The Physical causes of Erectile Dysfunction
Blockage of Blood Vessels The primary cause of oxygen deprivation is ischemia, the blockage of blood vessels. The same conditions that cause blockage in the blood vessels leading to heart problems may also contribute to erectile dysfunction. For example, when cholesterol and other factors are imbalanced, a fatty substance called plaque forms on artery walls. As the plaque builds up, the arterial walls slowly constrict, reducing blood flow. This process, known as arteriosclerosis, is the major contributor to the development of coronary heart disease.
Diabetes may contribute to as many as 40% of impotence cases . Between one third and one half of all diabetic men report some form of sexual difficulty.
High Blood Pressure Erectile dysfunction is more common and more severe in men with hypertension than it is in the general population. Many of the drugs used to treat hypertension are thought to cause impotence as a side effect; in these cases, it is reversible when the drugs are stopped.
Parkinson's Disease As a risk factor for impotence, Parkinson's disease (PD) is an under-appreciated problem. It is estimated that about one-third of men with PD experience impotence.
Multiple Sclerosis affects the central nervous system, also precipitates sexual dysfunction in as many as 78% of males suffering for MS.
Prostate Cancer and its Treatments can damage nerves needed for erectile function.
Radiation the side effects of radiation therapy include most of those of surgery, but the risks for impotence and incontinence are considerably lower.
Medications about a quarter of all cases of impotence can be attributed to medications. Many drugs pose a risk for erectile dysfunction. Among the drugs that are common causes of impotence are the following:
* Drugs used in chemotherapy.
* Many drugs taken for high blood pressure, particularly diuretics and beta blockers.
* Most drugs used for psychological disorders, including anti-anxiety drugs, anti-psychotic drugs, and antidepressants.
Physical Trauma, Stress or Injury
Injury : spinal cord injury and pelvic trauma, such as a pelvic fracture, can cause nerve damage that results in impotence.
Bicycling : studies have indicated that regular bicycling may pose a risk for erectile dysfunction by reducing blood flow to the penis.
Vasectomy : does not cause erectile dysfunction. When impotence occurs after this procedure, it is often in men whose female partners were unable to accept the operation.
Hormonal Abnormalities : Hypogonadism in men is a deficiency in male hormones, usually due to an abnormality in the testicles, which secrete these hormones. It affects 4 to 5 million men in the United States.
Low Testosterone Levels : only about 5% of men who see a physician about erectile dysfunction have low levels of testosterone, the primary male hormone. In general, lower testosterone levels appear to reduce sexual interest, not cause impotence. A 1999 study, however, suggests that testosterone levels are not an accurate reflection of sexual drive.
Lifestyle changes to help prevent Erectile Dysfunction
Maintain General Health : Because many cases of impotence are due to reduced blood flow from blocked arteries, it is important to maintain the same lifestyle habits as those who face an increased risk for heart disease.
Diet : Everyone should eat a diet rich in fresh fruits and vegetables, whole grains, and fiber and low in saturated fats and sodium. Because erectile dysfunction is often related to circulation problems, diets that benefit the heart are especially important.
Exercise : A regular exercise program is extremely important. One study reported that older men who ran 40 miles a week boosted their testosterone levels by 25% compared to their inactive peers. Another study found that men who burned 200 calories or more a day in physical activity (which can be achieved by two miles of brisk walking) cut their risk of erectile dysfunction by half compared to men who did not exercise.
Limit Alcohol and Quitting Smoking : Men who drink alcohol should do so in moderation. Quitting smoking is essential.
Stay Sexually Active : Staying sexually active can help prevent impotence. Frequent erections stimulate blood flow to the penis. It may be helpful to note that erections are firmest during deep sleep right before waking up. Autumn is the time of the year when male hormone levels are highest and sexual activity is most frequent.
Kegel Exercises : The Kegel exercise is a simple exercise commonly used by people who have urinary incontinence and by pregnant women. It may also be helpful for men whose erectile dysfunction is caused by impaired blood circulation. The exercises consist of tightening and releasing the pelvic muscle that controls urination
Changing or Reducing Medications : If medications are causing impotence, the patient and physician should discuss alternatives or reduced dosages.
Psychotherapy and Behavioral Therapy Interpersonal, supportive, or behavioral therapy can be of help to a patient during all phases of the decision-making process regarding possible methods of treatment. Therapy may also ease the adjustment period after the initiation or completion of treatment. It is beneficial to have the partner involved in this process. The value of sex therapy is questionable. In one study, 12 out of 20 men whose dysfunction had a psychological basis and who were advised to enter a sex clinic resisted sex therapy out of embarrassment or because they felt it wouldn't help. Of the eight who entered therapy, only one actually achieved satisfactory sex.
Treatment with medication
Viagra : is now prescribed in over 90% of erectile dysfunction cases. Studies indicate that it helps 70% of patients achieve sexual function. In one 1999 study, overall male satisfaction was 65%. Not surprisingly, the best results occurred in men who had the fewest sexual problems before treatment, but even men with severe erectile dysfunction had a 41% satisfaction rate. A 2000 study of men who had responded well initially to sildenafil found that 96% of them were satisfied with the treatment after two to three years.
Administration and Effect Sildenafil is effective within 20 to 40 minutes. The drug works only when the man experiences some sexual arousal.
Mechanism of Actions Sildenafil was originally developed for heart disease, but was found to have a unique mechanism of action that targeted only factors in the penis. The drug blocks the enzyme phosphodiesterase. This action maintains persistent levels of cyclic GMP, a chemical that is produced in the penis during sexual arousal and which is the primary chemical that relaxes smooth muscles and increases blood flow.
Common Side Effects Common side effects include the following:
* Muscle aches.
* Gastrointestinal distress.
* Nasal congestion.
Cialis : is a potent and highly-selective PDE5 inhibitor and may not affect other parts of the body, including the brain, heart, kidney and eyes. Clinical trials are reporting significant success rates in up to 88% of patients. It appears to take effect in 15 minutes and the effects last up to 24 hours. Improved results were reported in men suffering from erectile dysfunction of varying severity and causes. Common side effects include headache, muscle pain, stomach upset following meals, and back pain.
Vardenafil : is another PDE5 inhibitor currently being investigated. A small study concluded that it increased penile rigidity and tumescence. Further evaluation is warranted.
Testosterone Replacement Therapy
Testosterone replacement therapy may be effective in inducing puberty in adolescent boys with hypogonadism and may also be helpful for some adult patients with the condition. Some experts believe testosterone replacement therapy also may be helpful for older men whose testosterone levels are deficient.