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Erectile Dysfunction


Disease: Erectile Dysfunction Erectile Dysfunction
Category: Sexual diseases

Disease Definition:

When a man isn’t able to maintain a firm erection long enough to have sex, it means that he has erectile dysfunction. This common problem can occur at any age; however, it is more common in older men. Although having trouble from time to time isn’t necessarily a cause for concern, however, if the problem is ongoing, it could affect self-esteem and cause relationship problems and stress.


In the past, erectile dysfunction was called impotence and it was a taboo subject. It used to be considered either a natural consequence of growing older or a psychological issue. However, these attitudes have changed now. At the present, it is known that many men have normal erections into their 80s and that this condition is usually due to physical problems rather than psychological ones.


Seeking medical help for erectile dysfunction could be worth the effort, despite the fact that talking with a doctor about sexual issues could be embarrassing. In most men with erectile dysfunction, sexual function is restored with treatments, which range from medications to surgery. In some cases, this condition could be caused by heart disease or some other underlying condition and because of this, it is quite important to take erectile dysfunction seriously.

Work Group:

Symptoms, Causes


When a man can't maintain an erection sufficient for sexually intercourse at least 25% of the time, it means that he has erectile dysfunction.
It is quite normal to experience an occasional inability to maintain an erection, and it happens to most men. However, when erection problems are ongoing, it could be a signs of erectile dysfunction, which should be evaluated. As mentioned before, an underlying condition that needs treatment could be the cause of erectile dysfunction.


The brain, emotions, hormones, muscles, nerves and blood vessels, all of these contribute in sexual arousal in males. An erectile dysfunction could result in case something affects any of the systems mentioned above, or the delicate balance among them.


Running along the penis’s length are two cylindrical, sponge-like structures called corpus cavernosum, which are parallel to the tube that carries semen and urine (urethra). Whenever a man becomes sexually aroused, nerve impulses cause the blood flow to the cylinders to increase several times the normal amount. This sudden influx of blood expands the sponge-like structures and causes an erection by stiffening and straightening the penis.


The higher rate of blood flow into the penis is maintained by continued sexual arousal; the blood flow out of the penis is limited, keeping the penis firm. When the sexual excitement passes, or after ejaculation, the excess blood is drained out of the spongy tissue, making the penis return to its non-erect size and shape.



In the past, erectile dysfunction was thought to be due to psychological issues. However, this has proven not to be true. Despite the fact that emotions and thoughts always play a role in getting an erection, however, erectile dysfunction is normally caused by something physical, such as the side effects of a medication or a chronic health problem. In some cases, an erectile dysfunction could be due to a combination of things. Some of the common causes of this condition are:


  • Obesity
  • Heart disease
  • Metabolic syndrome
  • High blood pressure
  • Diabetes
  • Clogged blood vessels (atherosclerosis)


Some of the other causes of erectile dysfunction could be:


  • Tobacco use
  • Multiple sclerosis
  • Peyronie’s disease
  • Parkinson’s disease
  • Treatment for prostate cancer
  • Certain prescription medications
  • Alcoholism and other forms of drug abuse
  • Some hormonal disorders, such as low testosterone (hypogonadism)
  • Surgeries or injuries that affect the pelvic area or spinal cord.


Erectile dysfunction may be in some cases one of the first signs of an underlying medical problem.



The brain plays a key role in triggering the series of physical events that cause an erection, which begins with feelings of sexual excitement. Some of the factors that can interfere with sexual feelings and thus, lead to erectile dysfunction are:


  • Stress
  • Anxiety
  • Depression
  • Fatigue
  • Poor communication or conflict with the partner.


A minor physical problem that slows sexual response could cause anxiety about maintaining an erection, and the resulting anxiety could worsen the erectile dysfunction. This means that the physical and psychological causes of erectile dysfunction interact.





The available treatments for an erectile dysfunction range from medications and simple mechanic devices to surgery and psychological counseling. The best treatment or combination of treatments in a particular case will be determined by the cause and severity of that specific condition.



Some of the oral medications that treat erectile dysfunction are vardenafil, sildenafil and tadalafil. These drugs are chemically known as phophodiesterase inhibitors. They enhance the effects of a chemical called nitric oxide, which relaxes muscles in the penis, and so increases the amount of blood flow and allows a natural sequence to occur, an erection in response to sexual stimulation.


These medications allow an erection to occur after physical and psychological stimulation; they don’t produce an erection automatically. After taking these medications, regardless of the cause of their impotence, many men experience improvement in erectile function.


Although these three medications work in much the same way and share many similarities, but they also have their differences. These medications vary in their dosage, possible side effects and duration of effectiveness. It is still not known which drug is best for certain types of men because no study has directly compaired these three medications.


Not all men should take these medications, despite the fact that they can help many people. A man shouldn’t take these medications in case:


  • He takes anticoagulants, which are blood-thinning medications
  • Takes certain types of alpha blockers for enlarged prostate (benign prostatic hyperplasia) or high blood pressure
  • Takes nitrate drugs for angina, including isosorbide dinitrate, isosorbide mononitrate and nitroglycerin.


Vardenafil, sildenafil and tadalafil might not be a good choice for a man in case:


  • He has had a stroke
  • Has uncontrolled diabetes
  • Has severe heart disease or heart failure
  • Has hypotension
  • Has uncontrolled hypertension


These medications don't fix erectile dysfunction immediately. In some cases, the dosage may need to be adjusted. In order to find the right treatment and dosage, the person should work with their doctor.


Here are some of the points that a person should discuss with the doctor before taking any medication, including vardenafil, sildenafil and tadalafil:


  • Any illnesses or serious health problems he has had in the past, or has now
  • The potential side effects and benefits of the medication he is considering
  • Any prescription or over-the-counter medications he is taking, including herbal remedies.


Prostaglandin E:

There are two treatments that use a drug called alprostadil, which is a synthetic version of the hormone prostaglandin E. This hormone enhances the blood flow needed for an erection by relaxing muscle tissue in the penis. Two ways of using alprostadil are available:


Needle-injection therapy:

In this method, a fine needle is used to inject alprostadil into the base or side of the penis. After 5 to 20 minutes of the injection, an erection is produced, which lasts about an hour. Alprostadil is an effective treatment for many men because the injection goes directly into the spongy cylinders that fill with blood. Pain from the injection is usually minor because the needle used is so fine. Prolonged erection, formation of fibrous tissue at the injection site and bleeding from the injection are some of the other side effects of an alprostadil injection. Because the cost per injection is expensive, a mixture injection of alprostadil and other prescribed drugs could be more effective and less expensive. Some of the drugs that could be injected as a mixture with alprostadil are phentolamine and papaverine.


Self-administered intraurethral therapy (Muse):

In this procedure, a disposable applicator is used to insert a tiny alprostadil suppository, which is about half the size of a grain of rice, into the tip of the penis. The erectile tissue in the penis absorbs the suppository, which is placed about two inches into the urethra, and thus the blood flow that causes an erection increases. This method could be quite painful, despite the fact that no needles are involved. Some of its side effects are:


  • Pain
  • Dizziness
  • Formation of fibrous tissue
  • Minor bleeding



Testosterone replacement therapy may be an option for men who have testosterone deficiency.



For men whose blood flow has been blocked by an injury to the penis or pelvic area, this treatment could be quite effective. When an erectile dysfunction is caused by vascular blockage, this surgery may also be effective. Correcting a blockage of blood flow to the penis is the goal of this treatment, in order for the erections to occur naturally. However, the long-term success of this surgery is still not clear.



In this treatment, a hollow tube with a hand-powered or battery-powered pump is used. After the tube is placed on the penis, the pump sucks out the air, creating a vacuum that pulls blood into the penis. When an adequate erection is achieved, a tension ring is slipped around the base of the penis in order to maintain the erection, and then the vacuum device is removed. Usually, the erection will last long enough so that a couple could have sex, and after intercourse, the tension ring is removed.



During this treatment, a device is surgically inserted into the two sides of the penis, allowing erection to occur as often and for as long as desired. This inflatable device allows a man to control when and how long he has an erection, and the semirigid rods keep the penis in a rigid state all the time. An inflatable device or semirigid rods made from silicone or polyurethane are the two things that these implants may consist of. This treatment is not recommended until other methods have been considered or tried first, and it’s quite expensive. This method has its risk of complications, including infection, such as with any surgery.



A man may be suggested visiting a psychologist or counselor with experience in treating sexual problems (sex therapist) in case his erectile dysfunction is due to anxiety, depression or stress. Erectile dysfunction could cause stress and relationship tension even when it is caused by something physical. Counseling can help, particularly when the partner also participates.


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