Monday, July 31, 2006

Erectile Dysfunction

Erectile Dysfunction, also known as impotence, affects an estimated 15 to 30 million men in the United States. Erectile dysfunction is when a man cannot get or keep an erection long enough for sexual intercourse. Erectile dysfunction often has physical causes in older men, such as injury, disease, of side effects of drugs, but erectile dysfunction happens in men of any age.

How do Erections Happen?
There are two chambers in the penis, which are called the corpora cavernosa running the length of the penis. They are filled with spongy tissue containing fibrous tissues, veins, smooth muscles, spaces, and arteries. Around the corpora cavernosa is a membrane called the tunica albuginea. Urine and ejaculate are expelled through the urethra, which runs along the underside of the corpora cavernosa, which is surrounded by the corpus spongiosum.Mental and/or sensory stimulation start an erection. Nerve and brain impulses signal muscles in the corpora cavernosa to relax, which lets blood flow fill the spaces. Pressure in the corpora cavernose from the blood makes the penis expand, and the tunicia albuginea helps trap blood in the corpora cavernosa, keeping the erection sustained. When the muscles in the corpora cavernosa are contracted, it stops blood from coming in and lets the blood leave, and the penis loses its erection.

Causes of Erectile Dysfunction
The progression of events described above cause an erection, so any disruption in that series of events can cause erectile dysfunction. The progression includes brain nerve impulses, nerve impulses in the spinal column, and areas around the penis, along with reactions of arteries, veins, fibrous tissues, and muscles in and around the corpora cavernosa. Most frequently, erectile dysfunction is caused by injury or damage to fibrous tissues, arteries, nerves, and smooth muscles. This damage is frequently the result of disease. About 70 percent of erectile dysfunction cases is caused by kidney disease, diabetes, multiple sclerosis, atherosclerosis, chronic alcoholism, vascular disease, and neurologic disease. Among men with diabetes, erectile dysfunction affects between 35 and 50 percent of those men.Surgery, such as radical prostate and gallbladder surgery, can damage arteries and nerves near the penis, also causing erectile dysfunction.

Injuries to the prostate, spinal cord, bladder, pelvis, and penis can damage arteries, fibrous tissues, and smooth muscles can cause erectile dysfunction.Drug side effects are reported to be the cause of 25 percent of all erectile dysfunction cases. Blood pressure medications, antidepressants, tranquilizers, the ulcer drug cimetidine, appetite supppressants, and antihistamines can have erectile dysfunction as a side effect.10 to 20 percent of erectile dysfunction cases can have psychological causes. Anxiety, depression, low self-esteem, stress, and fear of a sexual malfunction, although those with a physical cause often have the same psychological reactions.Smoking affects vein and artery blood flow, and hormone problems are other possible causes of erectile dysfunction.

Treatments for Erectile Dysfunction
Less invasive treatments are usually done first for erectile dysfunction. Drugs that have erectile dysfunction side effects are considered, and alternative medications are discussed and prescribed. Blood pressure medications work in different ways, and some are more likely than others to cause erectile dysfunction. Behavior modification and psychotherapy are the next option considered. Then, oral and locally injected drugs, vacuum pumps, surgical implants, and lastly, artery or vein surgery options are attempted.

  • Psychotherapy - Relaxation techniques to reduce anxiety are used, and sometimes the patient’s partner assists in these techniques.
  • Drug Treatment
    Medications for erectile dysfunction are administered orally, or by injection directly into the penis. Oral medications for erectile dysfunction were a revolution in treatment options. The FDA (Food and Drug Administration) approved Viagra as an erectile dysfunction treatment in March, 1998, followed by the approval of Levitra (vardenafil hydrochloride) in August, 2003. There are a number of herbal remedies on the market as well, which claim to aid in erectile dysfunction with Zenerx being one of the more popular.

    Viagra and Levitra enhances the effects of nitric oxide. Nitric oxide relaxes the smooth muscles in the penis to allow greater blood flow when taken an hour before sex. Recommended dosage for Viagra is 50 mg (milligrams), but your physician may prescribe 25 mg to 100 mg, depending on the patient. Levitra has a recommended dosage of 10 mg, but 2.5 mg to 20 mg may be prescribed. Other medications taken and medical conditions may warrant the lowest dosage of Levitra.
    Nitrate based drug users, such as nitroglycerin, should not take Viagra or Levitra, as this could cause a sudden drop in blood pressure. Levitra and Viagra should not be taken more than once a day. Alpha-blocker (for prostate or high blood pressure) class drug users should not use Levitra as well. These remedies are made up of all natural ingredients which may include some of the following: horny goat weed, tribulus, tongkat ali, mucuna pruriens, maca, shilajit, and ashwagandha to name a few. There are few studies that actually show the claims of these products to be true, and like all products, one which works for someone may or many not work for another. The makers of these drugs are hard to stay on top of due to the lack of ligitimate study and research proff provided when they are making their claims. However, the claims are such that they work, and I am sure for some they actually do.

    Some men with erectile dysfunction have low levels of natural testosterone, and oral testosterone can help erectile dysfunction, but is frequently not effective and may cause liver damage. Yohimbine hydrochloride, dopamine, trazodone, and serotonin agonists are oral drugs that have inconsistent results in studies, but some men claim work. These claims of success could be a result of the “placebo effect”, where a patient believes a treatment will work, and it does, simply because he believes it will.

    Papaverine hydrochloride, alprostadil (Caverject), and phentolamine can be injected directly into the penis, causing a stronger erection. Scarring and priapism (a persistent erection) are two side effects of this treatment. Erections can be enhanced when a muscle relaxant called nitroglycerin is rubbed onto the penis.
    Alprostadil pellets (Muse) can be inserted into the urethra an inch deep, causing an erection that may last 30 to 60 minutes 8 to 10 minutes after insertion. Common side effects are a warm or burning feeling in the urethra, minor urethral bleeding, aching testicles or penis, and redness.

  • Vacuum Pumps
    The penis is placed inside a plastic cylinder, and a vacuum pump draws blood into the corpora cavernosa, causing an erection, and an elastic band is placed around the base of the penis, keeping the blood in the penis, and maintaining the erection.
  • Surgery
    Three types of surgery are usually performed:
    1. Implanting a device into the penis that enables an erection
    2. Arteries are reconstructed to regain penis blood flow
    3. Blocking veins off stopping penile tissue leaks

    Implants can regain an erection though either paired rods or inflatable implants. Paired rods are manually adjusted by the user to the desired position, but length and width of penis won’t change. Inflatable implants are powered by a scrotum mounted pump which, when pressed, inflates the two pressurized cylinders expand the penis in length and width. Possible problems can be mechanical failure and infection.

    Artery repair surgery has best results on young men with blockage due to an injury. Older men with widespread blockage have a slim chance of success with this surgery. Vein repair surgery blocks veins on purpose to block blood leakage, so that an erection can be maintained. Long-term effects are questionable, and this surgery is rarely performed.