Erectile dysfunction: Causes and Treatment.

Erectile dysfunction (ED) or impotence is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual activity. A penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis. The process is often initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis.

Generally, it is okay for men to lose erection at times. It only becomes a problem when the male organ lacks fullness and hardness and erection is not enough to sustain having sex. When things become a little serious and persistent, that is when it can be called as erectile dysfunction (ED) or impotence. However, it should be not be confused with lack of appetite for sex, orgasm, or premature ejaculation.

There are at least 10 million men that are dealing with this problem in the US and the numbers are increasing as men age.

Causes of erectile dysfunction

There are many physical and psychological causes of erectile dysfunction. The most common physical causes are nerve damage and reduced blood flow in the penis. These include:

 

• Drugs (anti-depressants and nicotine are most common)
• Neurogenic disorders: Stroke and injuries with spinal cord and brain can cause erectile dysfunction when they interfere with the transfer of nerve impulses from the brain down to the penis. Other neurologic disorders can also lead to impotence and these include Parkinson’s disease, Alzheimer’s, and multiple sclerosis.
• Cavernosal disorders (Peyronie’s disease⁾
• Psychological causes: performance anxiety, stress, mental disorders, psychological problems, negative feelings.
• Surgery:Just like pelvic trauma, surgical procedures done at the colon, bladder, prostate, and rectum can damage the nerves and veins required for erection as well.
• Aging. It is four times more common in men aged in their 60s than those in their 40s.
• Kidney failure
• Diseases such as diabetes and multiple sclerosis (MS). While these two causes have not been proven they’re likely suspects as they cause issues with both the blood flow and nervous systems.
• At least one paper has suggested that arsenic poisoning from contaminated well water may be a cause in some regions, perhaps by alteration of voltage gated potassium channels.
• Lifestyle: smoking is a key cause of erectile dysfunction.

 

TREATMENT OF ERECTILE DYSFUNCTION.

 

Treatment depends on the cause.

Exercise, particularly aerobic exercise during midlife is an effective for preventing ED; exercise as a treatment is under investigation.

Oral pharmacotherapy and vacuum erection devices are first-line treatments, followed by injections of drugs into the penis, and penile implants.

Oral medication

Phosphodiesterase type 5 inhibitors

The cyclic nucleotide phosphodiesterases constitute a group of enzymes that destroy the cyclic nucleotides cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). Phosphodiesterases exist in different molecular forms and are unevenly distributed throughout the body. One of the forms of phosphodiesterase is termed PDE5, and inhibiting PDE5 increases the amount of cGMP available in the blood supply to the penis, thus increasing blood flow. The PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally.

Topical medication

Alprostadil

A topical cream combining Alprostadil with the permeation enhancer DDAIP has been approved in Canada under the brand name Vitaros as a first line treatment for erectile dysfunction.

Injected medication

Another treatment regimen is injection therapy. One of the following drugs is injected into the penis: papaverine, phentolamine, and prostaglandin E1.

Pumps

A vacuum erection device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available with a doctor’s prescription. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants may be fitted surgically.

Surgery

Often, as a last resort if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.