Erectile dysfunction

Erectile dysfunction: Description, Causes and Risk Factors:Abbreviation: ED.The penis contains two chambers, called the corpora cavernosa, which run the length of the organ. A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosaErection begins with sensory and mental stimulation. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the open spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps to trap the blood in the corpora cavernosa, thereby sustaining erection. Erection is reversed when muscles in the penis contract, stopping the inflow of blood and opening outflow channels.Erectile dysfunctionIt is estimated that erectile dysfunction affects as many as 30 million men in the United States. In 1985 the total direct costs for erectile dysfunction exceeded $146 million. While erectile dysfunction is not life threatening, it may result in withdrawal from sexual intimacy, decreased quality of life, decreased working productivity.Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health problems can cause or worsen erectile dysfunction. Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical problem that slows your sexual response may cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.Erectile dysfunction causes and risk factors may include:
  • Diabetes (high blood sugar).
  • Stress, anxiety or depression.
  • Hormone imbalance.
  • Hypertension (high blood pressure).
  • Atherosclerosis (hardening of the arteries).
  • Smoking, alcohol, and tobacco use.
  • Some prescription medications, such as antidepressants, pain medicine and medicine for high blood pressure.
  • Fatigue.
  • Brain or spinal-cord injuries.
  • Hypogonadism (which leads to lower testosterone levels).
  • Peyronie's disease.
  • Multiple sclerosis.
  • Parkinson's disease.
  • Radiation therapy to the testicles.
  • Stroke.
  • Some types of prostate or bladder surgery.
Symptoms:Penile erection is a complex interaction of both halves of your autonomic nervous system, your blood circulation, and your emotions. Therefore, symptoms may suggest a psychological problem, such as depression, and/or a medical problem, such as diabetes. Any one of these conditions can lead to erectile dysfunction. More serious cases could not only produce difficulties in erection but it can also markedly reduce the libido and sexual thoughts. When the man is getting involved in sexual activities, there is no or partial erection of the penis. The male organ is not capable to retain the blood in its chambers and so there will be no fuller and firmer penis. The penis does not stand straight and as a result of that the man is not able to perform sexual act. On the other hand, his sexual partner also loses the enjoyment and interest in sex. Diagnosis:The diagnosis and etiology of erectile dysfunction require a detailed sexual and medical history, physical examination and laboratory tests. The following things may help in diagnosis of ED may include:Patient History: Medical and sexual histories help define the degree and nature of erectile dysfunction. A medical history can disclose diseases that lead to erectile dysfunction, while a simple recounting of sexual activity might distinguish between problems with sexual desire, erection, ejaculation, or orgasm.Physical Examination: A physical examination can give clues to systemic problems. For example, if the penis is not sensitive to touching, a problem in the nervous system may be the cause. Abnormal secondary sex characteristics, such as hair pattern, can point to hormonal problems, which would mean that the endocrine system is involved. The examiner might discover a circulatory problem by observing decreased pulses in the wrist or ankles. An unusual characteristics of the penis itself could suggest the source of the problem--for example, a penis that bends or curves when erect could be the result of Peyronie's disease. Laboratory Tests: Several laboratory tests can help diagnose erectile dysfunction. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. Measuring the amount of testosterone in the blood can yield information about problems with the endocrine system and is indicated especially in patients with decreased sexual desire. Some of the tests generally employed in erectile dysfunction diagnosis are:
  • Blood Tests.
  • Urinalysis.
  • Complete blood count (CBC).
  • Liver and Kidney Function Tests.
  • Thyroid Function Tests.
  • Erectile Function Tests.
  • Duplex Ultrasound.
  • Prostate Examination using a digital rectal examination (DRE).
  • Penile Nerve Function using bulbocavernosus reflex test.
  • Nocturnal Penile Tumescence (NPT).
  • Penile biothesiometry.
  • Vasoactive Injection.
Ultrasound: This test can check blood flow to your penis. It involves using a wand-like device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems. This test is sometimes done in combination with an injection of medications into the penis to determine if blood flow increases normally.Overnight erection test: Most men have erections during sleep without remembering them. This simple test involves wrapping special tape around your penis before you go to bed. If the tape is separated in the morning, your penis was erect at some time during the night. This indicates the cause is of your erectile dysfunction is most likely psychological and not physical.Other Tests: Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of ED. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then Erectile Dysfunction (ED) is likely to have a physical rather than psychological cause. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results.Psychosocial Examination: A psychosocial examination, using an interview and a questionnaire, reveals psychological factors. A man's sexual partner may also be interviewed to determine expectations and perceptions during sexual intercourse. The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. Decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient.Treatment:Despite the distress and anxiety, even an awkward condition like erectile dysfunction can be easily controlled with a few lifestyle alterations. While a large component of the condition is psychological, a few positive habits can go a long way in dealing with the physical factors as well. Here are a few ideas to keep your anxiety in check.Treating underlying issues: In some cases, it may be possible to actually treat erectile dysfunction by curing the underlying causes. In other cases, the underlying problem may be addresses first, then the erectile dysfunction secondly. Doctors and medical professionals will usually try to fix the root problem first.Pharmacological Options: The introduction of Viagra by Pfizer in March, 1998, marked the beginning of a revolution in the oral medical management of erectile dysfunction. The launch of Viagra was soon followed by that of Levitra and Cialis. Other drugs are also in the pipeline.Basic lifestyle alterations: Like with most medical conditions, erectile dysfunction can be treated and cured by simply changing the way you live your life. Below are the main ways in which you can make lifestyle changes that may have a strong impact on fixing your condition:Hormone Therapy: If your erectile dysfunction is related to hypogonadism, you will be referred to an endocrinologist. An endocrinologist is a medical professional that specialized in hormone conditions. Your endocrinologist may give you an injection to restore your hormone levels if they are low.Finally, there remains the option of surgical treatment, the mainstay of which is the insertion of penile prostheses. Indications for surgical referral include severe Peyronie's disease, primary penile anatomical abnormalities and correction of a phimosis prior to restoration of erectile function.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care. 


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