What is #Erectile #Dysfunction
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ERECTILE DYSFUNCTION

Erectile dysfunction (ED) is the inability to get and keep an erection firm enough for sex. Trouble with erection from time to time is not necessarily a cause for concern. However, it can cause stress, affect one's self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment. A man's muscles in the penis relax when he is sexually excited. This allows for increased blood flow through the penile arteries. Blood fills two chambers inside the penis. As the chambers fill with blood, the penis grows rigid. This process ends when the muscles contract and the accumulated blood flow out via the penile veins.

CAUSES

Psychological causes

Male sexual arousal is a complex process involving the brain, hormones, emotions, nerves, muscles and blood vessels. A problem with any of these can result in erectile dysfunction. Stress and mental health concerns can either cause and or worsen erectile dysfunction.

Other times a combination of physical and psychological issues can cause erectile dysfunction.

Physical causes

Common causes include:

  • Cardiovascular disease - Heart disease encompasses a wide range of cardiovascular problems. Several diseases and conditions fall under the umbrella of heart disease.
  • Diabetes - Diabetes mellitus, commonly known as diabetes, is a metabolic disease that causes high blood sugar.
  • Hypertension, or high blood pressure - High blood pressure, otherwise known as hypertension, can contribute to erectile dysfunction (ED). Some of the medications used to treat high blood pressure can cause ED as well.
  • Obesity - Obesity means having a body mass index (BMI) of 30 or more. BMI is a calculation that takes a person's weight and height into account.
  • Kidney diseases - There is one kidney on each side of the spine. Kidneys are essential to having a healthy body. They are mainly responsible for filtering waste products, excess water, and other impurities out of the blood.
  • High cholesterol - The most common cause of ED is atherosclerosis, which is a narrowing of the blood vessels. Many things can lead to atherosclerosis, including high cholesterol because high levels of cholesterol in the blood can cause a buildup in the arteries which can narrow these blood vessels.
  • Low testosterone levels or hormone imbalances - Testosterone is a hormone produced by the human body. Testosterone affects a man's appearance and sexual development. It stimulates sperm production as well as a man's sex drive. It also helps build muscle and bone mass.
  • Increased age - Erectile dysfunction (ED) is a health problem which mainly effects elderly men and this problem has become a more important health problem with the increased life expectancy. The basic risk factors of ED are hypertension, dyslipidemia, diabetes mellitus, and atherosclerotic heart disease which also have a higher incidence in the elderly men.
  • Insomnia and Sleep disorders - Sleep disorders are a group of conditions that affect the ability to sleep well regularly. Whether they are caused by a health problem or by too much stress, sleep disorders are becoming increasingly common
  • Stress - Stress is a situation that triggers a particular biological response. When a person perceives a threat or a major challenge, chemicals and hormones surge throughout the body.
  • Anxiety - Anxiety is the body's natural response to stress. It is a feeling of fear or apprehension about what is to come.
  • Depression - Depression is a mood disorder. It may be described as feelings of sadness, loss, or anger that interfere with a person's everyday activities.
  • Drug use - Some types of antidepressants can cause erectile dysfunction, these drugs alter levels of different chemicals in the brain, such as dopamine, prolactin, and serotonin. However, it isn't fully known how these chemicals regulate sexual function.
  • Consuming too much alcohol - Alcohol is one of the most popular psychoactive substances in the world. It can have powerful effects on one's mood and mental state. By reducing self-consciousness and shyness, alcohol may encourage people to act without inhibition. It is addictive and highly toxic.
  • Smoking and Use of other tobacco products - Tobacco is one of the most widely abused substances in the world. It is highly addictive. Nicotine is the main addictive chemical in tobacco. It causes a rush of adrenaline when absorbed in the bloodstream or inhaled via cigarette smoke.
  • Peyronie disease - One rare form of ED is called Peyronie's disease. This results in a bend in the penis that can make an erection painful.

SYMPTOMS

Erectile dysfunction symptoms might include persistent:

  • Reduced sexual desire - a common problem that affects many men at some point in their life. It is often linked to relationship issues, stress or tiredness, but can be a sign of an underlying medical problem, such as reduced hormone levels.
  • Difficulty in getting an erection - Most men occasionally fail to get or keep an erection. This is usually caused by stress, tiredness, anxiety or drinking too much alcohol, and it's nothing to worry about. If it happens more often, it may be caused by physical or emotional problems.
  • Difficulty in keeping an erection - Most men occasionally fail to get or keep an erection. This is usually caused by stress, tiredness, anxiety or drinking too much alcohol, it is really nothing to worry about. If it happens more often, it may be caused by physical or emotional problems.

Other sexual disorders related to ED include:

  • Premature ejaculation
  • Delayed ejaculation
  • Anorgasmia (the inability to achieve orgasm after ample stimulation)

WHEN TO SEE A DOCTOR

Men should see their doctor if;

  • They have diabetes, heart disease or another known health condition that might be linked to erectile dysfunction
  • They have concerns about erections or experience other sexual problems such as premature or delayed ejaculation.
  • They have other symptoms along with erectile dysfunction

Men should speak with their doctors if they have any of these symptoms, especially if the symptoms have lasted for 3 or more months. They can help determine whether the symptoms are caused by an underlying condition that requires to be treated.

RISK FACTORS

As one grows older, erections might take longer to develop and might not be as firm as used to be. In some cases, one might need more direct touch to the penis to get and keep an erection.

Various risk factors that can contribute to erectile dysfunction may include:

  • Medical conditions (particularly diabetes or heart conditions)
  • Smoking and use of Tobacco products (which restricts blood flow to veins and arteries), over time, this can cause chronic health conditions that lead to erectile dysfunction
  • Being obese or overweight
  • Certain medical treatments (e.g. prostate surgery or radiation treatment for cancer)
  • Injuries (particularly if the nerves or arteries that control erections are damaged)
  • Medications (antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions)
  • Psychological conditions (e.g. stress, anxiety or depression)
  • Use of drugs and alcohol (especially a long-term drug user or heavy drinker)

DIAGNOSIS

A variety of steps may be used to test for ED, including a physical examination and taking into consideration the patient's general health and sexual history. Additional tests may be performed to determine if the symptoms being experienced are caused by an underlying condition.

  • Physical exam - Patients should look forward to a physical exam where the doctor will check the blood pressure, listen to the heart and lungs, and examine the testicles and penis. They may also recommend a rectal exam to check the prostate.
  • Psychosocial history : The patient will be asked to fill out a questionnaire about the symptoms, health history, and sexual history. The responses can help in evaluating the severity of the ED.

Questions that may be asked could include:

  • How long has the condition been experienced
  • Whether or not he has any problems with sexual desire, ejaculating, or reaching orgasm?
  • Did the ED come on suddenly or gradually?
  • How often he has sex?
  • Has this frequency changed recently?
  • How firm are his erections?
  • Is this affected by any particular situation or types of stimulation?
  • Whether or not he wakes up in the morning or in the middle of the night with erections?
  • State of his current relationship?
  • Whether or not he has been experiencing a lot of stress?
  • What medications he is currently taking?
  • Whether or not he uses tobacco, alcohol, or nonprescription drugs?
  • If he has any underlying conditions or has had any surgery on or injury to the pelvic area?

Additional tests

Additional tests to help diagnose the ED can include;

Ultrasound - This can be used to examine the blood vessels of the penis to determine if there is a problem with penile blood flow.

Nocturnal penile tumescence (NPT) test - A portable, battery-powered device is strapped to the thigh, it is used to evaluate the quality of nocturnal erections. Data is stored in the device, which the doctor can access later.

Injection test - A medicine would be injected directly into the penis to stimulate an erection. This allows for the doctor to evaluate the firmness of the erection and how long it lasts.

Urine tests - Underlying health conditions like diabetes or others can be checked for with Urine tests.

Blood tests - conditions such as diabetes, heart disease, thyroid issues, and low levels of testosterone can be checked for with blood tests.

These tests can help the doctor determine if an underlying condition may be causing the ED. They may also be used as guide to the treatment regimen.

TREATMENT

Treatment for erectile dysfunction (ED), will depend largely on the cause(s). The various treatments for erectile dysfunction are outlined below.

Treating underlying conditions - If the erectile dysfunction is caused by an underlying health condition, such as heart disease or diabetes, it may be prudent to treat that condition first. In some cases, treating the underlying cause may also resolve the problem.

If the patient is taking medication that can cause erectile dysfunction, there may be an alternative. It is important never to stop taking a prescribed medication unless advised to do so by a doctor or another qualified healthcare professional.

Lifestyle changes - Erectile dysfunction can often be improved by making changes to one's lifestyle, e.g.

  • Reducing stress
  • Exercising regularly
  • Losing weight if patient is overweight
  • Giving up smoking
  • Cutting back alcohol consumption
  • Not taking illegal drugs

These changes can also improve a person's general health and help reduce the risk of cardiovascular disease as well as helping to improve the erectile dysfunction.

Phosphodiesterase-5 (PDE-5) inhibitors : These are one of the most widely used and effective types of medication for treating erectile dysfunction. They work by temporarily increasing the blood flow to the penis.

Popular PDE-5 inhibitors that are available for treating erectile dysfunction are:

  • Avanafil : brand name - Spedra
  • Sildenafil : brand name - Viagra
  • Vardenafil : brand name - Levitra
  • Tadalafil : brand name - Cialis

Tadalafil lasts for up to 36 hours and is more suitable if treatment is required for a longer period of time. Sildenafil, vardenafil and avanafil work for about eight hours.

Depending on the type of PDE-5 inhibitor and the dose, it normally takes approximately 30-60 minutes before it starts to work. One should be able to have sex from one to 10 hours after taking sildenafil, vardenafil and avanafil. It is best to take them on an empty stomach.

Generally, at least two-thirds of men report of improved erections after taking one of these medicines.

Many reasons can be adduced if PDE-5 inhibitors are found to be ineffective. It may be because:

  • Patient did not have enough sexual stimulation (These medications are triggered by sexual stimulation, so one needs to be aroused for them to work).
  • Patient did not wait long enough after taking the dose
  • Patient waited too long after taking the dose
  • The dose was not high enough

Warnings

Even though sexual activity is likely to be beneficial for cardiovascular health, PDE-5 inhibitors should be used with caution in men who have cardiovascular diseases, such as coronary heart disease.

PDE-5 inhibitors should also be used with caution in men who:

  • May be at risk of painful erection that lasts for several hours (priapism)
  • May be taking medication used to treat conditions such as high blood pressure (long lasting alpha-blockers)
  • Are also taking medicines or recreational drugs that contain nitrates. (A combination of the two substances can have a dangerous effect on the heart). Organic nitrates are often used to treat angina, and butyl nitrate is a recreational drug that is more commonly known as 'poppers'.

Patients are also warned not to take PDE-5 inhibitors if they:

  • Have been advised to refrain from sexual activity or in activities that widen the blood vessels.
  • Are hypotensive (Have low blood pressure)
  • Are recovering from a recent stroke
  • Suffer from an underlying heart condition that causes symptoms such as chest pain (unstable angina)
  • Have suffered a heart attack
  • Have a history of an eye condition that causes a sudden loss of vision (arteritic anterior ischemic optic neuropathy)

Side effects

Some of the side effects PDE-5 inhibitors can cause, are:

  • Vision disturbances
  • Flushing (redness)
  • Indigestion
  • Muscle pain
  • Headaches and migraines
  • Nausea
  • Vomiting
  • Blocked or runny nose
  • Back pain

Vacuum pumps - A clear plastic tube that is connected to a pump it is either hand or battery operated. The penis is placed in the tube and all of the air inside is pumped out. This creates a vacuum that causes the blood to fill the penis, making it erect. A rubber ring is placed around the base of the penis to keep the blood in place, allowing the maintenance of an erection for around 30 minutes. Nine out of 10 men are able to have sex after using a vacuum pump, regardless of the cause of their ED. Patients should however not use the vacuum pump if they have a bleeding disorder or are taking anticoagulant medicines. Side effects of vacuum pumps include pain or bruising, although these seldom occur.

Alprostadil - Should the erectile dysfunction not respond to treatment, or patient is unable or unwilling to use PDE-5 inhibitors or even a vacuum pump, a medicine called Alprostadil could be recommended. This is a man-made (synthetic) hormone that helps to stimulate blood flow to the penis.

Alprostadil is available as:

  • An injection that is directly into the penis (Intracavernosal injection)
  • A small pellet placed inside the tube that carries urine from the bladder to the tip of the penis urethra (urethral application).

A patient may be trained to correctly inject or insert Alprostadil, however if the female partner is pregnant, use a condom during sex if Alprostadil is inserted into the urethra.

The dose will determine how long the erection lasts but Alprostadil will usually produce an erection after five to 15 minutes. Out of 100 men who did not respond to PDE-5 inhibitors, Alprostadil injections were successful in 85.

Warnings

Alprostadil should not be used:

  • If patient has a penile implant or has been advised to avoid sexual activity
  • For men at risk of priapism (which is a painful erection that lasts for several hours)
  • Together with other erectile dysfunction medications

The urethral application may also not be used in:

  • Men who have conditions that affect the physical structure of the penis. (Anatomical problems)
  • Men who have inflammation of the head of the penis. (E.g. balantis)

Side effects

Alprostadil can cause some side effects including:

  • Reactions at the site of the injection
  • Changes in blood pressure
  • Urethral burning or bleeding
  • Dizziness
  • Headache
  • Pain in penis

Hormone therapy - If a hormonal condition is causing the erectile dysfunction, the patient may be referred to a specialist who specializes in the treatment of hormonal conditions, (an endocrinologist). Hormones are chemicals produced by the body. Many hormonal conditions can be treated with injections of hormones that are man-made (synthetic) to restore normal hormone levels.

Surgery - Usually surgery for erectile dysfunction is only recommended when all other treatment methods have failed.

It may also be considered for:

  • Younger men who have experienced serious injury to their pelvic area.
  • Men who have a significant anatomical problem with their penis

Penile implants

This happens to be a type of surgery that may be considered. These can be:

Semi-rigid implants : This may be more suitable for older men who do not have sex regularly

Inflatable implants : consists of two or three parts which can be inflated to give a natural erection.

Psychological treatments - If conditions such as anxiety or depression is the cause of the erectile dysfunction, the patient may benefit from counselling.

PREVENTION

The best prevention is to make healthy lifestyle choices and to manage any existing health conditions effectively e.g.:

  • Manage diabetes, heart disease or other chronic health conditions with the doctor.
  • Availing oneself for regular checkups and medical screening tests.
  • Stop smoking, limit or avoid alcohol, and don't use illegal drugs.
  • Exercise regularly.
  • Take steps to reduce stress.
  • Get help for anxiety, depression or other mental health concerns.

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