What is Erectile Dysfunction (ED)?
What is Erectile Dysfunction
ED is the repeated inability of a man to achieve or sustain an erection. Sexual intercourse can be challenging or impossible if effected by the condition. Changing lifestyles and aging populations are increasing the number of men who are impacted by ED.
ED occurs as the body loses its ability to fill chambers within the penis with blood. Erections are blood filling events. Erections happen as chambers in the penis (Corpora Cavernosa) receive and hold blood flow.
Absence of the ability of the penis to expand from the flaccid state is half of what characterizes erectile dysfunction. In addition to engorgement or expansion of the penis to the erect state, blood flow must remain in erectile tissues long enough to have sexual intercourse. This is the other half of the process.
For more information, check out our “Guide to Erectile Dysfunction“.
The Erection Process
Erections occur when neurotransmitters in penile nerve tissue release nitric oxide. This chemical release from nerve endings causes relaxation of penile tissues (corpora cavernosa) thus brining blood flow into the organ. Blood flow creates the erection. Relaxation of penile tissues that encourage blood flow is the result of a chemical process that begins with some form of stimulation. This maybe from the result of touch or smell. It may be sexual in nature, it may be auditory or visual.
Regardless of the stimulation that leads to creating the erectile response, information is sent along nerves that travel from the brain to the base of the spine. Primary nerve fibers at the base of the spine connect to the penis and regulate blood flow during and after erections. Nitric oxide is a key chemical and neurotransmitter in the process.
Natural erectile function is a reflex action. It starts with a stimulus, then leads to chemical process in the nerve centers. Erections occur during the expansion of smooth muscle in penile tissues after the release of nitric oxide. It happens without a great deal of planning or effort. When the smooth muscle relaxes (Corporus Cavernousum), blood flow dramatically increases, and the spongy tissue (Corpus Spongiosum) within the penis becomes full and rigid. The conduits that release blood become closed or compresses as the erection enlarges which holds the erection.
When nitric oxide or muscle-releasing chemicals are no longer present the penis becomes flaccid. The medical term for this process is Detumescence ( the process by which a penis becomes flaccid).
Who is effected by ED
Erectile dysfunction, or ED, can develop at any age. The condition does become more common after the age of 40. By this age, 40% of men experience mild or occasional impotence. That number increases by 10% per decade of life.
Men who have diabetes are at great risk of developing ED. Men who smoke and have hypertension also increases the chance of experiencing the condition. Studies show that African-American men seek medical care for erectile dysfunction at a rate that is twice that of other racial groups.
Men that are taking hypertensive medications, have prostate cancer, or diabetes are more effected by ED then other men. Medical factors can easily interrupt the delicate metabolic and physical processes that work together to produce healthy erectile function.
How to prevent Erectile Dysfunction
Avoiding lifestyle choices that could potentially damage blood circulation as a great way to prevent erectile dysfunction. If you sidestep activities that impair blood flow through arteries that lead to the penis you are on the right path.
Studies support claims that regular exercise and maintaining a healthy weight will also prevent erectile dysfunction. Certain over the counter drugs, blood pressure medications, antidepressants and tranquilizers are linked to erectile dysfunction. Review your medications, weight, and exercise routine with your doctor for prevention suggestions.
A heart healthy diet will reduce the intake of medications associated with heart disease that lead to erectile dysfunction. Fried foods and high cholesterol diets are not good for reducing high blood pressure. Fruits, vegetables, and fish are all great alternatives to artery clogging foods. Prevent underlying medical causes that are known to be associated with erectile dysfunction though your diet. Prevention is a sure way to increase your quality of life and avoid diseases that are primary to erectile dysfunction.
Symptoms of ED
The occasional inability to achieve and maintain an erection is completely normal and happens to all men. As the severity and frequency of the problem worsens, however, erectile dysfunction may be to blame. With chronic erectile dysfunction, erections may be too soft for sexual intercourse or simply lose pressure before orgasm. Stress and anxiety frequently develop as ED symptoms progressively worsen.
Causes of Erectile Dysfunction
Up to 90% of chronic erectile dysfunction relates back to a physical cause. Some causes may have a mental component but this is rarely true. Medical conditions that affect the health of the cardiovascular system contribute to the development of erectile dysfunction.
A wide range of conditions and diseases can contribute to or cause ED. Often men experience erectile dysfunction as an indication of an underlying condition. It is important to consult with your medical doctor if you experience impotence or ED to determine the primary cause.
The sudden development of ED can act as a warning sing for serious health condition, including:
Metabolic Syndrome Causes Erectile Dysfunction
A high percentage of patients with metabolic syndrome also have erectile dysfunction. Lifestyle modifications, including weight control, may be a very good strategy for treating ED patients with metabolic syndrome. Clinical Studies have established a bidirectional relationship between metabolic syndrome and erectile dysfunction.
Diabetes Causes Erectile Dysfunction
High levels of sugar in the blood stream lead to damage of the nerve and vascular systems. At least 50% of men with diabetes mellitus eventually develop erectile dysfunction. In as many as 12% of Diabetic cases diagnosed in men, ED is the first sign of the condition.
Peripheral neuropathy is nerve damage caused by chronically high blood sugar and diabetes. It is commonly known to lead to numbness, sensation loss to the feet, legs, or hands. Peripheral neuropathy is also directly linked to erectile dysfunction. The American Diabetes Association recognizes diabetes sexual dysfunction as common. A medical vacuum pump is listed on the ADA website as a widely accepted treatment for men that are searching for ED help.
Hypertension Causes Erectile Dysfunction
Hypertension is also known as high blood pressure. Stress can cause hypertension. Renal failure or kidney disease can be the cause of hypertension. Left untreated stroke, heart attack, and vision loss are often reported. The drugs used to treat hypertension often cause erectile dysfunction.
To counter elevated blood pressure on blood vessels which characterizes hypertension, physicians prescribe medications designed to decrease blood flow. Decreasing the level of blood flow into the penis causes erectile dysfunction. Diuretics and beta-blockers both decrease blood flow and cause impotence or erectile dysfunction.
Atherosclerosis Causes Erectile Dysfunction
Atherosclerosis reduces the blood supply to vital organs such as the heart, brain, intestines, and penis. Hardening of the arteries and plague build up are the same thing as atherosclerosis. Smoking, dietary choices, a sedentary lifestyle, and genetic predispositions contribute to abnormal blood flow and vascular disease. Penile health and blood flow are inseparable in the case of erectile dysfunction.
Heart Disease Causes Erectile Dysfunction
In a survey of 20,000 men who received his prescription from a Urologist for a vacuum erection device, Augusta Medical Systems discovered 51% have a diagnosis of heart disease. Much to the surprise of individuals learning about erectile dysfunction, the circulatory system, heart, and penis are fundamental parts of the male reproductive system. This fact is one of the main reasons why you should work with your physician if you experience any symptoms of Chronic erectile dysfunction. ED may be one of the first indications that you have an undiagnosed medical condition related to heart health. According to the Mayo Clinic, signs of erectile dysfunction can be one of the first signs of heart disease.
Multiple Sclerosis Causes Erectile Dysfunction
Multiple sclerosis also known as MS is a disease of the nervous system. Symptoms range from vision loss to paralysis and it effects the spinal cord, brain, and optic nerves. Sexual dysfunction is not uncommon in men and may take the shape in ejaculation disorders as well as the inability to achieve and maintain an erection. The National Multiple Sclerosis Society recognizes sexual dysfunction problems associated with MS.
Parkinson’s Disease Causes Erectile Dysfunction
The Parkinson’s disease foundation defines PD as a chronic and progressive movement disorder. As a neurological disorder in the nervous system of the body it can take shape in various ways. Neurons in the brain die as the disease progresses. Male erectile dysfunction is often present and a primary result of the condition.
As these health conditions progress, healthy blood flow throughout the body decreases. Reduced changes in blood flow leaves the erectile tissues without the pressure required to maintain an erection.
The development of scar tissue in the penis, a condition called Peyronie’s disease, can also impede blood flow to the erectile tissue. This condition arises after trauma to the penis causes scar tissue.
Traumatic injuries to the spinal cord or pelvic nerves have the potential to trigger erectile dysfunction by blocking signals carried through the pudendal nerve canal. Surgical treatment for prostate cancer, and other conditions affecting the lower back or pelvic area, carries a risk of damage branch of nerves causing ED. Without the proper signals from the rectal, perineal and dorsal nerves, the erectile tissues do not properly engorge with blood nor retain enough pressure to maintain an erection.
Erectile Dysfunction Treatment
Only about 30% of men with erectile dysfunction seek medical assistance for their condition. In addition to leaving serious health problems undetected, the absence of treatment for ED can cause psychological health problems to arise. Depression, anxiety and low self-esteem often develop as the symptoms of erectile dysfunction takes a toll on mental health.
Acquiring treatment for erectile dysfunction can prevent or reverse these psychological issues and improve quality of life as a whole. Common ED treatment options include:
Psychotherapy Treatment for ED
Prior to the 1980’s impotence was considered to be purely psychological. Today we know that more than 80% of cases are organic or physical in nature. Only a small percentage of cases are though psychological. These cases require counseling or sex therapy.
Men who are candidates for this treatment like suffer from anxiety, post traumatic stress disorder, depression, guilt, indifference, low-self esteem, and stress.
Vacuum Therapy for ED
Vacuum therapy systems work by manually creating an erection. The use of medically approved vacuum therapy has a high success rate. VED’s offer the safest, most conservative, non-invasive option available for the treatment of erectile dysfunction. Vacuum therapy is the only treatment that is effective when used along with other treatments.
Oral Medications For ED
ED pills or oral medications used to treat erectile dysfunction include selective enzyme inhibitors, vardenafil HCI, and tadalafil. Selective enzyme inhibitors are available by prescription. They improve partial erections by inhibiting the enzyme that facilitates their reduction and increase levels of cylic guanosine monophosphate (cGMP, a chemical factor in metabolism), which causes the smooth muscles of the penis to relax, enabling blood to flow into the corpora cavernosa.
Patients taking nitrate drugs (used to treat chest pain) should not take selective enzyme inhibitors. There are precautions for men taking alpha blockers. Dosages of the drug should be limited in patients with liver or kidney disorders.
Penile Injection For ED
Penile injection therapy is a process that creates a usable erection within a short period of time. Using a small syringe and needle, a smooth muscle relaxing drug or drug combination is injected into the penis. The patient injects into the corpora cavernosum of the penis causing increased blood flow and an erection.
No device is worn during sexual intercourse and partners need not be aware how the erection was achieved. A meeting with your physician is often required to determine the correct dosage and to teach the proper injection technique. Frequent follow-up is normal to evaluate any plaque, fibrosis, scarring, etc. resulting from the injection.
Physician training and careful monitoring for risks is important. Monitoring for infection, pain, bruises, fibrosis or scarring within the penis, “priapism” (a permanent painful erection), dizziness, elevated blood pressure, heart palpitations or a flushed feeling, are typical and most doctors limit use to two to three times weekly.
Urethral suppository For Erectile Dysfunction
The practice of using medicated urethral to create an erection was introduced in 1997 after having shown a success rate of 66% in clinical trials. Alprostadil suppositories normally come in four dosages. They work by inserting an applicator slightly over an inch long into the end of the penis (urethra). Once in place, the penis is massaged between both hands to release the medication within the suppository. An erection usually results within 5 to 10 minutes after application.
Hormone Replacement Therapy For ED
Hormone Replacement Therapy Doses of the male hormone Testosterone may improve erectile function for those few patients with testosterone deficiency. Replacement is rarely helpful when hormone levels are within normal limits. Testosterone therapy is normally administered with extreme caution in patients with history of prostate cancer, heart, kidney or liver disease. In a very few patients, elevated blood levels of the hormone, Prolactin, may cause erectile difficulty. This condition can usually be controlled with medication.
Penile Implants For Erectile Dysfunction
Penile implants are commonly recommended after careful consideration of less invasive treatments or when application of simpler treatments are unsuccessful. Implants are fixed or mechanical devices surgically implanted within the two corpora cavernosum of the penis allowing immediate and predictable erection whenever desired. A short hospital stay is usually needed, although surgeons are implanting some models in outpatient settings. A four to eight week post-op recovery period should be allowed before the prosthesis is used.
Penile Revascularization For Erectile Dysfunction
Penile Revascularization & Venous Ligation are complex surgical procedures. Only a few physicians, mostly at major medical centers, are qualified to perform these procedures and only a small number of patients, mostly young men whose erectile dysfunction is due to physical trauma, make suitable candidates. A post-op recovery period of at least six weeks is required before attempting intercourse. Techniques are improving, but available data shows only 30-50% of these procedures are successful with a very high relapse rate within two years.
Costs of ED treatment: Average costs for one-year period
Counseling Several thousand
Vacuum Therapy $160-$500
Injection Therapy $2,400
Hormone Therapy $8,000
Oral Drugs $1,700
Implant $7,500 to 20,000
(compiled from multiple sources including treatment vendors)