The Causes Of Erectile Dysfunction

What causes erectile dysfunction? Erectile dysfunction or "impotence" means you can't get or keep an erection that will allow you to penetrate your partner during sex; note that problems such as lack of sexual desire are not the cause of what we call erectile dysfunction, though you may not get an erection if you don't desire your partner. Erectile dysfunction causes

Erectile dysfunction varies from the complete inability to get an erection through to the occasional failure of your erection during sex. It also refers to the situation where a man can only keep an erection for a brief time.

It's been estimated that one visit in fifty to a doctor's office is related to erectile dysfunction! And it's become much more widespread in later years - or, at least, the reporting of it has. Maybe the fact that men are much more willing to talk to their doctors about erectile dysfunction is something to do with the fact that there has been so much publicity about Viagra lately?

It's surprising to think that Viagra has been around for about ten years now; apparently it is mentioned about three million times a year in doctor's offices, even during appointments which were for conditions that had nothing to do with erectile dysfunction. Apparently one man in twenty at the age of forty has erectile dysfunction; and up to a quarter of men at the age of 65 are experiencing some problems with erectile dysfunction.

We should perhaps describe how an erection develops before we look at the mechanism of erectile dysfunction.

Two chambers known as the corpora cavernosa run along the centre of the penis; these chambers are filled with spongy tissue with great capacity for expansion. The urethra, along which semen and urine flows, is located under the corpora cavernosa; its surrounded by the corpus spongiosum.

An erection begins to develop when a man has either physical or mental stimulation. Nerve impulses make the muscles of the  corpora cavernosa relax, and this permits blood to flow in. As it does so, it expands the tissues of the corpora cavernosa and causes the penis to increase in size. The tunica albuginea (the tissue around the corpora) is less flexible - it traps the blood, preventing it flowing out, and therefore keeps the penis erect.

Arteries (top) and veins (bottom) run through the corpora cavernosa and the corpus spongiosum. You get an erection when when relaxed muscles allow the corpora cavernosa to fill with blood. At the same time, the veins are blocked and blood cannot flow out. Effects of erectile dysfunction are discussed here.

What's the most likely cause of erectile dysfunction?

There are many steps in an erection, and unfortunately, if the process goes wrong at any of them, a man may find he has erectile dysfunction.

A common cause of erectile dysfunction is damage to any of the tissues of the the penis or pelvic region through atherosclerosis, vascular disease, and neurologic disease (damage to the nerve cells). This explains a large proportion of erectile dysfunction. And a majority of men with diabetes experience erectile dysfunction.

Aspects of lifestyle like a high fat diet, smoking, and low levels of exercise, both of which contribute to heart disease and vascular problems, also raise a man's risk of experiencing erectile dysfunction.

Surgery (especially prostatectomy and bladder surgery for cancer) are likely to damage nerves and arteries near the penis, and this can cause erectile dysfunction. Needless to say, any injury to the pelvic regions in general or the penis, spinal cord, prostate and bladder in particular, can lead to erectile dysfunction by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

Many common medicines such as drugs to treat blood pressure, antihistamines, antidepressants, tranquilizers, some appetite suppressants, and even ranitidine and cimetidine (an anti-acid drug) may produce erectile dysfunction as a side effect.

But the really important thing to know is that psychological factors such as stress, anxiety, depression, low self-esteem, and sexual anxiety caused by fear of sexual failure, are at the root of a large proportion of erectile dysfunction. And to make this more complicated, men whose erectile dysfunction is caused by physical problems usually have emotional reactions such as stress, anxiety, guilt, depression. And finally, other causes of erection problems are smoking, which may affect the blood flow in the veins and arteries of the penis, and hormonal problems including low testosterone.

Diagnosis of erectile dysfunction

Medical history

A man's medical history can reveal certain causes of erectile dysfunction, while a review of sexual activity might bring to light  problems with sexual desire, libido, erection, ejaculation, or orgasm.

Amazingly, the side effects of drugs can account for 25 percent of erectile dysfunction, and changing medications can often alleviate the problem.

Physical Examination

A physical examination can be helpful in elucidating problems in this area. For example: if a man's penis does not have normal sensitivity, this may indicate a problem in the nervous system; hormonal problems might be revealed in the state of a man's musculature or body tissue; and an erect penis with a significant bend might indicate Peyronie's disease, which can cause erectile problems.

Biochemical tests can also be useful: blood counts, urine analysis, lipid levels, liver enzymes, and free testosterone levels in the blood can provide information about anomalies in the endocrine system and are very useful for men with a low level of sexual desire.

Monitoring erections that occur during sleep (also known as nocturnal penile tumescence) can eliminate physical causes of erectile dysfunction. A man in good health will have involuntary erections as he sleeps; if he does not, his erectile dysfunction is most probably caused by a physical problem.

How is erectile dysfunction treated?

Most doctors would like to see a combination of treatment approaches - lifestyle changes such as stopping smoking, losing the excess pounds, and increasing one's level of physical activity may be enough for a man to get his erection back. Of course, reducing any prescription or non-prescription drugs that may have a role in erectile dysfunction is necessary. Most useful, though, for the majority of men is sexual psychotherapy. Viagra is a very helpful medication, and in the comparatively small number of cases where this does not work, vacuum cylinders and pumps, or surgically implanted inflatable devices, may be be used. In rare cases, surgery involving veins or arteries may be considered. Testosterone administration should always be considered, which may involve hormone replacement therapy in a variety of forms.

Psychotherapy - the best treatment for erectile dysfunction

A good approach to the treatment of erectile dysfunction whose origin lies in psychological effects is to use any psychotherapy technique which reduces anxiety around sex, relationships or intimacy. It is necessary for a man's partner to help with the treatment techniques, which involve gradually increasing levels of intimacy and sexual stimulation. These approaches are also useful when anxiety that arises from physically based erectile dysfunction is being treated.

Drug Therapy

Viagra (sildenafil), Levitra (vardenafil hydrochloride) and Cialis (tadalafil) have all been approved for the treatment of erectile dysfunction. They belong to a group of drugs called phosphodiesterase (PDE) inhibitors, which work by enhancing the effects of nitric oxide (the chemical that relaxes smooth muscles in the erectile mechanism of the penis), or rather preventing its breakdown, thereby allowing it to continue its effect of increasing blood flow.

The advised amount of Viagra as a starting dose is 50 mg, though 25 mg or 100 mg may be required. Levitra and Cialis start at 10 mg, and the doctor may adjust this dose to 20 mg or 5 mg as required.

None of these phosphodiesterase inhibitors is to be taken more than once a day and nitrate-based drugs such as nitroglycerin for heart problems can be seriously affected by them. Also, combining a phosphodiesterase inhibitor with an alpha-blocker may result in a drop in blood pressure.

Testosterone can effectively reduce erectile dysfunction in a large number of men with lowered levels of their own testosterone, and men have claimed that other oral drugs such as yohimbine hydrochloride, or the more esoteric dopamine and serotonin agonists are effective, but scientific evidence is lacking.

Vacuum Devices

Mechanical vacuum pumps induce an erection by producing a partial vacuum, the effect of which is to help suck blood into the penis, so it engorges and expands. These are not penis enlargement pumps, they are medical devices which include an elastic band, which, when fastened around the base of the penis, will ensure the erection is maintained when cylinder is removed, so that a man and his partner will be able to have sexual intercourse.

Figure 2. A vacuum pump device induces an erection by producing a partial vacuum around the penis, and this sucks blood into the corpora cavernosa.

Alternatively, a stiff rubber sheath may be placed on the penis before it becomes erect and if left in place can help to enable penetration and intercourse.

Surgery

Although a radical treatment, surgery can be used to implant a prosthesis, so that a man with erectile dysfunction may be able to induce an artificial erection. The failure rate of surgery is high, and some of these implants do not produce an increase in size on "erection".

Surgery on blocked arteries may be useful in reducing erectile dysfunction, though the procedure works best for young men with an identifiable discrete block in an artery caused by injury to the groin or pelvis. It doesn't work for older men with more widespread problems. Surgery to the veins in which blood leaves the penis is rarely done as it appears to be ineffective.

Summary