Medicine for Africa - Medical Information Service
Erectile Dysfunction (ED), also called ‘impotence’, is the inability to achieve and/or sustain a penile erection that is sufficient for normal sexual activity. ED includes cases, where the penis may become partly erect, but not hard enough to conduct sexual intercourse. At times, the penis does not achieve any swelling or fullness at all.
The most common cause of ED (in 7 out of 10 cases) is due to insufficient blood flow into the swell bodies (corpora cavernosae) of the penis due to narrowing of the blood vessels, secondary to atherosclerotic plaques (e.g. cholesterol).
ED should not be confused with other conditions that can interfere with male sexual intercourse, such as e.g. ‘ejaculatory dysfunction’, which includes physiological problems with ejaculation and achieving an orgasm, or decreased libido (lack of sexual desire), which may be due to hormonal imbalance.
Psychological problems can also result in temporary loss of proper sexual function and often be mistaken for physiologically based ED. However, once the psychological problems have been resolved, the ‘temporary ED’ will be cured as well.
ED varies in severity – while some men experience an occasional inability to achieve an erection, others may have lost this ability entirely, or may only be able to have a very short lasting erection. Often, men are embarrassed regarding their ‘increasing sexual incompetence’ and thus, reluctant to discuss ED with their doctor. Thus, ED is gravely under-diagnosed in every civilization and culture. Studies have shown that ED increases from about 5% among men 40 years of age to about 20% at the age of 55, to up to 50 % of men in their 70s.
Risk factors that can cause ED may include one or more of the following:
In the case of psychological causes, ED usually develops quite suddenly, and may resolve again when the mental state has improved. However, at times, men may become even more anxious and depressed, when they notice that they also develop ED, resulting in a vicious circle, if the interrelationship between mental problems and ED is not recognized and resolved. As mentioned above, many medications that are used for treating depression or other psychiatric disorders may also cause ED or other ejaculatory problems.
Note: A psychological cause is more likely the basis for your ED, if there are times when you can get a good erection (e.g.when you masturbate, or wake up in the morning with an erection), even though most of the time you cannot, when you are with a woman.
Erectile dysfunction is the inability to maintain a penile erection that is firm enough to have sex. Symptoms that are related to ED may include:
A diagnosis of erectile dysfunction is made when a man experienced repeated inability to achieve and/or maintain an erection that was sufficient to conduct satisfactory sexual performance over a period of at least three months.
For the establishment of a proper diagnosis, an open discussion between the patient and his doctor is necessary, in order to assess its severity and to find the underlying cause/ disease that may be the cause of your ED (see above).
A physical exam, including a careful examination of the penis and testicles and checking their sensitivity (nerve involvement) and the recording of the medical history can often be sufficient to recommend an appropriate treatment.
Other underlying causes can often be revealed via laboratory tests, which should include:
At times, X-rays, especially following pelvic trauma, may reveal bony abnormalities, or an ultrasound may be performed to check for testicular size or structural abnormalities.
An overnight erection test is a simple test to find out whether an erection has occurred at night – most men have erections during sleep (in the REM cycle of sleep). A special tape is wrapped around the penis before going to sleep – if the tape is separated from the penis in the morning, it indicates that an erection has occurred during the night, which indicates that the cause of ED is most likely psychological rather than physical in nature.
Today, erectile dysfunction is treatable in any age group. However, treatment depends on the underlying cause of your particular form of ED.
If your ED is caused by lifestyle related problems, it could markedly improve by:
In many ‘temporary ED’ cases, the above lifestyle changes can make a long-lasting impact on your ‘perceived’ erectile dysfunction.
If there is an underlying disease present, such as e.g. diabetes mellitus, depression, anxiety, heart disease or other cardiovascular problems, hormonal imbalance, etc., it is important to primarily treat the underlying disease first. Successful treatment of the underlying disease in combination with the above listed lifestyle changes will have a considerable positive influence on your erectile function, sustainability and love life.
Also, if you are on any kind of medication for any of the above mentioned or other healthcare problems, it is important to evaluate your current medications and their side effects, as many drugs may cause ED as one of their adverse side effects. Thus, changing your current medication may help to improve your erectile capacity, especially in connection with the above lifestyle changes.
Pelvic floor muscle exercises:
The pelvic floor muscles are a group of muscles that wrap around the underside of the bladder and rectum. One of these muscles (the bulbocavernosus muscle) also partly wraps around the base of the penis. This muscle is involved with preventing blood from escaping out of the swell bodies during an erection; it is also active during ejaculation and when emptying the urethra of ‘the last drop of’ urine.
These are the muscles that can be trained and strengthened. Ideally, discuss with your doctor, whether this option is appropriate for you.
Other treatment options for ED include:
The oral medications Viagra, Levitra and Cialis work rather similar by enhancing the effects of nitric acid, a natural chemical that causes muscle relaxation in the penis, thus allowing for increase blood inflow and subsequent erection upon sexual stimulation.
Recent studies have shown that regularly taken Viagra in small doses may have a long-term positive effect on erection problems.
Apomorphine works by increasing the level of certain chemical compunds in the brain, sending signals to the nerves of the penis, when you are sexually aroused.
Discuss with your doctor, whether and if so, which of these drugs are appropriate for you – beware that they may not be effective or even dangerous for you, if:
Penile implants – are surgically implanted devices into both swell bodies (corpora cavernosae) of your penis. There are two types of implants:
As with all surgery, they are expensive and are associated with a certain risk of complications, e.g. infections, not proper functioning, etc.
Alternative treatments can be used to treat erectile dysfunction; however, their effectiveness may be very selective, as not everybody will respond to them successfully, and their safety may be questionable.
There are dozens of so-called impotence herbs available without prescription that are said to have sex enhancing properties, such as ashwagandha, catuaba, ginseng, horny goat weed, maca, mucuna pruriens, muira puama, tongkat ali, tribulus terrestris and yohimbine. It is quite impossible to predict which single herb or herb combination will be effective for you or whether it will provide a cure.
Relatively safe forms of alternative treatment with potentially some effect include:
Herbal Viagra – the US Food and Drug Administration (FDA) has issued warnings regarding several types of “herbal Viagra”, because they contain potentially harmful drug compounds that are not listed on the label. Some of these ‘drugs’ can interact with prescription drugs and result in dangerously low blood pressure; furthermore, they may be even more dangerous for men who take nitrates for heart problems.
Other so-called home remedies are less well known to be effective and should rather be avoided, since the adverse side effects may way outweigh the results.
Erectile dysfunction can lead to mental and emotional stress for both you and your partner, no matter whether its cause is physical, psychological or a combination of both. Here are some suggestions:
There is no one preventive measure for erectile dysfunction. The best way to prevent ED is to lead a healthy lifestyle and to treat any arising health problems as soon as possible.
Based on the above causes for ED, you could do the following to prevent or delay the development of ED:
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