Erectile dysfunction (ED) is the inability of a man to maintain a firm erection long enough to have sex. Most men have odd times when they cannot get an erection. For example, they may not get an erection so easily if they are tired, stressed, distracted, or have drunk too much alcohol. For most men it is only temporary, and an erection occurs most times when they are sexually aroused. But if the problem is ongoing, it can cause stress and relationship problems and affect self-esteem.
ED can occur at any age, but becomes more common with increasing age. Nonetheless, 70 per cent of all 70-year-olds are sexually potent. In younger males, the most frequent cause is anxiety – particularly nervousness about having sex, about causing a pregnancy, or about using a condom. In middle age, overwork, stress and guilt are the common causes.
It is now clear that in a very high proportion of cases, erectile dysfunction (formerly called impotence) is caused by physical problems than by psychological ones. Erectile dysfunction treatments ranging from medications to surgery can help restore sexual function for most men. Sometimes erectile dysfunction is caused by an underlying condition such as heart disease. So it's important to take erectile trouble seriously because it can be a sign of a more serious health problem.
What is an erection?
When a man becomes sexually aroused, nerve impulses cause the blood flow to increase several times the normal amount in the two cylindrical sponge-like structures (corpus cavernosum) that run along the penis lenght. sThis sudden influx of blood expands the sponge-like structures and produces an erection by straightening and stiffening the penis.
Continued sexual arousal maintains the higher rate of blood flow into the penis and limits the blood flow out of the penis, keeping the penis firm. After ejaculation or when the sexual excitement passes, the blood flow to the penis returns to normal, and the penis gradually returns to the non-erect state.
What causes erectile dysfunction?
Male sexual arousal is a complex process involving the brain, hormones, emotions, nerves, muscles and blood vessels. If something affects any of these systems - or the delicate balance among them - erectile dysfunction can result.
Physical causes
While thoughts and emotions always play a role in getting an erection, erectile dysfunction is usually caused by something physical, such as a chronic health problem or the side effects of a medication.
- Reduced blood flow to the penis because of deterioration of the arteries – this is a physical change which is common in older men, including those with high blood pressure.
- Diabetes
- Heart Disease
- Smoking
- Obesity
- Alcohol and drug abuse
- Diseases which affect the nerves going to the penis. For example, multiple sclerosis, a stroke, etc.
- Injury to the nerves going to the penis. For example, spinal injury, fractured pelvis, radiotherapy to the genital area, etc.
- Side-effects of certain medicines, notably ones for blood pressure and depression.
- Hormonal disorders such as low testosterone.
Psychological causes
The brain plays a key role in triggering the series of physical events that cause an erection. A number of things can interfere with sexual feelings and lead to (or worsen) erectile dysfunction.
- Anxiety
- Depression
- Stress
- Fatigue
- Relationship difficulties
As a rule, a psychological cause is more likely for the ED than a physical cause if there are times when you can get a good erection, even though most of the time you cannot. For example, if you can get an erection by masturbating, or wake up in the morning with an erection.
What should I do if I'm having potency problems?
If erectile dysfunction is more than a temporary, short-term problem, see your doctor. Your doctor can help you determine the underlying cause or causes of erectile dysfunction and then help you find the right type of treatment. In most cases, erectile dysfunction can be successfully treated.
Depending on your symptoms, likely cause of the ED, age, etc, your doctor may suggest that you have some tests. Tests may include: a blood test to check the level of cholesterol, a blood sugar level test, a check of you blood pressure, a heart tracing (ECG) and other heart tests if heart disease is suspected.
What are the treatment options?
A variety of options exist for treating erectile dysfunction. They range from medications and simple mechanical devices to surgery and psychological counseling. The cause of the ED determines the best treatment.
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Oral medications: Oral drugs which help produce an erection in response to sexual stimulation have revolutionised the treatment of ED. They don't work for everybody, but they do work for the majority – even in diabetes. Oral medications available to treat ED include:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
These medications work when there is sexual stimulation. Depending on the treatment, it will need to be taken 20 minutes to 1 hour before sex and the period of time over which it works can vary between 3 hours and up to 36 hours.
It is not safe for some people to use these drugs, and some medications interact dangerously with them. Therefore, before going on any of these pills you should always see a doctor, talk things over with him, and have a physical check-up. Also, all medications have side effects. So, before taking any medication (including Viagra, Levitra or Cialis) make sure to discuss with your doctor.
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Alprostadil: Alprostadil is a synthetic version of the hormone prostaglandin E. The hormone helps relax muscle tissue in the penis, which enhances the blood flow needed for an erection. Alprostadil can be injected into the penis or inserted using a special applicator - usually just before sexual intercourse.
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Vacuum Therapy: This treatment involves the use of a hollow tube with a hand-powered or battery-powered pump. The tube is placed over the penis, and then the pump is used to suck out the air. The device helps draw blood into the penis by applying negative pressure. A tension ring is applied at the base of the penis to help maintain the erection. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse.
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Surgery: This treatment is usually reserved for men whose blood flow has been blocked by an injury to the penis or pelvic area. The goal of this treatment is to correct a blockage of blood flow to the penis so that erections can occur naturally. But the long-term success of this surgery is unclear.
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Counselling: Counselling is often a consideration, both where a psychological cause is suspected or must be ruled out, or to assist in management of any distress.
Whether the cause is physical factors or psychological factors or a combination of both, erectile dysfunction is usually treatable these days. Commonsense measures will often help – for instance, cutting down on stress, alcohol or smoking or getting more sleep.
