosocial.
- Medical– these are illnesses or anatomical changes that prevent the penis from becoming or staying erect.
- Psychosocial– this refers to psychological influences on sexual performance; it might include problems within a relationship or stress at work.
It is important to note that there can be overlap between medical and psychosocial causes. For instance, if a man is obese, blood flow changes can affect his ability to maintain an erection (a medical cause); he may also have low self-esteem, which can also impact erectile function (psychosocial cause).
Drug treatments for erectile dysfunction
Men can take a group of drugs called PDE-5 (phosphodiesterase-5) inhibitors.
Most of these pills are taken 30-60 minutes before sex – the best known being the blue-colored pill sildenafil (Viagra). Other options are:
- vardenafil (Levitra)
- tadalafil (taken as a once-daily pill; Cialis)
- avanafil (Stendra)
PDE-5 inhibitors are only available on prescription. A doctor will check for heart conditions and ask about other medications being taken before prescribing.
Side-effects associated with PDE-5 inhibitors include:
- visual abnormalities
- hearing loss
Less commonly used drug options include prostaglandin E1, which is applied locally, into the penis (either injected into it or inserted down the opening into the urethra). Most men prefer a pill, however, so these locally acting drugs tend to be reserved for men who cannot take oral treatment.
Not all male sexual problems are caused by ED. Other types of male sexual dysfunction include:
- premature ejaculation
- delayed or absent ejaculation
- lack of interest in sex
ED vs. Poor Libido
There are several forms of male sexual dysfunction, including poor libido and problems with ejaculation. But ED refers specifically to problems achieving or maintaining an erection. Men with ED often have a healthy libido, yet the body fails to respond. In most cases, there is a physical basis for the problem.
What are the symptoms of ED?
You may have erectile dysfunction if you regularly have:
- trouble getting an erection
- difficulty maintaining an erection during sexual activities
- reduced interest in sex
- Erections that are too soft for sexual intercourse.
- Erections that are too brief for sexual intercourse.
- An inability to achieve erections.
Other sexual disorders related to ED include:
- premature ejaculation
- delayed ejaculation
- anorgasmia, which is the inability to achieve orgasm after ample stimulation
You should talk to your doctor if you have any of these symptoms, especially if they’ve lasted for two or more months. Your doctor can determine if your sexual disorder is caused by an underlying condition that requires treatment.
Who Gets ED?
Sexual dysfunction and ED become more common as men age. The percentage of complete ED increases from 5% to 15% as age increases from 40 to 70 years. But this does not mean growing older is the end of your sex life. ED can be treated at any age. Also, ED may be more common in Hispanic men and in those with a history of diabetes, obesity, smoking, and hypertension. Research shows that African-American men sought medical care for ED twice the rate of other racial groups.
The Mechanics of ED
An erection occurs when blood fills two chambers known as the corpora cavernosa. This causes the penis to expand and stiffen, much like a balloon as it is filled with air. The process is triggered by impulses from the brain and genital nerves. Anything that blocks these impulses or restricts blood flow to the penis can result in ED.
Causes of ED: Chronic Disease
The link between chronic disease and ED is most striking for diabetes. Men who have diabetes are two to three times more likely to have erectile dysfunction than men who do not have diabetes. Among men with erectile dysfunction, those with diabetes may experience the problem as much as 10 to 15 years earlier than men without diabetes. Yet evidence shows that good blood sugar control can minimize this risk. Other conditions that may cause ED include cardiovascular disease, atherosclerosis (hardening of the arteries), kidney disease, and multiple sclerosis. These illnesses can impair blood flow or nerve impulses throughout the body.
There are many possible causes for ED, and they can include both emotional and physical disorders. Some common causes are:
- cardiovascular disease
- damage from cancer or surgery
- obesity or being overweight
- increased age
- relationship problems
- drug use
- alcohol use
ED can be caused by only one of these factors or several. That’s why it’s important to work with your doctor so that they can rule out or treat any underlying medical conditions.
Surgery, including treatments for prostate cancer, bladder cancer, or BPH can sometimes damage nerves and blood vessels near the penis. In some cases, the nerve damage is permanent, and the patient will require treatment to achieve an erection. In others, surgery causes temporary ED that improves on its own after 6 to 18 months.
ED may be a side effect of medication, including certain blood pressure drugs, antidepressants, and tranquilizers. Men should talk with their doctor if they suspect a prescription or over-the-counter drug may be causing erectile problems. Never stop any medicine without first consulting your doctor.
ED usually has something physical behind it, particularly in older men. But psychological factors can be a factor in many cases of ED. Experts say stress, depression, poor self-esteem, and performance anxiety can short-circuit the process that leads to an erection. These factors can also make the problem worse in men whose ED stems from something physical.
ED and Bicycling
Research suggests avid cyclists suffer more ED than other athletes. The trouble lies in the shape of some bicycle seats that put pressure on the perineum. This area between the anus and scrotum contains arteries and nerves vital to sexual arousal. Cyclists who ride for many hours each week may benefit from seats designed to protect the perineum.
Diagnosing ED: Physical Exam
To diagnose ED, your doctor will ask you questions about your symptoms and medical history. The doctor will conduct a complete physical exam to uncover signs such as poor circulation or nerve trouble. And your physician will look for abnormalities of the genital area that could cause problems with erections.
Physical causes of erectile dysfunction
It is always worth consulting a physician about persistent erection problems, as it could be caused by a serious medical condition.
Whether the cause is simple or serious, a proper diagnosis can help to address any underlying medical issues and help resolve sexual difficulties.
The following list summarizes many of the most common physical or organic causes of erectile dysfunction:
- Heart diseaseand narrowing of blood vessels.
- High blood pressure.
- High cholesterol.
- Obesityand metabolic syndrome.
- Parkinson’s disease.
- Multiple sclerosis.
- Hormonal disorders including thyroid conditions and testosteronedeficiency (hypogonadism).
- Structural or anatomical disorder of the penis, such as Peyronie disease.
- Smoking, alcoholism, and substance abuse, including cocaine use.
- Treatments for prostate disease.
- Surgical complications.
- Injuries in the pelvic area or spinal cord.
- Radiation therapyto the pelvic region.
Atherosclerosis is a common cause of blood flow problems. Atherosclerosis causes a narrowing or clogging of arteries in the penis, preventing the necessary blood flow to the penis to produce an erection.
Numerous prescription medications can also cause erectile dysfunction, including those below (anyone taking prescription medications should consult their doctor before stopping or changing their medications):
- Drugs to control high blood pressure.
- Heart medications such as digoxin.
- Some diuretics (known as ‘water pills’ that increase urine output).
- Drugs that act on the central nervous system(on the brain or spinal cord), including some sleeping pills and amphetamines.
- Anxietytreatments (anxiolytics).
- Antidepressants, including monoamine oxidase inhibitors (MAOIs), selective serotoninreuptake inhibitors (SSRIs), and tricyclic antidepressants.
- Opioid painkillers.
- Some cancer drugs, including chemotherapeutic agents.
- Prostate treatment drugs.
- Hormone drugs.
- The peptic ulcermedication cimetidine.
Physical causes account for 90 percent of erectile dysfunction cases, with psychological causes much less common.
Diagnosing ED: Lab Tests
Several lab tests can help diagnose male sexual problems. Measuring testosterone levels can determine whether there is a hormonal imbalance, which is often linked to decreased desire. Blood cell counts, blood sugar levels, cholesterol levels, and liver function tests can reveal medical conditions that may account for ED.
ED: A Sign of Heart Disease?
In some cases, ED can be a warning sign of more serious disease. One study suggests ED is a strong predictor of heart attack, stroke, and death from cardiovascular disease. The researchers say all men diagnosed with ED should be evaluated for cardiovascular disease. This does not mean every man with ED will develop heart disease, or that every man with heart disease has ED, but patients should be aware of the link.
Treating ED: Lifestyle Changes
Many men with ED are able to improve sexual function by making a few lifestyle changes. Giving up smoking, losing weight, and exercising more often can help by improving blood flow. If you suspect a medication could be contributing to ED, talk to your doctor about adjusting the dosage or switching to another drug.
Treating ED: Oral Medications
You’ve probably heard of Viagra, but it’s not the only pill for ED. This class of drugs also includes Cialis, Levitra, Staxyn, and Stendra. All work by improving blood flow to the penis during arousal. They’re generally taken 30-60 minutes before sexual activity and should not be used more than once a day. Cialis can be taken up to 36 hours before sexual activity and also comes in a lower, daily dose. Staxyn dissolves in the mouth. All require an OK from your doctor first for safety.
Treating ED: Injections
While pills for ED are convenient, some men sustain stronger erections by injecting medication directly into the penis. Drugs approved for this purpose work by widening the blood vessels, causing the penis to become engorged with blood. Another option is inserting a medicated pellet into the urethra. The pellet can trigger an erection within 10 minutes.
Treating ED: Vacuum Devices (Pumps)
Vacuum devices for ED, also called pumps, offer an alternative to medication. The penis is placed inside a cylinder. A pump draws air out of the cylinder, creating a partial vacuum around the penis. This causes it to fill with blood, leading to an erection. An elastic band worn around the base of the penis maintains the erection during intercourse.
Treating ED: Surgery
If ED is caused by a blockage in an artery leading to the penis, surgery can often restore blood flow. Good candidates are typically younger men whose blockage stems from an injury to the crotch or pelvis. The procedure is not recommended for older men with widespread narrowing of the arteries.
Treating ED: Implants
In men with persistent ED, a penile implant can restore sexual function. An inflatable implant uses two cylinders that are surgically placed inside the penis. When an erection is desired, the man uses a pump to fill the cylinders with pressurized fluid. Another option is a malleable implant, which bolsters erections with surgically implanted rods.
Treating ED: Psychotherapy
Even when ED has a known physical cause, psychotherapy can be beneficial. A therapist can teach the man and his partner techniques to reduce performance anxiety and improve intimacy. Therapy can also help couples adjust to the use of vacuum devices and implants.
Treating ED: Alternative Therapies
Talk with your doctor before trying supplements for ED. They can contain 10 or more ingredients and may complicate other health conditions. Asian ginseng and ginkgo biloba (seen here) are popular, but there isn’t a lot of good research on their effectiveness. Some men find that taking a DHEA supplement improves their ability to have an erection. Unfortunately, the long-term safety of DHEA supplements is unknown. Most doctors do not recommend using it.
Treating ED: Buyer Beware
A quick web search will reveal dozens of “dietary supplements” that claim to treat ED. But the FDA warns that many of these are not what they seem. An investigation discovered the pills often contain prescription drugs not listed on the label, including the active ingredient in Viagra. This puts the man at risk for dangerous drug interactions.
ED: Reducing the Risk
Some tips to reduce the risk of ED include:
- Exercise and maintain a healthy weight.
- Stop smoking.
- Avoid alcohol and substance abuse.
- Keep diabetes under control.
- Discussing ED With Your Partner
- It’s natural to feel angry or embarrassed when dealing with ED. But don’t forget that your partner is also affected. Talking openly about ED will help your partner understand the diagnosis and treatment options. This can reassure a partner that you haven’t lost interest.
What causes an erection?
An erection is the result of increased blood flow into your penis. Blood flow is usually stimulated by either sexual thoughts or direct contact with your penis.
When a man becomes sexually excited, muscles in their penis relax. This relaxation allows for increased blood flow through the penile arteries. This blood fills two chambers inside the penis called the corpora cavernosa. As the chambers fill with blood, the penis grows rigid. Erection ends when the muscles contract and the accumulated blood can flow out through the penile veins.
ED can occur because of problems at any stage of the erection process. For example, the penile arteries may be too damaged to open properly and allow blood in.
How does age affect incidence of ED?
Up to 30 million American men are affected by ED, according to the National Institute of Diabetes and Digestive and Kidney Diseases. The prevalence of ED increases with age. ED affects:
- 12 percent of men younger than 60
- 22 percent of men in their 60s
- 30 percent of men 70 or older
Although the risk of ED increases with age, ED is not inevitable as you get older. It may be more difficult to get an erection as you age, but that doesn’t necessarily mean you will develop ED. In general, the healthier you are, the better your sexual function.
Online pharmacies selling drugs for erectile dysfunction
It is possible to buy treatment over the internet for erectile dysfunction; however, it is advisable to exercise caution.
The Food and Drug Administration has a consumer safety guide about this, including a recommendation to check that the online pharmacy:
- Is located in the U.S. and licensed (check the list maintained by the National Association of Boards of Pharmacy).
- Has a licensed pharmacist to answer questions.
- Requires a prescription.
- Offers direct contact with a person who can discuss any problems.
The FDA also offers tips for spotting the dangers of an unsafe website, including watching out for the following clues:
- There is no way to contact the website by phone.
- Prices are dramatically lower than those offered by legal online pharmacies.
- Prescription drugs are offered without requiring a prescription – which is illegal.
- Personal information is not protected.
The FDA adds that these illegal sites may send drugs of unknown quality and origin, even sending the wrong drug or a dangerous product.
How is ED diagnosed?
Your doctor will ask you questions about your symptoms and health history. They may do tests to determine if your symptoms are caused by an underlying condition. You should expect a physical exam where your doctor will listen to your heart and lungs, check your blood pressure, and examine your testicles and penis. They may also recommend a rectal exam to check your prostate. Additionally, you may need blood or urine tests to rule out other conditions.
Nocturnal penile tumescence (NPT) test
An NPT test is done using a portable, battery-powered device that you wear on your thigh while you’re sleeping. The device evaluates the quality of nocturnal erections and stores the data, which your doctor can later access. Your doctor can use this data to better understand your penis function and ED.
Nocturnal erections are erections that occur while you’re sleeping, and they’re a normal part of a healthily functioning penis.
Your doctor may prescribe medication to help manage your symptoms of ED. You may need to try several medications before you find one that works. These medications can have side effects. If you’re experiencing unpleasant side effects, talk to your doctor. They may be able to recommend a different medication.
The following medications stimulate blood flow to your penis to help treat ED:
- alprostadil (Caverject)
- avanafil (Stendra)
- sildenafil (Viagra)
Natural remedies and herbs for ED
For some men, natural remedies may help treat ED. Talk to your doctor before trying a new supplement or herb.
You should also use caution when buying supplements and herbs. Many aren’t regulated, which means they may contain additional ingredients not listed on the labels. Ask your doctor to recommend reputable brands and avoid purchasing supplements online.
The following herbs and supplements have been shown to have varying degrees of success for the treatment of ED:
- Asparagus racemosus
Psychological factors are a common cause of ED, including:
- post-traumatic stress disorder (PTSD)
If you’re experiencing psychological ED, you may benefit from talk therapy. Therapy can help you manage your mental health. You’ll likely work with your therapist over several sessions, and your therapist will address things like major stress or anxiety factors, feelings around sex, or subconscious conflicts that could be affecting your sexual well-being.
Some men use a form of massage therapy called prostatic massage. Practitioners massage the tissues in and around your groin to promote blood flow to your penis. There are limited studies on the efficacy of this type of massage.
Acupuncture may help treat psychological ED, though studies are limited and inconclusive. You’ll likely need several appointments before you begin to notice any improvements. When choosing an acupuncturist, look for a certified practitioner who uses disposable needles and follows U.S. Food and Drug Administration guidelines for needle disposal and sterilization.
Pelvic floor muscle exercises
A small study of 55 men saw improvement to penile function after three months of regular pelvic floor muscles exercises, and after six months, 40 percent of men had regained normal erectile function. Kegel exercises are a simple exercise you can use to strengthen your pelvic floor muscles. Here’s how you do them:
- Identify your pelvic floor muscles. To do this, stop peeing midstream. The muscles you use to do this are your pelvic floor muscles. Your testicles will also rise when you contract these muscles.
- Now that you know where these muscles are, contract them for 5 to 20 seconds. Then release them.
- Repeat this exercise 10 to 20 times in a row, three to four times a day.
Lifestyle changes and diet
Lifestyle choices that impair blood circulation can contribute to ED. Smoking, excessive drinking, and drug abuse may damage the blood vessels and reduce blood flow to the penis. Smoking makes men with atherosclerosis particularly vulnerable to ED. Being overweight and getting too little exercise also contribute to ED. Studies indicate that men who exercise regularly have a lower risk of ED.
Healthy lifestyle habits may prevent ED, and in some situations reverse the condition:
- Exercise regularly.
- Maintain a low blood pressure.
- Eat a balanced, nutritious diet.
- Maintain a healthy weight.
- Avoid alcohol and cigarettes.
- Reduce your stress.
ED is often related to problems with your blood flow, so maintaining your blood vessel health through exercise and a healthy diet may help reduce your risk for ED.
change your medications
In some cases, medications used to treat other conditions may cause ED. Talk to your doctor about medications you’re taking and whether they could be causing your symptoms. There may be other medications you can take instead.
Don’t stop taking medications without first talking to your doctor.
Is ED reversible?
In many cases, you can improve your symptoms of ED. Many medications and treatments are available. As well, certain devices, like an erectile dysfunction pumpor erectile dysfunction ring, may help temporarily manage symptoms of ED so that you can continue to engage in sexual intercourse.
ED is a common condition, and it has many possible causes. Discuss your symptoms with your doctor early so that they can rule out underlying causes and begin a treatment plan.
Vacuum erection devices are a mechanical way of producing an erection for men who do not want or cannot use drug treatments, or find they are not working. The penis is made rigid by the use of a vacuum pump sealed around it that draws up blood – this is prevented from then leaving the penis by the use of an accompanying band.
The lack of spontaneity with the use of vacuum devices means that many men find other treatments for erectile dysfunction preferable.
Tests and diagnosis for erectile dysfunction
The numerous potential causes of erectile dysfunction means that a doctor will typically ask a lot of questions and arrange for blood tests to be performed. Such tests can check for heart problems, diabetes, and low testosterone, among other things. The doctor will also carry out a physical examination, including of the genitals.
Before considering a diagnosis of erectile dysfunction that requires treatment, a doctor will look for symptoms that have persisted for at least 3 months. Once a patient’s history has been established, a doctor will then undertake further investigation. One simple test, known as the ‘postage stamp test,’ can be helpful in determining if there is a medical cause of erectile dysfunction rather than a psychological one. This test checks for the presence of erections at night – men usually have 3-5 a night – by seeing if postage stamps applied around the penis before sleep have snapped off overnight. Other tests of nocturnal erection include the Poten test and Snap-Gauge test. These methods provide limited information but can help guide a doctor’s choice of further tests.
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