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Erectile Dysfunction

Erectile dysfunction (sometimes called “impotence”), is the inability for a male to obtain and/or sustain an erection for sexual purposes. Although most men describe the condition as “embarrassing” or “humiliating,” the problem is a common experience affecting about five percent of men in their 40s and 15 to 25 percent of men by the age of 65. Transient erectile dysfunction and inadequate erection affect as many as 50 percent of men between the ages of 40 and 70.

Most men have experienced erectile failure at some time during their lives, usually due to temporary stress, fatigue, or excessive consumption of alcohol. With erectile dysfunction (ED), a man cannot achieve or maintain an erection at least 50 percent of the time that he attempts intercourse. ED is a chronic (ongoing) condition for which there are usually identifiable physical causes.

Untreated ED can cause emotional and relationship problems, and often leads to diminished self-esteem.

What is an Erection?
The process of erection begins in the brain and involves the nervous and vascular systems. Physical or psychological stimulation (arousal) causes the nerves to send messages to the vascular system, which diverts a substantial amount of blood flow to the penis. Two arteries in the penis supply blood to the erectile tissue which becomes engorged as a result of increased blood flow and pressure.

Since blood must remain in the penis to maintain its rigidity, the erectile tissue is enclosed by elastic sheaths. These tighten to prevent blood from leaving the penis during erection. When stimulation finishes or ejaculation takes place, the pressure in the penis decreases, blood is released, and the penis resumes its normal size and shape.

The Causes of Erectile Dysfunction
Close to 85 percent of ED cases result from a medical condition, or the medications taken for a medical condition. Circulatory problems, diabetes, depression, and lifestyle factors such as alcoholism and stress are all conditions that can cause ED, as explained below.

Circulatory problems: The most common cause of ED - particularly for men over the age of 50 - is a problem with circulation. To become erect, the spongy tissue inside the penis needs to be engorged with blood. Any condition that reduces the amount of blood passing through the vessels that supply the penis can cause ED. Failure to achieve an erection can also result from a blood clot or surgery that impairs blood flow to the penis.

In some cases, blood flows into the penis normally, but flows back out too quickly, resulting in the inability to sustain a successful erection.

Diabetes: The complications with circulation that often accompany Type 1 and Type 2 diabetes frequently give rise to ED.

Between 35 and 50 percent of men with diabetes experience ED at some time during the disease’s progression. The condition usually becomes apparent 10 to 15 years earlier than in men who do not have diabetes.

Use of medications: Over 200 prescription drugs may cause some degree of impotence as a side effect. The most common are diuretics and blood pressure drugs. Tranquilizers and other psychiatric drugs, antidepressants, sedatives, cimetidine (used to treat stomach ulcers) and many over-the-counter medications can also cause ED.

Depression: The cause of ED can be psychological, physical, or both. Sometimes, depression leads to ED which, in turn, increases depression. Since certain medicines used to treat depression can cause ED as a side effect, the cause and effect cycle continues.

Lifestyle factors: Long-term use of alcohol, nicotine and illegal drugs such as marijuana and cocaine can also give rise to ED. (The consumption of alcohol slows down the central nervous system, making it more difficult to achieve and/or sustain an erection.)

Ongoing stress also contributes towards ED. Often, following one futile attempt to achieve an erection, a man will become very stressed in anticipation of repeated failure. Consequently, a pattern develops.

Treatments
It is important to recognize that ED is a treatable condition and not a disease. No one has to live with ED. There are many forms of treatment, depending on the cause and nature of the problem.

Counselling/ therapy: This is helpful when psychological factors such as depression, anxiety or stress are the cause. Many thousands of men have overcome ED through counselling alone or with their partner.

Oral medications: Oral prescription medications such as sidenafil are frequently employed to treat ED. Sidenafil causes the smooth muscles of the penis to relax, enabling blood to flow into the erectile tissues. This medication is absorbed rapidly by the body and is taken 30 minutes to one hour prior to intercourse.

Self-injection: Self-injection involves using a short needle to inject prescription medication through the side of the penis directly into the erectile tissues. This normally produces an erection that lasts from 30 minutes to several hours.

Vacuum devices: Vacuum devices manually create an erection. The penis is inserted into a plastic tube, which is pressed against the body to form a seal. A hand pump attached to the tube creates a vacuum that draws blood into the penis, causing it to become engorged. The penis is removed from the tube and a soft rubber ring is placed around the base of the penis to contain the blood and maintain the erection. The ring may be safely left in place for 25 to 30 minutes.

Vacuum devices work best in men who are able to achieve partial erections on their own.