Most
men have had to deal with moments when there is a temporary loss of erection,
which could be frustrating. The truth is that it is completely normal. Most men
get worried and this leads to a vicious cycle propagated by anxiety. For example feeling nervous about having sex after a bad experience or
because of a previous episode of loss of erection during sex and feeling
self-conscious that you can't enjoy sexual intercourse or thinking that your
partner is reacting negatively to you, could cause persistent loss of erection
during sex.This
is called performance anxiety. It is very different from erectile dysfunction
(known in the past as impotence). An occasional problem achieving
an
erection is nothing to worry about. But failure to do so more than 50% of
the time at any age may indicate a condition that needs treatment.
Men find it difficult
to tell their doctor they have problems with maintaining an erection. They may
visit the doctor and complain about other things, finding it difficult to talk
about what really brought them (fortunately, doctors are trained to probe
further, so you don’t have to go home with the problem).
What really is
erectile dysfunction (ED)? It is a form of sexual dysfunction characterized by persistent inability to develop or
maintain an erection of the penis during sexual activity. Emphasis is on
persistent.
Sexual dysfunction is difficulty experienced by an individual
or a couple during any stage of a normal sexual activity, including physical
pleasure, desire, preference, arousal or orgasm. Many of the sexual
dysfunctions that are defined are based on the human sexual response cycle. The
human sexual response cycle is a four-stage model of physiological
responses to sexual stimulation, which, in order of their occurrence, are the
excitement phase, plateau phase, orgasmic phase, and resolution phase.
How does
erection occur?
Penile erection is managed by two mechanisms: the
reflex erection, which is achieved by directly touching the penile shaft, and
the psychogenic erection, which is achieved by erotic or emotional stimuli. The
former uses the peripheral nerves and the lower parts of the spinal cord,
whereas the latter uses the brain (limbic system). In both cases, an intact
neural system is required for a successful and complete erection. Nitric oxide (NO)
is secreted following stimulation of the penile shaft. This leads to relaxation
of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and
subsequently penile erection. Additionally, adequate levels of testosterone (produced
by the testes) and an intact pituitary gland are required for the development
of a healthy erectile system. As can be understood from the mechanisms of a
normal erection, impotence may develop due to hormonal deficiency, disorders of
the neural system, lack of adequate penile blood supply or psychological
problems.
The causes of erectile
dysfunction are generally divided into two:
·
Psychological cause
·
Organic causes
Psychological cause is where erection or penetration fails due to
thoughts or feelings (psychological reasons) rather than physical impossibility;
this is somewhat less frequent but can often be helped. Notably in this type, there
is a strong response to ineffective treatment (placebo treatment). Obtaining
full erections at some times, such as when asleep (when the mind and
psychological issues, if any, are less present), tends to suggest that the
physical structures are functionally working.
Organic causes are due to disease processes in the
body. The most important organic causes are heart and blood vessel
(cardiovascular) diseases, diabetes, neurological problems (for example, trauma
to the nerves after surgery to remove the prostate), insufficient sex hormones and
side effects of some drugs.
Below are the common causes of erectile dysfunction
- Psychological
causes: performance anxiety, stress, and mental disorders.
- Surgery
- Aging:
It is four times more common in men aged in their 60s than those in their
40s (ED becomes more common as you get older. But it's not a natural part
of aging).
- Kidney failure.
- Lifestyle:
smoking is a key cause of erectile dysfunction. Smoking causes impotence
because it promotes arterial narrowing, thereby decreasing blood flow to
the penis.
- Alcohol and
tobacco use - Tobacco, alcohol and recreational drugs can all damage a
man's blood vessels and/or restrict blood flow to the penis, causing ED.
- Atherosclerosis
(hardening of the arteries) - Atherosclerosis alone accounts for 50% to
60% of ED cases in men 60 and older.
- Diabetes
mellitus (high blood sugar) - Between 35% and 50% of men with diabetes
have ED, and ED may be a predictor for other vascular problems.
- Neurogenic
disorder (due to a disorder in the nerves going to the penis).
- Cavernosal
disorders (disorder of the erectile tissues in the penis)
- Fatigue -
Regular exercise can reduce the risk of ED.
- Hypertension
(high blood pressure)
- Hypogonadism
(which leads to lower testosterone levels)
- Multiple sclerosis
- Overweight
men are more likely to have ED
- Parkinson’s
disease
- Prescription
medications, such as antidepressants, pain medicine (long term use of non
steroidal anti-inflammatory drugs like naproxen, and the use of opioids)
and medicine for high blood pressure
- Exposing
the testicles to radiation.
- Stress and
anxiety including stress from work or family situations - Stress and
anxiety are leading causes of temporary ED.
- Stroke.
Research indicates that erectile dysfunction is
common, and it is suggested that approximately 40% of males suffer from
erectile dysfunction or impotence, at least occasionally.
A useful and simple way to distinguish between
physiological and psychological impotence is to determine whether the patient ever
has an erection. If never, the
problem is likely to be physiological; if sometimes (however rarely), it could be physiological or
psychological.
Exercise, particularly aerobic exercise during
midlife is effective for preventing ED; exercise as a treatment is under
investigation. For tobacco smokers, cessation results in a significant
improvement.
Treatment depends on the cause.
Oral pharmacotherapy and vacuum erection devices
are first-line treatments,[20]:20,24 followed
by injections of drugs into the penis, and penile implants.[20]:25–26
Oral medications such as The sildenafil (Viagra), vardenafil
(Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally
A topical drug combining alprostadil with the
permeation enhancer DDAIP has been approved in Canada under the brand name vitaros
as a first line treatment for erectile dysfunction.
One of the following drugs is injected into the
penis: papaverine,
phentolamine,
and prostaglandin E1
A vacuum erection device helps draw blood into the
penis by applying negative pressure. This type of device is sometimes referred
to as a penis pump, and may be used just prior to sexual intercourse. Several
types of FDA approved vacuum therapy devices are available with a doctor's
prescription. More drastically, inflatable or rigid penile implants may be
fitted surgically.
Often, as a last resort if other treatments have
failed, the most common procedure is a prosthetic implant which involves the
insertion of artificial rods into the penis.
Gene therapy is being developed that would allow
for weeks or months long effect, supporting erections.
A study done at the medical college of Georgia has
found that venom from the Brazilian wandering spider contains a toxin, called
Tx2-6, causes erections. Scientists believe that combining this toxin with
existing medication such as Viagra may lead to an effective treatment for
erectile dysfunction
During the late 16th and 17th centuries in France,
male impotence was considered a crime, as well as legal grounds for a divorce.
The practice, which involved inspection of the complainants by court experts,
was declared obscene in 1677.
In summary,
- Failure to
achieve an erection less than 20% of the time is not unusual and treatment
is rarely needed.
- Failure to
achieve an erection more than 50% of the time generally indicates there is
a problem requiring treatment.
·
A useful and
simple way to distinguish between physiological and psychological impotence is
to determine whether the patient ever has an erection. If never, the problem is likely to be
physiological; if sometimes (however
rarely), it could be physiological or psychological.
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