Erectile Dysfunction (ED)

Erectile dysfunction is defined as the inability to achieve, or maintain an erection, sufficient for completing the sex act. It is a common ailment, increasing in frequency with age, affecting approximately 30 million people in the U.S.

Due to embarrassment, many men avoid raising this issue with their physicians, and prefer to suffer in silence. This is unfortunate, as there are many good forms of treatment for this condition. Moreover, loss of erections can be a signal for other serious medical illnesses, such as vascular disease, diabetes, or coronary artery disease.

Mechanism of Erection

Erection is achieved by a complex mechanism, which regulates inflow and outflow of blood from the penis. With arousal, hormone and chemical transmitters increase blood flow to the genital region, while limiting the blood flow to other areas not involved in the arousal process. As the penis expands, pressure inside the penis increases and compresses veins, which carry blood away from the penis. This process leads to full erection until maximal pressure is achieved. After ejaculation, or with loss of erection, blood flow to the penis decreases, and as the pressure inside the penis goes down, the veins allowing for blood to flow away from the penis open up and the penis becomes flaccid.

Causes of ED

  • Diabetes – No.1 cause of ED in the U.S. This is caused by the effect diabetes has on blood vessels.
  • Elevated Blood Pressure – and the medications used to treat hypertension.
  • Heart Disease
  • High cholesterol
  • Certain Medications – cardiovascular, tranquilizers, and antidepressants
  • Cigarette smoking – also affects blood vessels.
  • Excessive alcohol – “gives the desire, but takes away the performance”.
  • Stroke, or neurological diseases (Alzheimer’s, MS, Parkinson’s).
  • Pelvic Surgery – radical prostate surgery, including robotic surgery.
  • Radiation therapy to treat prostate or rectal cancer.
  • Trauma to the pelvic area.

Use It or Lose It

Research indicates that men who remain sexually active report a decrease incidence of ED, which is directly related to the frequency of sexual activity. Occasional decrease in sexual performance, can be experienced by normal men, which can trigger a significant psychological reaction. This can lead to performance anxiety, depression or loss of confidence. Men can start avoiding sexual encounters for fear of failure. The fear factor causes vasoconstriction to areas unrelated to systems tied into defense mechanisms. This can spiral into psychological impotence. Being relaxed, and unconstrained by distracting thoughts allows for normal erections to occur. Having morning erections, is an indication of a working erectile mechanism.

When Treatment is Necessary

When organic causes are diagnosed to be the cause of ED, the options are good when delivered under the care of physicians who specialize in this area.

Oral medications are extremely effective in achieving erections and work in about 75% of people who use them. Drugs like Viagra, Cialis and Levitra have become part of the cultural lexicon and are frequently advertised in the media. A major downside is the high cost of therapy.

Other treatment options include Muse – a urethral insert, which is absorbed through the mucosa of the urinary channel. Penile injection therapy, which is not difficult to use, given a small amount of patient cooperation. Vacuum erection devices, which can work by itself, or in combination with some of the oral or injectable medications.

When all else fails, penile prosthesis is a reasonable option, which can restore a man’s sexual function and maintain an active sex life and satisfactory relations with his partner. This is a hospital procedure, which lasts about 1 hour, and introduces an implant, which can be controlled through a pump mechanism in the scrotum. Patients continue to experience normal ejaculation and orgasm.

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