About Erections and Erectile Dysfunction
Penile erection is managed by two different mechanisms:
- The first one is the reflex erection, which is achieved by directly touching the penile shaft.
- The second is the psychogenic erection, which is achieved by erotic stimuli.
The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both conditions an intact neural system is required for a successful and complete erection. Stimulation of penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy male erectile system.
Impotence & Erectile Dysfunction:
Erectile dysfunction (ED), previously termed as impotence, is the inability to achieve/ maintain an erection that is sufficient to ensure satisfactory sexual intercourse for both partners. Erectile Dysfunction may range from mild to severe dysfunction, ranging from partial to total inability to have erections.
As can be understood from the mechanisms of a normal erection, Impotence and Erectile Dysfunction may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems.
Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also include causation by prolonged exposure to bright light or chronic exposure to high noise levels.
A few causes of impotence may be iatrogenic (medically caused). Various antihypertensives (medications intended to control high blood pressure) and some drugs that modify central nervous system response may inhibit erection by denying blood supply or by altering nerve activity.
- Anti-depressants, especially SSRIs, can cause impotence as a side effect.
- Surgical intervention for a number of different conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Some studies have shown that male circumcision may result in an increased risk of impotence, while others have found no such effect, and another found the opposite.
- Excessive alcohol use has long been recognized as one cause of impotence, leading to the euphemism “brewer’s droop”; Shakespeare made light of this phenomenon in Macbeth.
- A study in 2002 found that Erectile Dysfunction can also be associated with bicycling. The number of hours on a bike and/or the pressure on the penis from the saddle of an upright bicycle is directly related to erectile dysfunction.
Because Erectile Dysfunction is a great cause of embarrassment to most men, those suffering from it tend to live in denial. They make up various excuses to justify their problem:
- Iím too tired
- Iím young, so I canít be having any problem
- It doesnít happen every time
- Iím just not up to it tonight
- Iím too stressed to pay attention
- Maybe Iím not happy with this relationship
- Iíve been drinking too much
Erectile Dysfunction is a serious problem, which often points to other diseases such as diabetes, arteriosclerosis, etc. and must not be ignored. Determine the cause of the problem, so that suitable corrective measures may be undertaken immediately.
The Erection Mechanism
The physiologic mechanism of erection of the penis involves release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation. Nitric Oxide then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus cavernosum and allowing the inflow of blood.
Basically, the erection process involves following from interest to arousal and finally resulting into penile erection:
- Sexual stimulation and excitement
- Relaxation of their smooth muscles in the genital area
- Dilation of arterioles in the genital area
- Blood fills up spaces of the Corpora Cavernosa in the penis
- Expansion of the Corpora Cavernosa
- Strong pressure exerted on the veins that normally drain blood from the penis
- Exerted pressure allows trapping the blood in the penis
- Thickening, rigidity, and elongation of the penis
- Erector muscle of penis draws the penis forward
- Penis ready for vaginal penetration
Causes of Erectile Dysfunction
Research has shown that a high majority of cases of Erectile Dysfunction arise from physical causes. The remaining cases are mostly caused by certain psychological origins.
Physical Factors
- Vascular Diseases
- Metabolic disorders
- Nerve Disease
- Cancer treatment
- Hormonal Problems
- Side Effects of Medications
- Alcohol: Long-term
- Smoking
- Sedentary Lifestyle
Psychological Factors
- Anxiety
- Stress
- Depression
- Relationship Problems
Psychosocial causes can occur alone or in combination with one or more of the physical causes of Erectile Dysfunction.
Erectile Dysfunction Diagnosis
There is no specific test conducted to determine if you have Erectile Dysfunction. To rule out or find the possible causes, a preliminary investigation should be conducted to determine the origin of your certain erectile dysfunction. It consists of some questions to be answered before going for any specific treatment, regarding medical history, lifestyle, and even emotional well being. Then certain tests are conducted to confirm the specific or potential causes.
Blood tests: Male hormone levels are measured and tests are conducted to eliminate diseases such as diabetes from the list of potential causes.
Penile nerve function: Physical tests are performed to determine sufficient nerve sensation in the penis.
Ultrasonography: Duplex ultrasound is used to assess the adequacy of arterial circulation in the genital area.
Nocturnal Penile Tumescence (NPT): Various methods are used to measure changes in penile rigidity and girth during nocturnal erections.
Cavernosometry: This test measures vascular pressure in the penis.
Treatment and care
Your doctor or other health care professional can suggest several treatment options for your problem, depending on its severity.
Oral Medication (prescription): The prescription PDE5 inhibitors sildenafil (ViagraÆ), vardenafil (LevitraÆ) and tadalafil (CialisÆ) are prescription drugs which are taken orally. They work by blocking the action of PDE5, which causes cGMP to degrade. cGMP causes the smooth muscle of the arteries in the penis to relax, allowing the corpus cavernosum to fill with blood.
Oral Medication (herbal remedies): These are supplements that might be taken before sexual activity to improve erectile function. Usually, herbal supplements like ProVigraX are a combination of herbs, vitamins and minerals that are risk-free and do not involve any side effects.
Vacuum pump: An external vacuum pump will produce an engorged penis with success approaching 90%; a penis ring will maintain this state, although it should be removed after not more than 30 minutes. The erection is not as rigid or hard as a natural erection; drugs or injections, when they work, may be preferable. Various studies show the degree of satisfaction of users and their partners to be vary variable, even when drugs and injections do not work; in one study, about 20% of men who tried a (high-priced) pump decided to proceed to purchase one. Other studies show higher percentages of satisfied users. In some cases frequent use of a vacuum pump can eventually improve the degree of erection attainable without use of the pump. Claims of cheap “penis pumps” to permanently increase maximum penis size should be viewed with caution,
Sex Counseling: Consulting a trained counselor, psychologist or psychiatrist may help you identify, understand and deal with your sexual distress.
Penile Injection Therapy: Shortly before sexual activity, the patient injects a medication that increases blood flow to the penis.
Intraurethral Therapy: Pellets of a medication that increases blood flow are inserted into the urethra (through which urine flows out).
Vacuum Therapy: A vacuum device is used to cause blood to flow into the penis and a constriction ring is placed at its base to maintain the erection.
Penile Implant Surgery: This is a device that is surgically inserted into the penis and used when there is a desire for sexual intercourse.
Controversial and unapproved treatments
Bremelanotide
The experimental drug Bremelanotide (formerly PT-141) does not act on the vascular system like the former compounds but allegedly increases sexual desire and drive in males as well as females. It is applied as a nasal spray. Bremelanotide allegedly works by activating melanocortin receptors in the brain. It is currently in Phase II trials.
hMaxi-K
hMaxi-K is a form of gene therapy using a plasmid vector that expresses the hSlo gene that encodes the alpha-subunit of the Maxi-K channel. It has undergone phase I safety trials.
Ginseng
A double-blind study appears to show evidence that ginseng is better than the placebo.
Herbal and other alternative treatments
These are generally ineffective when tested blind, but may be useful for their psychological (placebo) effect: if a good result is expected, any highly-praised, and often expensive, treatment can be effective. Reputable drugs can also benefit from the same effect.
Before starting any medication for Erectile Dysfunction, it may be advisable to make some simple changes to your daily routine. Your doctor or health care professional may recommend and help you follow a few of these:
- Exercise
- Healthy Diet
- Stress management
- Quit smoking
- Reduce alcohol intake
more…