Erection problems and impotence
Impotence / Erectile Dysfunction What is erectile dysfunction (ED)?
Impotence, or erectile dysfunction, is the inability
to achieve an erection, and/or dissatisfaction with the size, rigidity,
and/or duration of erections. Erection problems affects millions of
Although in the past it was commonly believed to be
due to psychological problems, it is now known that 80 to 90 percent of
impotence is caused by physical problems, usually related to the blood
supply of the penis. Many advances have occurred in both diagnosis and
treatment of erectile dysfunction including the introduction of erection
enhancing drugs such as Viagra..
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Possible Causes of Erection Problems & Risks
Many men experience difficulty in getting
an erection due to the types of medicine they take to treat high blood
What are the risk factors for erectile dysfunction?
According to the National Institutes of Health,
erectile dysfunction is also a symptom in many disorders and diseases.
Direct risk factors for erectile dysfunction
may include the following:
- High blood pressure
- prostrate problems
- type 2 diabetes
- vascular disease and vascular surgery
- high levels of blood cholesterol
- lack of knowledge
- poor techniques
- inadequate interpersonal relationships
- many chronic diseases, especially renal failure and
- smoking, which accentuates the effects of other risk
factors such as vascular disease or hypertension
- Age appears to be a strong indirect risk factor
in that it is associated with increased likelihood of direct risk
factors, some of which are listed above.
It is estimated that nearly 5 percent of men become
impotent by the age of 40, and 15 to 25 percent by the age of 65.
Accurate risk factor identification and characterization are essential
for prevention or treatment of erectile dysfunction.
What are the different types (and causes) of ED?
The following are some of the different types and
possible causes of erection problems and impotence:
premature ejaculation (PE)
Premature ejaculation is the inability to maintain an erection long
enough for mutual satisfaction. Premature ejaculation is divided
into primary and secondary forms:
primary premature ejaculation
Primary premature ejaculation is a learned behavior that
begins when a male first become sexually active. Like any
learned behaviors, it can be unlearned. This form of primary PE
is psychogenic (as opposed to organic or physical) impotence. (Congenital
venous leak is a subset of primary PE and is caused by a
congenital venous leak in which the venous drainage system in
the penis does not shut down properly.)
secondary premature ejaculation
Secondary premature ejaculation occurs when, after years of
normal ejaculation, the duration of intercourse grows
progressively shorter. Secondary PE is due to physical causes,
usually involving the penile arteries, veins, or both.
Performance anxiety is a form of psychogenic impotence -usually
caused by stress or anxiety.
Depression is another cause of psychogenic impotence. Some
antidepressant medications cause erectile failure.
Organic impotence involves the penile arteries, veins, or both,
and is the most common cause of impotence, especially in older men.
When the problem is arterial, it is usually caused by
arteriosclerosis, or hardening of the arteries, although trauma to
the arteries may be the cause. The controllable risk factors for
arteriosclerosis - being overweight, lack of exercise, high
cholesterol, high blood pressure, and cigarette smoking - can cause
erectile failure often before progressing to affect the heart. Many
experts believe that when veins are the cause, a venous leak or
"cavernosal failure" is the most common vascular problem.
Impotence is common in persons with diabetes. There are 7.8
million adult men in the US with diabetes, and it is estimated that
35 percent to 50 percent are impotent. The process involves
premature and unusually severe hardening of the arteries. Peripheral
neuropathy, with involvement of the nerves controlling erections, is
commonly seen in persons with diabetes.
There are many neurological (nerve problems) causes of impotence.
Diabetes, chronic alcoholism, multiple sclerosis, heavy metal
poisoning, spinal cord and nerve injuries, and nerve damage from
pelvic operations can cause erectile dysfunction.
A great variety of prescription drugs, such as blood pressure
medications, anti-anxiety and antidepressant medications, glaucoma
eye drops, and cancer chemotherapy agents are just some of the many
medications associated with impotence.
Hormonal abnormalities such as increased prolactin (a hormone
produced by the anterior pituitary gland), steroid abuse by
body-builders, too much or too little thyroid hormone, and hormones
administered for prostate cancer may cause impotence. Rarely is low
testosterone responsible for impotence.
How is ED diagnosed?
Diagnostic procedures for ED may include the following:
patient medical/sexual history - may reveal
conditions or diseases that lead to impotence and helps distinguish
among problems with erection, ejaculation, orgasm, or sexual desire.
physical examination - to look for evidence
of systemic problems, such as the following:
laboratory tests - to help diagnose
impotence include blood counts, urinalysis, lipid profile, and
measurements of creatinine and liver enzymes. When low sexual desire
is a symptom, measurement of testosterone in the blood can yield
information about problems with the endocrine system.
- A problem in the nervous system may be involved
if the penis does not respond as expected to certain touching.
- Secondary sex characteristics, such as hair
pattern, can point to hormonal problems, which involve the
- Circulatory problems could be indicated by an
- Unusual characteristics of the penis itself
could suggest the basis of the impotence.
psychosocial examination - to help reveal
psychological factors. The sexual partner also may be interviewed to
determine expectations and perceptions encountered during sexual
Treatment for ED:
Specific treatment for erectile dysfunction will be
determined by your physician based on:
- your age, overall health, and medical history
- extent of the disease
- your tolerance for specific medications,
procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
Some of the treatments available for ED include the
hydraulic pump - a pump and two
cylinders are placed within the erection chambers of the penis
which causes an erection by releasing a saline solution; it can
also remove the solution to deflate the penis.
Viagra - sildenafil citrate
This is the first approved non-surgical treatment for
erectile dysfunction that does not have to be either injected or
inserted directly into the penis to achieve and maintain erection.
The oral medication was approved by the US Food and Drug
Administration (FDA) for prescription sale in 1998.
The medicine (viagra) does not directly cause penile erection, but affects the
response to sexual stimulation. Experts recommend that men have a
complete medical history and physical examination to determine the
cause of your erectile dysfunction. Men should tell their physician
about all the medications they are taking - including
over-the-counter ones - because there are medications (in addition
to nitrates) known to be contraindicated with this medicine.
The FDA recommends that men follow these general precautions:
hormone replacement therapy
- Men who are taking medications that contain
nitrates, such as nitroglycerin, should NOT use this medicine. The two
taken together can lower blood pressure too much.
- It should NOT be used by women or children.
- Use in combination with other ED
treatments has not been studied, therefore, its use in
combination with other treatments is NOT recommended.
- Elderly men are especially sensitive to the
effects of it, which may increase their chance of having
- Men with medical conditions that may cause a
sustained erection such as sickle cell anemia, leukemia or
multiple myeloma, or a man who has an abnormally shaped penis
may not be able to take Viagra. Also, men with liver diseases or
a disease of the retina, such as macular degeneration or retina
pigmentosa, may not be able to take it, or may need to take
the lowest doseage.
- Research is being conducted in patients who
have a history of heart attack, stroke, or life-threatening
irregular heart rhythm within the last 6 months; very low and
very high blood pressure; heart failure or unstable chest pain;
and certain eye disorders.
Testosterone replacement therapy may improve energy, mood, and bone
density, increase muscle mass and weight, and heighten sexual
interest in older men who may have deficient levels of testosterone.
Testosterone supplementation is not recommended for men who have
normal testosterone levels for their age group due to the risk of
prostate enlargement and other side effects. Testosterone
replacement therapy is available in an oral form and as a skin
There are three types of implants used to treat ED, including the
prosthesis - two semi-rigid but bendable
rods are placed within the erection chambers of the penis which
allows manipulation into an erect or non-erect position.
interlocking soft plastic blocks - these
are placed within the erection chambers of the penis and can be
inflated or deflated using a cable that passes through them.
Infection is the most common cause of penile implant
failure and is treatable with antibiotics. In some cases, the infected
implant must be replaced by a new implant. Implants are usually not
considered until other methods of treatment have been tried.
Coping with Erection problems:
Erectile dysfunction can cause strain on a couple. Many
times, men will avoid sexual situations due to their emotional pain
associated with ED, causing their partner to feel rejected or
inadequate. It is important to communicate openly with your partner.
Some couples consider seeking treatment for ED together, while other men
prefer to seek treatment without their partner's knowledge. A lack of
communication is the primary barrier for seeking treatment, and can
prolong the suffering. The loss of erectile capacity can have a profound
effect on a man. The good news is that ED can usually be treated safely
Feeling embarrassed about being impotent may prevent
many men from seeking the medical attention they need, which can delay
diagnosis and treatment for more serious underlying conditions.
Impotence itself is often related to an underlying problem, such as
heart disease, diabetes, liver disease, or other medical conditions.
Since impotence can be a forewarning symptom of progressive coronary
disease, physicians should be more direct when questioning patients
about their health. By asking patients more directly about their sexual
function, through conversation or a questionnaire during a check-up,
physicians may be able to detect more serious health conditions sooner.
The British Medical Journal has revealed that people who monitor their own
blood pressure at home have better blood pressure control more...