Causes of Erectile Dysfunction

The incidence of erectile dysfunction increases with age. Hardening of the arteries and blockage within the arteries is the most common cause of erection problems. Very often, blockage of the arteries of the penis occurs with blockage of the coro

C.B. Dhabuwala, M.D.

Erectile Dysfunction:

Also referred to as impotence. The inability to achieve or maintain an erection for sexual intercourse.

Leriche's Syndrome:

Involves blockages of the lower aorta as well as the arteries in the pelvis coming off the aorta, including the iliac arteries. It is characterized by claudication, which is pain, aching, and tiredness of the legs and buttocks. It is associated with erectile dysfunction.

Guanosine Monophosphate (Cyclic GMP):

A chemical neuromediator that helps to transmit messages through the nervous system.

nary arteries of the heart. In many individuals, the erection problem is followed a few years later by coronary artery disease and even heart attack. Blockage of the terminal aorta (Leriche's syndrome), internal iliac arteries, or internal pudendal arteries by the atherosclerotic process can also lead to erectile dysfunction.

There are many other reasons for erectile dysfunction. People with diabetes are at increased risk of developing erection problems. Several studies suggest that almost half the people suffering from diabetes develop erectile dysfunction. High blood pressure can lead to progressive thickening of the arteries of the penis and is associated with erection problems. Smoking cigarettes, excessive use of alcohol, and abuse of substances such as marijuana and cocaine are also associated with erection problems. Automobile and motorcycle accidents causing fracture of the pelvis can very often interrupt the blood supply or the nerve supply of the penis, leading to erection problems.

Other causes of erectile dysfunction include surgeries for cancer of the rectum or prostate cancer, which can damage the nerves that register sexual excitement. Certain medications used for treating high blood pressure, diseases of the nervous system such as multiple sclerosis and spinal cord injury, and even radiation therapy for prostate cancer can also lead to erectile dysfunction.

In younger individuals without any risk factors such as diabetes, high blood pressure, and cigarette smoking, the cause of erectile dysfunction is often psychological.

About 5 percent to 10 percent of men with erection problems have low levels of male hormones. Many men can be effectively treated with male hormones.

Medical Treatment of Erectile Dysfunction

Treatment of erectile dysfunction very often depends upon the cause of erectile dysfunction. A person with hormone deficiency will respond best to hormone replacement. Erectile dysfunction due to the use of medications may respond to a change in the medications. Very often, replacing one medication with another may resolve erectile problems.

Viagra, a Pill that Helps Men with Erectile Dysfunction

Viagra, which is also called sildenafil, has provided a breakthrough in the oral treatment of erectile dysfunction. An erection normally occurs with the relaxation of the smooth muscles of the cavernous sinuses and an increase in blood flow to the penis. Nitric oxide produced in response to erotic stimuli acts through a secondary system involving cyclic GMP. This cyclic guanosine monophosphate, or GMP, relaxes the smooth muscles, which increases blood flow and penile erection. The human body naturally inactivates cyclic GMP. Viagra prevents this local in-activation of cyclic GMP, thereby enhancing the erection.

In clinical trials, Viagra-related improvement in erections occurred in 70 percent to 90 percent of patients. The pill is taken one hour before sexual activity. It is effective in enhancing penile erection in a wide variety of patients with erectile dysfunction.

Viagra and Heart Patients

The side effects reported with Viagra are usually mild to moderate in nature. These include a flushing sensation, indigestion, nasal congestion, some alteration in vision, diarrhea, and headache. Viagra should not be used by men with coronary artery disease who are taking medicine containing nitrates. Nitrates are found in many prescription medicines used to treat chest pain, or angina, due to coronary artery disease. These medicines include nitroglycerin sprays, ointments, pastes, or tablets that are swallowed, chewed, or dissolved in the mouth. Nitrodur, Imdur, and

Ismo are a few popular ones. If you are not sure whether any of your medications contain nitrates, or if you do not understand what nitrates are, consult your doctor or pharmacist.

Taking Viagra and nitrates can be dangerous. It can lead to a sudden decrease in blood pressure, dizziness, or even death.

Similarly, patients taking medicines to treat high blood pressure and patients who have had heart attacks should check with their doctors before using Viagra.

Some medicines like erythromycin and cimetidine can affect the metabolism of Viagra. Liver problems, kidney problems, or even old age can also affect the way Viagra is handled by the human body. One should never experiment with Viagra by borrowing a pill from a friend. It must always be used under medical supervision after an adequate history assessment and physical examination.

Penile Injection Therapy

Besides Viagra, there are numerous other options for treating erectile dysfunction that are proven and have been used for some time. Medications such as pa-paverine and prostaglandin, for example, dilate blood vessels, increasing the blood flow and dilating the smooth muscles of the penis. These medications are best administered by a direct injection into the side of the penis using a very fine needle. After the injection, patients experience increase in the blood flow and an erection within fifteen to thirty minutes.

Vacuum Devices

Vacuum devices are another treatment option. They consist of three common components: a plastic cylinder, a vacuum pump, and a constriction ring. The quality of erection produced by the vacuum device, however, is inferior to that of a normal erection. Numbness or a cold sensation of the penis occurs in nearly 75 percent of patients. This can be quite un comfortable. The tight rubber band used to maintain erection also leads to altered feelings of orgasm and may cause a blood clot to form under the skin. Similarly, tiny purplish spots may appear under the skin from microscopic hemorrhages.

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