Erectile Dysfunction
Erectile Dysfunction is the repeated inability to get or keep an erection firm enough for sexual intercourse. Since an erection requires a precise series of events, Erectile Dysfunction, commonly referred to as "ED", can occur when any of these events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.
Incidence and Prevalence
Erectile dysfunction, or E.D., can be a total inability to achieve an erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining E.D. and estimating its incidence difficult. Estimates range from 15 million to 30 million, depending on the definition used. According to the National Ambulatory Medical Care Survey (NAMCS), for every 1,000 men in the United States, 7.7 physician office visits were made for E.D. in 1985. By 1999, the rate had nearly tripled to 22.3. The increase happened gradually, presumably as treatments such as vacuum devices and injectable drugs became more widely available and discussing erectile dysfunction became accepted. Perhaps the most publicized advance was the introduction of oral drug sidenafil citrate (Viagra) in March 1998.
In older men, E.D. usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that
causes injury to the nerves or impairs blood flow in the penis has potential to cause E.D.. Incidence increases with age: About 5 percent of 40 year old men and between 15 and 25 percent of 65 year old men experience ED. But it is not an inevitable part of aging.
Common Causes of Erectile Dysfunction
Damage to nerves, arteries, smooth muscles, and fiborous tissues, often as a result of disease, is the most common cause of E.D. Diseases- such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease – account for about 70 percent of E.D. cases. Between 35 and 50 percent of men with diabetes experience E.D.
Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of erectile dysfunction. Smoking, being overweight and avoiding exercise are possible causes of E.D.
Also, surgery (especially radical prostate and bladder surgery for cancer) can injure nerves and arteries near the penis, causing E.D. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to E.D by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa. In addition, many common medicines—blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug)—can produce E.D. as a side effect.
Treatment
Most physicians suggest that treatment for Erectile Dysfunction (E.D.) proceed from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Quitting smoking, losing excess weight, and increasing physical activity may help some men regain sexual function. Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20 percent of E.D. cases. Psychotherapy and behavior modifications in these patients may be of benefit. Men with a physical cause for E.D. frequently experience the same sort of psychological reactions (stress, anxiety, guilt, and depression). Other possible causes are smoking which affects blood flow in veins and arteries, and hormonal abnormalities, such as not enough testosterone.
Cutting back on any drugs with harmful side effects is considered next. For example, Beta blockers for high blood pressure may affect erections. If you think a particular drug is causing problems with erection, tell your doctor and ask whether you can try a different class of blood pressure medicine.
The Oral medications typically used for E.D. include Viagra, Levitra, and Cialis. Some patients may not be candidates for these medications. They should not be tried without asking a physician.
These patients who do not respond to the oral medication or are not candidates for these medications may be instead candidates for other treatments. These include:
Vacuum Erection Device
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Penile prosthesis
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Penile Injection
Muse –
A tiny pellet which is inserted in to the top of the penis that contains medication that will draw blood into the penis resulting in an erection.
The Doctors at Huron Valley Urology Associates are happy to discuss these options with you and can help decide which treatment option may be the best for you.
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