What is ED?
Erectile dysfunction (ED), also called as impotence, is the inability for achieving or sustaining a stiffer penile erection for satisfactory completion of sexual activity. ED condition is different from other health issues that might interfere with male sexual function like lack of sexual desire (lowered libido) and issues with ejaculation release of the fluid from the penile (ejaculatory dysfunction) and orgasm/climax (orgasmic dysfunction), and penile curvature (Peyronie's condition), although these issues might also be present. Impotence issue affects about 50% of men age 40 and over. This article mainly focuses on the impotence condition evaluation and treatment of erectile dysfunction.
How Common Is Erectile Dysfunction?
Erectile dysfunction is known for varying in severity; some men might fail to have an erection at all, whereas other men might sometimes have issues in attaining a stiffer penile erection, and others might attain a stiffer penile erection but it shall only last for a short period of time. Approximately 50% of men over the age of 40 have issues with penile like erectile dysfunction condition.
While erectile dysfunction or impotence issue can occur at any age, the risk of evolving impotence issue might enhance with age. As per the Massachusetts Male Aging Study, the prevalence of impotence issue in men was 52% in 40-70 years of age. The prevalence of complete impotence issue can enhance from 5% at 40 years of age to 15% among men that are 70 years of age and older.
What Is Normal Penis Anatomy?
The penile with three cylinders, the two corpora cavernosa that are located on the top of the penile, whereas, and two cylinders are involved in penile erection. The third cylinder has the urethra, the tube that the urine and ejaculate pass through for running along the underside of the penile region. The corpus spongiosum is known for surrounding from the urethra. Spongy tissue that has muscles, fibrous tissues, veins, and arteries within shall end up making the corpora cavernosa. The inside of the corpora cavernosa is a sponge, along with potential spaces that can help in filling up the blood and distend (called as sinusoids). A layer of tissue is likely, called the tunica albuginea, surrounded by the corpora. Veins are located just under the tunica albuginea for draining the blood out of the penile.
How Does Erection Occur?
Penile erections are known as a neurovascular event, which means that the nerves and blood vessels (arteries and veins) are all widely involved in the process of an erection and all might work properly for attaining a stiffer penile erection that shall last longer for planned lovemaking session. Penile erection shall be attained only in presence of complete sexual stimulation or while consuming Filitra. Sexual stimulation can be tactile (for example, by partner touching the penile or while performing an act of masturbation) or mental (for example, by having some visual sexual fantasies, watching porn). Sexual stimulation or sexual arousal causes the nerves going to the penile for releasing a chemical called as nitric oxide. Nitric oxide can enhance the production of another chemical known as cyclic GMP (cGMP), which is in the muscle of the corpora cavernosa. The cGMP causes the muscles of the corpora cavernosa for relaxing that shall further allow more amount of the blood to flow into the penile region. The incoming blood shall fill up the corpora cavernosa, which helps in expanding the penile.
How Can Man Sustain An Erection?
When the appropriate amount of blood flows into the penile, the corpora cavernosa swell, and its hall further compresses the veins against the tunica albuginea. Compression of the veins prevents the blood from leaving the penile region. This may create a hard erection even when Filitra pill is consumed. When the amount of cGMP lowers along with the action of a chemical known as phosphodiesterase type 5 (PDE5), the muscles in the penile tightens, and the blood flows into the penile region lowers. With less blood passing through the penile, the veins are not compressed, which allows blood to drain out of the penile, and the erection might be lost.
What Causes Erectile Dysfunction in Men?
The ability for achieving and sustaining a stiffer penile erection requires the following:
- Having a healthy nervous system that might help the nerve to impulses in the brain, spinal column, and the penile
- Healthy arteries in and near the corpora cavernosa that shall be stimulated for getting the enhanced flow of blood into the penile region
- Healthy muscles and fibrous tissues within the corpora cavernosa can distend for allowing the penile to fill with the appropriate amount of blood in it
- Adequate levels of nitric oxide in the penile
- Normal-functioning tunica albuginea, which further helps in compression of the veins
- Appropriate psychosocial interactions
Erectile dysfunction condition in men can take place if a man does not meet one or more of these requirements mentioned below. The below-mentioned list of causes of impotence or erectile dysfunction, and many men having more than one potential cause are mentioned below:
- Aging: The two main reasons as to why older men are more likely for experiencing impotence or erectile dysfunction than younger men are - First, older men are more likely to develop diseases that are directly associated with impotence. Second, being the aging process alone can lead to erectile dysfunction in some men by causing changes in the muscle and tissue within the penile
- Diabetes Mellitus: Erectile dysfunction tends to develop 10 to 15 years earlier in men detected with diabetes than among nondiabetic men. Enhanced risk of impotence among men with diabetes mellitus might be due to the earlier onset and greater severity of atherosclerosis (hardening of the arteries) that might narrow the arteries and thereby lowers the delivery of blood amount to the penile region
- Hypertension (High Blood Pressure): Men with high blood pressure like condition have an enhanced risk of evolving impotence or erectile dysfunction condition. Hypertension can lead to issues with erections that are directly related to atherosclerosis or from the low levels of nitric oxide production from the arteries in the penile region. Medications to treat hypertension might lead to impotence or erectile dysfunction in men
- Cardiovascular Diseases: This is one of the most common causes of cardiovascular diseases in the United States is atherosclerosis, the narrowing, and hardening of arteries might lower the blood flow in the penile. Atherosclerosis, a type of vascular disease typically affects arteries throughout the body; hypertension, high blood cholesterol levels, smoking cigarette, and diabetes mellitus aggravate atherosclerosis. Hardening of the arteries right up to the penile and pelvic organs, atherosclerosis, causes an insufficient amount of the blood flow into the penile
- Metabolic Syndrome: Associated with multiple risk factors for impotence or erectile dysfunction including diabetes, hypertension, abnormal lipid profile, and obesity
- Cigarette Smoking: Cigarette smoking is known for aggravating atherosclerosis and it can also lead to some condition called vasospasm (spasms of the arteries) and thereby it enhances the risk for impotence in men
- Nerve Or Spinal Cord Damage: Damage to the spinal cord and nerves present in the pelvis leads to impotence issue in men. Nerve damage can be caused due to various health diseases, trauma, or surgical procedures
- BPH: Benign enlargement of the prostate is all well associated with impotence issue in men
- Trauma: Trauma to the pelvis can include pelvic fracture, which might lead to erectile dysfunction, and an untreated penile fracture might eventually result in erectile dysfunction
- Substance Abuse: Marijuana, crystal meth, cocaine, heroin, methamphetamines, and narcotic and alcohol abuse can all contribute to erectile dysfunction in men. Alcoholism, in addition, causes nerve damage, which can lead to atrophy (shrinking) of the testicles and lower testosterone levels
- Low Testosterone Levels: Testosterone is the primary sex hormone in men, which is not only necessary for sex drive but also is necessary for maintaining nitric oxide levels in the penile region. Therefore, men with hypogonadism can have a low sex drive and erectile dysfunction at the end of the day
- Medications: Use of numerous common medicines mighty lead to erectile dysfunction as a side effect. Medicines that can lead to impotence can include many for treating high blood pressure, antidepressants, antihistamines, tranquilizers, and appetite suppressants. Examples of some common medicines that can lead to impotence include propranolol or other beta-blockers, hydrochlorothiazide, amitriptyline, famotidine, digoxin, cimetidine, metoclopramide, indomethacin, lithium, verapamil, naproxen, phenytoin, gemfibrozil, amphetamine/dextroamphetamine, and phentermine. Prostate cancer medications lower testosterone levels including leuprolide that might affect erectile function in impotent men. Some of the chemotherapies like cyclophosphamide might affect erectile function
- Recreational Drugs: Use of some recreational drugs, including consumption of alcohol, amphetamines, marijuana, barbiturates, heroin, nicotine, and cocaine, are all associated with erectile dysfunction in men
- Depression And Anxiety: Psychological factors are all highly responsible for impotence or erectile dysfunction. These factors are stress, guilt, anxiety, depression, low self-esteem, widower syndrome, posttraumatic stress disorder, and fear of having a sexual failure (performance anxiety)
Erectile Dysfunction Symptoms And Signs
Some of the signs and symptoms of impotence or erectile dysfunction are mentioned below:
- Penile erection takes place, but the penile does not remain hard enough for completion of a lovemaking session
- Erection of the penile is not hard enough for penetration
- There is an inability so as to obtain a stiffer penile erection
- Man can still achieve orgasm and ejaculate while having erectile dysfunction
How Do Health Care Professionals Diagnose Erectile Dysfunction?
Patient Health History: Physicians make a diagnosis of erectile dysfunction in men that complain of troubles in having a stiffer penile that does not last long enough. It is important as one might talk with the doctor that one can be candid in terms of when issues are started, how bothersome the erectile dysfunction is, how it might severe it, and discuss all the medical conditions along with prescribed and non-prescribed medications consumed.
Physical Examination: The physical examination can reveal clues for some physical causes of impotence or erectile dysfunction. The doctor shall perform an assessment of BMI and waist circumference for evaluating for abdominal obesity. A genital examination is known to be a part of the evaluation of erectile dysfunction. The examination shall further focus on the penile and testes. The doctor shall further ask about penile curvature and may examine the penile for seeing if there are any plaques (hard areas) palpable.
Laboratory Tests: Lab testing that is obtained for evaluation of the erectile dysfunction might vary along with the information obtained on the health history, physical examination, and some of the recent lab testing. A testosterone level is not necessary to be maintained in all men; however, some of the physicians shall order the lab for determining patient's testosterone level if other signs and symptoms of hypogonadism including decreased libido, loss of body hair, infertility, muscle loss, breast enlargement, osteoporosis, and decreased penile/testicular size are all present.
Imaging Tests: Healthcare professionals fail to obtain for imaging test in the evaluation of impotence or erectile dysfunction condition in men. Ultrasound with Doppler imaging (ultrasound including evaluation of the blood flow in the arteries and veins) provides some additional information about the blood flow of the penile and it might help in the further evaluation of the patients prior to surgical intervention. The study is typically performed post injection of a chemical that leads to the arteries for opening up, a vasodilator (prostaglandin E1), into the corpora cavernosa for causing dilation of blood vessels and promoting the blood flow into the penile.
Other Health Tests: Monitoring penile erections might occur during sleep, it can help you and your doctor for understanding if the erectile dysfunction is due to psychological or physical causes. The nocturnal penile tumescence test is a study for evaluating penile erection during the night time. Normally men might have three to five erections per eight hours of sleep.
Psychosocial Examination: If there seems to be some sort of psychological cause that might contribute to erectile dysfunction in men, the doctor might ask the patient questions for helping so as to determine stressor, events, and relationship issues that might lead to some of the erectile issues.
What Drugs Treat Erectile Dysfunction in Men?
Numerous medical treatment options exist for erectile dysfunction might include the following:
- Oral phosphodiesterase type 5 (PDE5) inhibitors (Sildenafil, Vardenafil [Filitra], Tadalafil, and Avanafil)
- Intracavernosal injections (papaverine, phentolamine, and PGE1, Bimix, and alprostadil injection)
- Intraurethral suppositories
- Testosterone in some of the individuals with Erectile Dysfunction and other signs/symptoms of hypogonadism and an unequivocally low serum testosterone