Erectile Dysfunction: Trusted and timely health information for men

Erectile dysfunction (ED) is the medical term given when a man cannot sustain an erection long enough to have sex, or when it is impossible to have an erection at all.

In some cases, a man can have an erection, but then lose it during intercourse. Also called male impotence, it affects over 15 million men in the United States.

Frequent cases of erectile dysfunction can cause emotional and relationship problems, and even cause self-esteem problems for some men. By the time they reach their 40’s, many men may have already experienced an occasional incident of erectile dysfunction but in most cases, it is a temporary condition. If symptoms continue then medical treatment should be considered. Your physician can help determine the erectile dysfunction treatment that is just right for you. including but not limited to the use of the best penis pumps for ED.

What are the Causes of Erectile Dysfunction?

During an erection, the penis becomes engorged with blood as blood vessels enlarge or dilate and allow an increased flow. Erectile dysfunction may occur due to a variety of medical conditions, including damage to the nerves, arteries, muscles and tissue. In order for an erection to take place, a series of precise events occur, which include nerve impulses in the brain, spinal column, and area around the penis. When those nerve impulses are received, the muscles, fibrous tissues, veins and arteries respond, which result in an erection. However, if there is a disruption in any of those signals, it can result in erectile dysfunction instead of an erection.

Often times a disease may be the cause of erectile dysfunction. Diseases, such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease, account for about 70 percent of ED cases.

Another possible cause of erectile dysfunction may be recent surgery, especially radical prostate and bladder surgery for cancer. Sometimes the surgery can injure nerves and arteries near the penis, causing erectile dysfunction. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and fibrous tissues of the area around the penis.

There are also a number of prescription drugs that affect some nerve centers, resulting in erectile dysfunction. Many common blood pressure drugs, antihistamines, antidepressants, tranquilizers, and other medications can produce ED in a man. Medical experts also have discovered that psychological factors, including stress, anxiety, guilt, depression, low self-esteem and fear of sexual failure can cause erectile dysfunction.

Other possible causes are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as not enough testosterone.

What are the symptoms of Erectile Dysfunction?

The symptoms of erectile dysfunction occur when a man cannot achieve an erection, or he has difficulty sustaining an erection long enough to reach orgasm during sex.

If erectile dysfunction occurs only occasionally, it is considered normal. However, if a man is experiencing frequent problems related to ED, then he should consult with a physician.

How is Erectile Dysfunction diagnosed or evaluated?

Patient History

If your physician suspects that you may be suffering from erectile dysfunction, they will review your medical and sexual history. In many cases, your medical history will reveal a few clues as to the cause of your ED. Learning about a patient’s sexual history and practices will also assist the physician. There may be problems associated with the patient’s sexual desires, ability to maintain an erection, ejaculation or orgasm.

Reviewing any drugs that have been prescribed for other medical conditions may also suggest a cause of erectile dysfunction. Drug interference with a man’s ability to have an erection accounts for one-fourth of all ED related cases. Your physician will be able to determine if substituting certain prescription medications will solve the problem.

Physical Examination

When your physician performs a physical examination, they may discover the cause of your erectile dysfunction. In some cases, a man’s penis may not respond to touching, which may indicate a problem in the nervous system. In other cases, abnormal secondary sex characteristics, such as hair pattern or breast enlargement, can point to hormonal problems. If that is the case, that would indicate that the endocrine system is involved.

Your physician will also check for any circulatory problems by observing decreased pulses in the wrist or ankles. Sometimes, however, the clue to your erectile dysfunction lies in the penis itself. If your penis bends or has a slight curve, the erectile dysfunction could be the result of Peyronie’s disease.

Laboratory Tests

Your physician may also order several laboratory tests to help confirm the diagnosis of erectile dysfunction. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. They may also perform a test that will measure the amount of free testosterone in your blood, which will reveal information about possible problems with the endocrine system, especially in patients who are experiencing a reduced sexual desire.

Other Tests

Healthy men normally have several involuntary erections each night while they are sleeping. Your physician will perform a routine test to determine if you are having those involuntary erections at night. If you are, that would indicate the problem may be more psychological than physical. It should be pointed out, however, that no test is infallible, and your physician will work with you to determine the cause of your erectile dysfunction.

Psychosocial Examination

To determine if your erectile dysfunction problem may be psychological, your physician may perform a psychosocial exam. This exam, which uses an interview and a questionnaire, reveals certain psychological factors to help uncover the reason for the ED. The man’s sexual partner may also be interviewed, to help determine sexual expectations and perceptions during intercourse.

What are the treatments and drugs to treat Erectile Dysfunction?

Many physicians will seek treatments that run from the least invasive to the most invasive. In many cases, if the patient is on medication for high blood pressure, they will check to see if there are any side effects that may be the cause of the erectile dysfunction.

Sometimes a patient will know of a medication they are taking that is causing problems with erections, and they will share that information with their physician. Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered.

In March 1998, the Food and Drug Administration (FDA) approved Viagra to treat ED, the first pill in a new drug class, phosphodiesterase inhibitors. In August 2003, the FDA gave approval to a second oral medicine, vardenafil hydrochloride (Levitra). Additional oral medicines have since been approved (Cialis, tadalafil) and more are being tested for safety and effectiveness.

Taken an hour before sexual activity, phosphodiesterase inhibitors such as Viagra and Levitra work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

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