If you’re impotent, you can’t get an erection hard enough for normal sexual activity. The amazing thing is that this is not so uncommon – in the US alone, between 10 and 20 million men suffer from erectile dysfunction.
Another 10 million have a problem with their erections, though they don’t have impotence – the persistent failure to get an erection suitable for sex. At the age of forty, one man in twenty has erectile dysfunction, and at the age of 65, up to a quarter of men can’t get an erection when they wish to have one. These are truly dreadful statistics.
It won’t surprise you to learn that there has to be a variety of treatment methods to deal with so many men, at such a wide variety of stages in their lives, and with so many causes to their erectile dysfunction. The problem, as we have already seen on this website, is that impotence, or erectile dysfunction if you prefer, is both a psychological and a physical problem.
The cause and the effect can be hard to separate, but happily the problem is now widely researched and a lot of effort has gone into finding solutions that will help as many men as possible.
It seems now that the majority of erectile dysfunction has a physical cause. It’s also clear that the condition can be truly awful for a man who suffers it, because his sense of manhood is taken away – not to mention the effect on his partner and family, especially if his erectile dysfunction is linked to a decline in testosterone. But happily, the good news now is that there is a wide range of treatments available which can help to alleviate or cure erectile dysfunction.
The most common cause of non-psychological cause of erectile dysfunction is vascular occlusion or impairment of blood flow – either in or out of the penis. If the flow of blood into the penis (cavernosal arterial insufficiency) or the blood flow out of the penis are disrupted (corporal veno-occlusion) impotence can result.
If you have nocturnal emissions or erections then you have not got a physically based case of erectile dysfunction; you have a psychological problem. Most men get between three and five erections per night, although the frequency declines with age. In adolescence, a young man may spend up to one fifth of the night with an erection.
It is of course a sad fact that the way you live has an impact on the vigour and health of your erections. Smoking, too much drinking, stress, being overweight, poor physical fitness and poor lifestyle, especially drug use and inadequate food can seriously hamper sexual performance.
As if that wasn’t bad enough, prescription drugs can have the same effects. Here’s a summary of the causes of erectile dysfunction:
Psychological causes: stress, relationship or family problems, employment worries, depression, and anxiety.
Physical: hormone problems, drugs, vascular disease, high blood pressure, nerve disorders, surgery to the pelvis or genital areas, radiation therapy, chronic illness.
Drugs: Blood pressure medication, antidepressants, antipsychotics, antiandrogens and others, including stomach medication and painkillers.
The evaluation of men with erectile dysfunction
Clearly the first step is to take a complete medical history and look into any of the possible causes listed above; then a psychological profile and hormone tests may be useful. As we have seen, nocturnal penile tumescence tests are one of the primary tests for erectile dysfunction and can serve to indicate if a man has a psychogenic case of ED or a physical one.
Test for nocturnal erections range from the “postage stamp” test – stamps glued wrapped around the penis (they break if the penis becomes erect) to more sophisticated strain gauges which require the patient to wear a penile strap all night. But having normal erections at night is a good sign, for it means there may be no physical problem.
Poor circulation, more exactly, deficient blood flow to the penile arteries because of hardening and narrowing (arteriosclerosis) can cause impotence. Also, abnormal leakage of blood from the penis can cause a man not to be able to keep his erection (or even get one in the first place).
So the evaluation of penile blood flow is very important in assessing the cause of erectile dysfunction. You can do this in two main ways: by using some kind of vasoactive drug injected into the penis, with Doppler Ultrasound, or by using invasive diagnostics such as cavanosometry, cavernosography, and pelvic arteriography.
But most surgeons would only do these tests if they expected to work on the arteries and veins of the penis. Think of bypass surgery like heart bypass surgery, and you get the idea. the success rate is, unfortunately, not high.
An erection occurs when you are aroused and / or stimulated. This is followed by nerve impulses to the penis, increases in blood flow to penis by an order of 10 fold, causing it to become erect, and the sequence of events leading to ejaculation and loss of erection.
In men there can be a counterpart to the female menopause, with sudden drops in testosterone in midlife. Generally though, hormone levels slowly decline by 30 to 40% in men from age 45 to 70 or so. You can read more about the male andropause here. Dehydroepiandrosterone or DHEA is an adrenal steroid changed in the body to more ptotent androgens.
DHEA is changed by tissue enzymes all over the body into testosterone or 5-alphadihydrotestosterone (DHT). The highest concentration of bodily DHEA is reached in a man’s twenties then it declines slowly at about 2% per annum. Many men take DHEA as a supplement. Others take androgens like testosterone. Research suggests that between 25 and 50 mg orally per day can increase serum DHEA levels back to those of a 30- to 40-year-old, with no excess of testosterone or DHT.