Erectile Dysfunction

Erectile Dysfunction



Definion of Erectile Dysfunction

Erectile dysfunction (ED) is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance.

A penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis. The process is often initiated as a result of sexual arousal, when signals are transmitted from the brainto nerves in the penis. Erectile dysfunction is indicated when an erection is difficult to produce. There are various circulatory causes, including alteration of the voltage-gated potassium channel, as in arsenic poisoningfrom drinking water. The most important organic causes are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects.

Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but often can be helped. Notably in psychological impotence, there is a strong response to placebo treatment. Erectile dysfunction, tied closely as it is about ideas of physical well being, can have severe psychological consequences.

Besides treating the underlying causes such as potassium deficiency or arsenic contamination of drinking water, the first line treatment of erectile dysfunction consists of a trial of PDE5 inhibitor drugs (the first of which was sildenafil or Viagra). In some cases, treatment can involve prostaglandin tablets in the urethra, injections into the penis, a penile prosthesis, a penis pump or vascular reconstructive surgery.

Cause of Erectile Dysfunction

  • Drugs (anti-depressants (SSRIs) and nicotine are most common)
  • Neurogenic disorders
  • Cavernosal disorders 
  • Psychological causes: performance anxiety, stress, mental disorders, psychological problems, negative feelings.
  • Surgery
  • Aging. It is four times higher in men in their 60s than in men in their 40s.
  • Kidney failure
  • Diseases such as diabetes and multiple sclerosis (MS). While these two causes have not been proven they’re likely suspects as they cause issues with both the blood flow and nervous systems.
  • Lifestyle: smoking is a key cause of erectile dysfunction. Smoking causes impotence because it promotes arterial narrowing. See also Tobacco and health.

A few causes of impotence may be iatrogenic (medically caused).

Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Complete removal of the prostate gland or external beam radiotherapy of the gland are common causes of impotence; both are treatments for prostate cancer.

ED can also be associated with bicycling due to both neurological and vascular problems due to compression. The increase risk appears to be about 1.7 fold.

A recent study suggests an epidemiological association between chronic periodontitis (periodontal inflammation) and erectile dysfunction, similarly to the association between periodontitis and coronary heart diseases, and cerebrovascular diseases In all the three conditions (erectile dysfunction, coronary heart disease and cerebrovascular diseases), despite the epidemiological association with periodontitis, no causative connection has proved yet.

February 2011: Men who use non-steroidal anti-inflammatory drugs (NSAIDs) 3 times a day for more than 3 months are at a 22 percent increased risk of erectile dysfunction. A link between NSAID use and erectile dysfunction still existed for different age, race, ethnicity, smoker, diabetes, hypertension, high cholesterol, coronary diasease and other health problems. But due to benefit of NSAID, it’s too early for men to avoid NSAIDs based solely on the research stated at Journal of Urology.

Signs and Symptoms of Erectile Dysfunction

Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection. It is analyzed in several ways:

  • 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.
  • Other factors leading to erectile dysfunction are diabetes mellitus (causing neuropathy).

Risk Factors for Erectile Dysfunction

Erections may take longer to develop and may not be as firm as you get older. You may need more direct touch to your penis to get and keep an erection. This isn’t a direct consequence of getting older. Usually health problems or taking medications, which is more common as men age, cause it.

A variety of risk factors can contribute to erectile dysfunction. They include:

  • Medical conditions: particularly diabetes or heart problems.
  • Smoking: it increases the effects of other blood vessel disorders, including high blood pressure and atherosclerosis.
  • Being overweight: especially if you’re very overweight (obese).
  • Certain medical treatments: such as prostate surgery or radiation treatment for cancer.
  • Injuries: particularly if they damage the nerves that control erections. Prolonged bicycling may compress nerves and affect blood flow to the penis.
  • Medications: including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate cancer.
  • Psychological conditions: such as stress, anxiety or depression.
  • Alcohol use: Alcohol depresses the central nervous system and impairs sexual function.
  • Drug: Illicit drugs such as heroin, cocaine, methamphetamines, and marijuana can affect sexual function.

Diagnosis of Erectile Dysfunction

There are no formal tests to diagnose erectile dysfunction. Some blood tests are generally done to exclude underlying disease, such as hypogonadism and prolactinoma. Diabetes is considered a disorder, but is also a risk. Impotence is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease such as coronary artery disease and peripheral vascular disease.

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. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence.

Duplex Ultrasound

Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue. Injecting prostaglandin, a hormone-like stimulator produced in the body, induces erection. Ultrasound is then used to see vascular dilation and measure penile blood pressure.

Penile Nerves Function

Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus.

Nocturnal Penile Tumescence (NPT)

It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections.

Penile Biothesiometry

This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.

Dynamic İnfusion Cavernosometry (DICC)

technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.

Corpus Cavernosometry

Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualised by infusing a mixture of saline and x ray contrast medium and performing a cavernosogram. Digital Subtraction Angiography: In DSA, the images are acquired digitally.

Magnetic Resonance Angiography (MRA)

This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a “contrast agent” into the patient’s bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies.

Prevention from Erectile Dysfunction

To make healthy lifestyle choices and to manage any existing health problems you have may prevent erectile dysfunction. Here are some things you can do:

  • Work with your doctor to manage diabetes, heart disease or other chronic health problems.
  • Stay sexually active
  • See your doctor for regular checkups and medical screening tests.
  • Quit smoking, limit or avoid alcohol, and don’t use street drugs.
  • Exercise regularly.
  • Take steps to reduce stress.
  • Get help for anxiety or depression.
  • Eat a diet rich in fresh fruits and vegetables, whole grains, and fiber and low in saturated fats and sodium.

Treatment of Erectile Dysfunction

Exercise, particularly aerobic exercise is an effective treatment for erectile dysfunction.

When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants may be fitted surgically. Medications carry risk of priapism.

All these mechanical methods are based on simple principles of hydraulics and mechanics and are quite reliable, but have their disadvantages.

Medication

Phosphodiesterase Type 5 İnhibitors

The cyclic nucleotide phosphodiesterases constitute a group of enzymes that catalyze the hydrolysis of the cyclic nucleotides cyclic AMP and cyclic GMP. They exist in different molecular forms and are unevenly distributed throughout the body.

One of the forms of phosphodiesterase is termed PDE5. The prescription PDE5 inhibitors sildenafil , vardenafil  and tadalafil  are prescription drugs which are taken orally. They work by blocking the action of PDE5, which causes cGMP to degrade.

Alprostadil

Alprostadil in combination with the permeation enhancer DDAIP has been approved in Canada under the brand name Vitaros as a topical cream first line treatment for erectile dysfunction.

Another treatment regimen is injection therapy. One of the following drugs is injected into the penis: papaverine, phentolamine, and prostaglandin E1.

Surgery

Often, as a last resort if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.

Devices

The device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as 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.