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OVERVIEW- Erectile Dysfunction Section I: History & Background Before accurately identifying what is erectile dysfunction, one must first understand what an erection is. By the standard definition, an erection is an increase in the blood flow to the penis caused by mental and/ or physical stimulation. An erectile dysfunction is the inability to develop and/ or sustain an erection in preparation for or during sexual intercourse. Hence, a man who suffers from erectile dysfunction is lacking the ability to increase blood flow to the penis. Many know erectile dysfunction to be referred to as “impotent” but it’s important to note “impotence” is different; impotence refers to problems with reaching orgasm or the inability to ejaculate. Data taken in 1985 shows that for every 1,000 men in the U.S., 7.7 of them went to the doctor to discuss and possibly diagnose erectile dysfunction. (NAMCS- National Ambulatory Medical Care Survey) Over time, thedoctor visits increased to 22.3 by 1999, partially because more men finally accepted talking about erectile dysfunction with a doctor. The biggest reason for the increase, though, happened in March 1998. Advances in medical science lead to the development of Viagra, a well-known oral male-enhancement drug. By 1999, according to the NAMCS, Viagra was mentioned during doctor’s visits approximately 2.6 million times. More importantly, one-third of the 2.6 million times it was mentioned came up while visiting the doctor for something other than erectile dysfunction. Men Affected by Erectile Dysfunction The age range for men dealing with erectile dysfunction is currently very broad. As a man’s age increases, though, so does his risk of erectile dysfunction; be it due to physical changes or causes and/ or other problems. Even though erectile dysfunction is not a definite consequence of aging, it does prove to be a risk to many men. Currently, approximately 5% of 40 year old men are dealing with erectile dysfunction. This is a much smaller group of men as opposed to the 15% to 25% of 65 year old men that are dealing with erectile dysfunction.
Section II: Is Erectile Dysfunction Treatable? Regardless of the age, erectile dysfunction is treatable and methods for treating this dysfunction range from the simplest to the most in depth testing. Thanks to the acknowledgement of erectile dysfunction and the acceptance of it, more men are becoming comfortable with seeking treatment. Thus, their sexual activity is changed and they can return to having a normal sex life; one without complications but complete enjoyment. Causes of Erectile Dysfunction The million dollar question for many men is what causes erectile dysfunction? The most common cause for erectile dysfunction is when the nerves, smooth muscles, arteries, and fibrous tissues are damaged. The damages usually occur from some sort of disease. Stimulation causes an erection so when anything relating to the erection is interrupted, erectile dysfunction can occur. Many things can cause erectile dysfunction and they range from mental to physical conditions. To mention a few, a reaction or side effect to a drug, injury, or disease can result in erectile dysfunction. Below is a chart outlining those diseases causing erectile dysfunction.
Seventy percent of erectile dysfunction cases recorded was the result of one of the above mentioned conditions and/ or diseases. In regards to diabetes, between 35% and 50% of diabetic men suffer from erectile dysfunction. Other than the conditions above, other choices made by men can result in diseases which cause erectile dysfunction; overweight, smoking, and lack of exercise. Smoking, for example, affects hormonal abnormalities (i.e. - low level of testerone) and the blood flow in the arteries and veins. Psychological issues, according to experts, also have the potential to cause erectile dysfunction. These factors account for 10 to 20 percent of the erectile dysfunction recorded. Psychological issues causing erectile dysfunction include but are not limited to:
Along with diseases and psychological issues, bodily changes and side effects to drugs can cause erectile dysfunction. Surgery such as prostate and bladder surgery can cause erectile dysfunction. With this type of surgery, men run the risk of injury to the nerves and arteries around the penis. Thus, this could lead to erectile dysfunction. Other injuries can lead to erectile dysfunction such as- injury to the penis, bladder, pelvis, prostate, and spinal cord. It’s also documented that side effects to drugs including illegal drugs can cause erectile dysfunction. These drug side effects include antihistamines, blood pressure medicines, antidepressants, ulcer medicines, tranquilizers, and appetite suppressants. These changes to a man’s body can result in erectile dysfunction. To summarize, any condition or disorder which injures the nerves or interrupts the blood flow to the penis can cause erectile dysfunction. Diagnosing Erectile Dysfunction Diagnosing erectile dysfunction begins with making an appointment with the doctor. To start, the doctor will get the man’s personal, medical history including sexual history. By collecting this history, a health or sexual problem or disease may be pin-pointed as the root cause for the erectile dysfunction. Following the personal history, doctors may resort to an exam or other form of testing to diagnose erectile dysfunction. The chart below outlines each and provides an explanation.
Treating Erectile Dysfunction As stated earlier, erectile dysfunction is treatable and methods for treating this dysfunction range from the simplest to the most in depth testing. For some, simply changing a medication or cutting back on the dosage can alleviate ED. Majority of doctors agree that testing should start with a simple test then a more in depth test should it be necessary. To start, doctors think changes made by the individual should be exhausted first. Many men may be able to solve the problem by simply making some changes associated with how they live their life on a daily basis. These changes include losing weight, quitting smoking, and diligently increasing exercise. Following changes made by the individual, doctors deem drug side effects as the next treatment. If the erectile dysfunction stems from a drug side effect, consult a doctor about changing to a different medicine; one that treats the same thing. An example is blood pressure medicine and how each varies with treatment and side effects. A version of blood pressure medicine may work wonders for one yet cause erectile dysfunction as a side effect for others. Once determining the existence of drug side effects, some patients are put through psychotherapy and behavior tests. Erectile Dysfunction which is psychologically based is treated using mental health techniques. Often, the man’s partner will assist in developing the intimacy and stimulation while the doctor is using certain techniques. These techniques reduce the level of anxiety the man has towards intercourse. After the modifications are performed, oral drugs, injected drugs, vacuum devices, and implants follow. In only extreme cases is surgery considered; a surgery which includes the veins and arteries. ORAL DRUGS In March 1998, the FDA (Food and Drug Administration) approved the first pill to treat ED. This pill was known as Viagra, an oral drug. Following its approval, Levitra and Cialis were put on the market. These drugs, known as phosphodiesterase inhibitors (PDE), enhance the effects of the chemical that allows for increased blood flow and relaxes the smooth muscles of the penis during stimulation. In short, these drugs improve the sexual stimulation of men. As science/ technology advance, other drugs will be tested and examined for safety and overall effectiveness; two essential areas necessary for the drug to be approved by the FDA.
WARNING: Any man taking a nitrate-based medication for a heart problem should not take any PDE inhibitor. Taking both could result in a drastic drop in blood pressure. If you’re taking an alpha blocker, used to treat prostate enlargement, consult your physician. Taking an alpha blocker and PDE inhibitor within four hours of each other may result in a drastic drop in blood pressure. It’s important to consult your physician prior to taking both as he may need to adjust your ED prescription or other prescription. Even though oral testosterone is often ineffective and can cause liver damage, it has been proven that oral testosterone helps reduce erectile dysfunction. Many patients have claimed that their erectile dysfunction improved with the use of other forms of oral drugs- dopamine and serotonin agonists, trazodone, and yohimbine. Scientific studies proving the effectiveness of these drugs have so far remained inconsistent. According to experts, men could be experiencing a placebo effect while on the medicine; a change occurs because the patient believes the medicine is working for them and improving their condition. INJECTED DRUGS Drugs injected directly into the penis help men have a stronger erection. The injected drugs simply cause the penis to be “over-loaded” with blood by expanding the blood vessels. Phentolamine, hydrochloride, and alprostadil (Caverject) are examples of drugs injected directly into the penis. Although the erection is much stronger, these drugs do have serious side effects. Side effects include scarring and a constant erection (priapism). Thanks to modern technology and the advances in medical science and research, more drugs are penetrating the market for treatment of erectile dysfunction. If you are considering your options with treating your case of erectile dysfunction, consult your physician about the latest treatments available. VACUUM DEVICES Vacuum devices, mechanical vacuum devices, cause an erection by drawing blood into the penis thus, expanding it. There are 3 components to a vacuum device:
The vacuum devices are typically the same with only one minor detail varying. On some, the device has a semi-rigid rubber casing which is placed on the penis. The casing remains on the penis after the erection is achieved and during intercourse. SURGERY All surgeries performed for the treatment of erectile dysfunction have the same objectives in mind.
Blocking off the veins (ligation) is rarely performed and experts continue to question this type of surgery. It is done so that blood doesn’t leak out from the penile tissues is done so that the amount of blood leaked out reduces. Implanting a device (prostheses) is done in order to restore a man’s erection. With some patients, malleable implants- paired rods, are surgically inserted in the corpora cavernosa- the two chambers of the penis. The man can adjust the position of the rods and penis. It’s important to note, though, the rods do not change the length of width of the penis. Although successful, there are side effects to surgically implanting a device such as an infection or mechanical malfunction. With today’s advances in technology, the number of malfunctioning devices has reduced. Other than devices being implanted such as the malleable implants, there are also inflatable implants available. The inflatable implants, to some degree, can increase the length and width of the penis but also cause the penis to be in more of a natural state when the implants are not in use. The implants consist of 2 paired cylinders that are surgically placed in the penis. The cylinders are connected by tubes to a fluid reservoir and pump which are also implanted. Surgery is used to repair the arteries which can lead to a reduction in erectile dysfunction, typically caused by obstacles which block the blood flow. Candidates for this surgery are young men with isolated blockage as a result from an injury to the pelvis or crotch. The surgery has been successful in younger men but older men dealing with extensive blockage have not had the same success. Research and Advances With each passing day, science and technology are growing rapidly with new discoveries, drugs, and advances in medical treatments. Advances targeting specifically erectile dysfunction have grown to include many options for treatment. Currently, oral drugs, injectable drugs, suppositories, implants, and vacuum devices have been created and/ or established for treating erectile dysfunction. Thanks to these advances, more men are seeking treatment. Another treatment yet to be marketed is being tested in the labs right now. Gene therapy is being tested by experts for the treatment of ED and one day, may offer a long-term and long-lasting therapy treatment for ED. Long-term research will continue to look for safe and effective treatments for ED. To note, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has created programs which are designed to understand the causes of ED and find treatments to stop the effects. Their divisions- Urologic, Kidney, and Hematologic Diseases- which happened to support the creation of Viagra, continue their research on the history of erectile dysfunction as well as the mechanisms of an erection. Don’t forget that ED affects approximately 15 – 30 million men in the US but it is treatable regardless of their age. Please consult your physician should you feel like you are suffering from ED. |
