Erectile Dysfunction

Erectile dysfunction used to be called "impotence" and involves the repetitive inability to get or maintain an erection significant enough for sexual intercourse. It can relate to problems with sexual desire, ejaculation or a lack of an orgasm but is not synonymous with these disorders.

Erectile dysfunction is also called ED. It can be a total, partial, or intermittent inability to achieve or maintain an erection. It can be a tendency to have only brief erections. There are about 15 to 30 million men in the US who suffer from erectile dysfunction, and, since the advent of medications for erectile dysfunction, there has been a huge increase in the number of doctor's visits for erectile dysfunction. In fact, around 22 out of every 1000 men see the doctor for erectile dysfunction and this is expected to increase with more men reaching an older age.

Erectile dysfunction has a physical cause in older men, including medications, injury, or medical diseases. Erectile dysfunction comes from any disease that damages the blood flow or the nerves of the penis. The incidence of erectile dysfunction increases with age, with about 5 percent of men at age 40 having ED and between 15 and 25 percent of men aged 65 having ED. It is not, however, an inevitable part of aging.

An erection happens when blood fills the corpora cavernosa, two chambers in the length of the organ. It contains spongy tissue that contains smooth muscle, veins, arteries and fibrous tissue. The urethra runs beneath the corpora cavernosa and is surrounded by the corpus spongiosum. When there is physical or mental stimulation, the muscles of the corpora cavernosa relax so that blood flows through the spaces within the corpora. The tunica albuginea helps trap the blood in the corpora cavernosa so the erection is maintained. Contractions of the smooth muscle reverse the erection.

Erectile dysfunction happens when any one of the parts of an erection are disrupted. This can include a lack of adequate brain activity, spinal column problems, vasculature or nerve function of the penis and problems with the tunica albuginea that keeps the blood in the penis. The most common cause of ED is diabetes, followed by kidney disease, MS, chronic alcohol abuse, atherosclerosis, vascular disease and neurological diseases. These account for 70 percent of all cases of erectile dysfunction. In diabetes, up to fifty percent of men with the disease have erectile dysfunction as well. Other possible causes of erectile dysfunction include smoking history, avoiding exercise and being overweight. Surgery to the prostate and bladder can injury the arteries and nerves supplying the penis, resulting in ED. An injury to the penis can contribute to ED as well.

Medications, such as blood pressure medications, antihistamines, tranquilizers, antidepressant, cimetidine and appetite suppressants have side effects that include erectile dysfunction. Psychological stressors can also contribute to ED in about 10-20 percent of cases. This is especially true for younger men who have no physical problems associated with erectile dysfunction.

Doctors diagnose erectile dysfunction by taking a careful history and doing a thorough physical examination. These alone can identify cases of erectile dysfunction. Sometimes a "tape test" is done in which a tape is put around the penis at night and, if the tape breaks during the night, nocturnal erections have occurred and the problem is likely psychological. Lab tests can look for elevated lipid profiles and testosterone amounts in the blood. Diabetes testing can be done with a blood test.

Erectile dysfunction is treated with medications and with devices that cause an erection. In many cases, men try Viagra or another anti-erectile dysfunction medication in order to create an erection. You can also cut back on any medication that is causing the disease, if this is possible. Psychotherapy is used in patients who have psychological causes of their erectile difficulties.

Medications used to treat erectile dysfunction include Viagra, Cialis and Levitra. These are called phosphodiesterase inhibitors or PDEs. They are taken an hour or so before sexual activity and enhance the function of nitric oxide in the penis. It relaxes smooth muscle in the penis and allows for increased blood flow.

Injections of certain medications into the dorsal vein of the penis allow for an immediate erection. Oral testosterone can be given in patients that have low testosterone syndromes. Yohimbine is used for erectile dysfunction by some men but it doesn't work in everyone.

Vacuum devices mechanically inflate the penis by creating a partial vacuum within the penis that draws blood into the organ. It engorges the penis, which gradually deflates over time. It is not used as often now that medications are available.