Erectile dysfunction, also known as “impotence,” is the repeated inability to get or keep an erection firm enough for sexual intercourse.
Erectile dysfunction (ED) affects the lives of many middle-aged men and their partners to one extent or another. The term erectile dysfunction, previously known as impotence, covers a wide range of disorders, but usually refers to the inability of a man to achieve or maintain an erection sufficient enough to fulfill his own sexual needs or those of his partner.
As men age, it's quite normal to experience changes in erectile function. Erections may take longer to develop, may not be as rigid or may require more direct stimulation to be achieved. Men may also notice that orgasms are less intense, the volume of ejaculate reduces and refractory period between erections increases. An occasional episode of erectile dysfunction happens to most men but they are not psychologically affected by it Some men, however, experience chronic and complete erectile dysfunction, while others have the ability to achieve partial or brief erections. Frequent erectile dysfunction can cause emotional and relationship problems, which often lead to low self-esteem. Erectile dysfunction has many causes, most of which are treatable, and is not an inevitable consequence of aging. Although erectile dysfunction is more common in men older than 40, it can occur at any age
Symptoms of Erectile dysfunction
Erectile dysfunction can be classified into the following patterns:
- Occasional inability to achieve a full erection
- Inability to maintain an erection during sexual intercourse
- Complete inability to achieve an erection
The Anatomy of the Penis
The penis consists of two cylindrical, sponge-like vascular tissue bodies (corpora cavernosa) that run along its length, parallel to the urethra – the tube that expells semen and urine. Also present are the erectile tissue surrounding the urethra, two main arteries and several veins and nerves. The longest part of the penis is the shaft, at the end of which is the head (glans penis). The opening at the tip of the glans is the meatus, which allows for urination and ejaculation.
The Mechanism of an Erection
When a man is sexually aroused, nerve impulses lead to a relaxing action and cause about a seven-fold increase in the blood flow to these cylinders. This sudden influx of blood expands the sponge-like chambers and produces an erection by straightening, elongating and stiffening the penis. Continued sexual excitation maintains this rush of blood, keeping the erection firm. After ejaculation, or when the sexual excitation ceases, the excess blood drains out of the spongy tissue, and the penis returns to its flaccid state.
The Causes of Erectile Dysfunction
If something affects any of the above factors that lead to a full erection, or the delicate balance among them, erectile dysfunction may result. Erectile dysfunction may have physical as well as nonphysical causes.
Physical causes account for about 80% cases of erectile dysfunction and may include:
- Diabetic neuropathy – nerve damage from chronic diabetes
- Cardiovascular disorders that might affect blood supply to the pelvis
- Certain prescription medications available in the market
- Operations e.g. removal of the prostate gland
- Fractures that might injure the spinal cord
- Multiple sclerosis
- Hormonal disorders
- Alcoholism or other forms of drug abuse
Non physical causes
Nonphysical causes may account for the remaining 20% cases of impotence observed. These may include:
Psychological problems – stress, anxiety, fatigue and depression.
Negative feelings – resentment, hostility or lack of interest exhibited by any of the two partners.
The physical and nonphysical causes of ED generally tend to interact. A minor physical problem that slows sexual responses may cause anxiety about attaining an erection and this anxiety in turn can worsen erectile dysfunction.
Risk factors as a result of Erectile Dysfunction
Erectile dysfunction may be one of the first signs of an underlying medical problem. A wide variety of physical and emotional risk factors can contribute to erectile dysfunction.
– Physical diseases and disorders: Chronic diseases of the lungs, liver, kidneys, heart, nerves, arteries/ veins, disorders of the endocrine system, diabetes can lead to ED. The accumulation of plaques in arteries (atherosclerosis) can prevent adequate amount of blood from entering the penis. Erectile dysfunction may be caused by reduced levels of the testosterone hormone in some men.
– Surgery or trauma: Damage to the nerves that control erections can cause ED. Such damage may result from an injury to the pelvic area or the spinal cord. Surgery to treat bladder, rectal or prostate cancer also can result in ED. Prolonged bicycle riding also can cause a temporary erectile problem.
– Medications: A wide range of drugs such as antidepressants, antihistamines, painkillers and medications to treat high blood pressure and prostate cancer can cause ED by obstructing proper functioning of nerve impulses or blood supply to the penis. Tranquilizers and sleeping aids also may pose a problem.
– Substance abuse: Chronic use of alcohol, marijuana or other drugs often causes ED and a decrease in sexual drive. Excessive tobacco use may damage penile arteries and thus contribute to ED.
– Stress, anxiety or depression: Psychological conditions also contribute to some cases of erectile dysfunction.
Occurrence and Prevalence of Erectile Dysfunction
Because of the various definitions attributed to ED, estimating the incidence of cases becomes a little difficult. According to the National Institutes of Health (NIH) in 2002, an estimated 15 – 30 million men in the US suffer from chronic erectile dysfunction. According to the National Ambulatory Medical Care Survey (NAMCS) in 1999, around 22 of every 1000 men in the US sought medical attention for ED.
Incidence of erectile dysfunction increases with progressing age. Chronic ED
affects about 5% of men in their 40s and 15–25% of men around the age of
65. Temporary ED and incomplete erection affect up to 50% of men between
40 and 70 years of age.
Diseases like diabetes,
alcoholism and atherosclerosis
account for as high as 70% of chronic ED cases while psychological factors
such as stress, anxiety and depression may account for about 10 – 20% of the total number of cases. Around 35-50% of men suffering from diabetes also experience ED.
Diagnosis of Erectile Dysfunction
Initially the physician conducts a thorough investigation to determine how and when the disorder was developed; and if other physical conditions exist and prepares a checklist of medications used, if any. Physical and emotional situations are also discussed, because a noteworthy number of ED cases can be traced to psychological origins. If an apparent physical cause is suspected, blood tests are first taken to check male hormone levels and also to eliminate a list of potential diseases such as diabetes. Additional specialized clinical tests may also be done
Penile nerve function: Determines adequacy of nerve sensation in the penis Duplex Ultrasound: Assesses adequacy of arterial circulation in the penis. Nocturnal Penile Tumescence (NPT): Measures changes in penile rigidity and girth during nocturnal erections. Cavernosometry: Measures vascular pressure in the penis.
Measures to Reduce The Chances of Erectile Dysfunction
Although most men experience episodes of erectile dysfunction from time to time, the following steps may be taken to decrease the likelihood of ED occurrences:
– Limited use of alcohol and similar substances.
– No Smoking.
– Regular exercise.
– Stress, anxiety and depression management.
– Sound sleep.
– Regular checkups and medical screening tests.
Coping with Erectile Dysfunction
Whether the resulting disorder has physical or psychological origins or a combination of both, ED can become a source of mental and emotional stress for both the man and his partner. If you experience ED occasionally, do not assume that you have a permanent problem or expect it to occur again during your next sexual encounter. Don't consider one episode of erectile dysfunction as a lasting comment on your masculinity, virility or general health.
If you experience occasional or persistent ED, remember that it is important to reassure your partner that your inability to have an erection is not a sign of diminished sexual desire. Try to communicate openly and honestly with your partner about your condition and strengthen the relationship you share with her. Couples may also want to seek counseling to deal with any concerns they may have regarding ED and to learn how to discuss their feelings with each other.
Good communication must be maintained throughout the diagnosis and treatment process. In fact, treatment is often more successful if the couple works together as a team