What Is Erectile Dysfunction? What Is Impotence?

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Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Urology / Nephrology;  Prostate / Prostate Cancer
Article Date: 17 Aug 2011 - 0:00 PST

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Erectile dysfunction, also known as ED or impotence, is a male's inability to achieve or maintain an erection that is sufficient for sexual intercourse. Occasional erection problems are not necessarily something to worry about. However, if the problem is ongoing, it may cause anxiety, stress, undermine self-confidence, and affect some relationships.

A significant proportion of men with erectile problems are embarrassed to talk to their doctor about it. However, individuals should go in for an evaluation. Not only because the condition can often be effectively treated, but also because erectile dysfunction may be a sign of an underlying health problem, such as diabetes, high blood pressure, or a cardiovascular disease, some of which may be life-threatening.

Treating an underlying health problem may also cure the erectile dysfunction.

What are the signs and symptoms of erectile dysfunction?

A sign is something the doctor, nurse, or somebody else may notice, such as a rash, while a symptom is something the patient feels, such as pain.

Signs and symptoms of impotence may include:

• Problems achieving an erection
• Problems sustaining an erection
• Reduced libido
• Only being able to achieve an erection during masturbation, but not during sexual intercourse

Most men occasionally experience problems in gaining an erection. This is not usually a problem. It becomes a problem if it occurs regularly.

When to see a doctor?

If the ED continues for more than a few weeks the individual should see a doctor. The doctor will assess his general state of health, because ED may be a sign of a more serious health condition, such as heart disease, diabetes, hypertension or something else.

There are numerous web sites that claim to be able to treat ED. Men are advised to see their doctor instead.

What are the causes of erectile dysfunction?

Before looking at the causes of erectile dysfunction, lets first look at what goes on when a man gets an erection.

When a man feels or sees something that is sexually stimulating, his brain sends out a signal that tells the muscles in his penis to relax, resulting in the engorgement (filling up of blood) of the corpa cavernosa - two tubes that run the length of the penis. This causes the penis to expand and harden. As the corpa cavernosa expand, they press against veins that carry blood away from the penis, effectively blocking them - so the penis stays erect.

Erectile dysfunction is mainly about a problem with blood flow to the penis. In many cases, if there is an underlying health problem, there may be problems with blood flow to other parts of the body too.

If a person's sex drive (libido) is reduced, the brain is less likely to trigger an erection.

In most cases, erectile dysfunction is linked to a problem with the nervous system, blood circulation, or loss of libido. Reduced libido can be caused by stress, anxiety, depression or changes in hormone levels.

Physical causes or erectile dysfunction

There are four main types of physical causes:

• Anatomical - there is something wrong with the physical structure of the penis
• Hormonal - hormone levels are not right
• Neurogenic - the nervous system is affected (brain, nerves and spinal cord)
• Vasculogenic - the blood flow to the penis is affected

Examples of physical causes may include:

• Alcohol
• Atherosclerosis (clogged blood vessels)
• Diabetes
• Enlarged prostate treatment
• Heart disease
• Hypertension (high blood pressure)
• Injuries to the pelvic area or spinal cord
• Hormonal problems - hypogonadism (low testosterone), hyperthyroidism (overactive thyroid), hypothyroidism (underactive thyroid), Cushing's syndrome (production of cortisol is affected)
• Kidney disease
• Metabolic syndrome
• Multiple sclerosis
• Obesity
• Parkinson's disease
• Peyronie's disease (scar tissue inside the penis)
• Prolonged cycling - the nerves which affect blood flow to the penis can become compressed, leading to a temporary problem. Special saddles for males can prevent this problem from occurring.
• Prostate cancer treatment
• Smoking - damages the blood vessels, which undermines blood flow to the penis.
• Some prescription drugs - including some diuretics, antihypertensives, fibrates, antipsychotics, antidepressants, corticosteroids, antihistamines, and anti-androgens.
• Stroke
• Substance abuse
• Surgery in the pelvic area or spinal cord

Psychological causes of erectile dysfunction

• Anxiety
• Stress
• Depression
• Fatigue
• Relationship problems

Sometimes ED may have a combination of physical and psychological causes. A person with diabetes who starts having some problems with erections may become anxious and stressed about it - the combination of diabetes and stress may exacerbate the ED.

Erectile dysfunction is not an inevitable part of ageing. It is usually linked to something else, such as a health condition. Many of these conditions come with age, but age itself does not cause ED.

Diagnosing erectile dysfunction

The patient usually visits his GP (general practitioner, primary care physician, family doctor) first. The GP will ask questions regarding the patient's:

• Symptoms, and how long they have been present, whether there is an erection first thing in the morning, or on other occasions (masturbating)
• Libido
• Overal physical health
• Overall mental health
• Alcohol intake
• Drugs
• Current medications
• Sexual history

If the AD occurs all the time, most likely there is a physical cause, if it only occurs when attempting to have sex with a partner, there may be other (psychological, mental) causes.

Cardiovascular health - if the ED is caused by a blood flow problem, the patient may have a cardiovascular disease which will need to be treated. The doctor may:

• Measure the patient's blood pressure for hypertension
• Listen to the patient's heart
• Take the patient's measurements - height, weight, and waist circumference
• Ask about the patient's physical activity
• Take a blood sample to check for glucose and lipid levels
• Take a urine sample - to test for signs of diabetes and other underlying conditions

Some physical examinations and tests

Penis - the doctor may examine the penis to rule out any structural problems.

Digital rectal exam - to check the prostate gland.

Blood tests - to check for hormone levels. The doctor may also order a PSA test which may point to a possibility of prostate cancer.

Nocturnal penile tumescence and rigidity (NPTR) - the patient spends two nights at the hospital and determines whether he gains erections during sleep. A piece of perforated tape is tied to the base of the penis. The tape breaks if the man has an erection. This test can help determine whether the problem is physical or psychological.

Intracavernous injection test - a synthetic hormone is injected into the penis to raise blood flow. Doctors sometimes use this test to asses any abnormalities to help plan for surgery. If no erection is gained it may mean there is a blood supply problem. If an erection is gained, there may be a problem with the blood vessels - if so, the doctor may order an ultrasound scan.

Duplex utrasound scan - this scan measures blood flow inside the penis.

Arteriography and dynamic infusion cavernosometry or cavernosography - a dye injected into the blood vessels of the penis, the doctor studies the dye on a scanner. This test may be used if the doctor is considering surgery, or if a problem with the blood vessels has been detected.

Psychological assessment - the doctor may refer the patient to a specialized psychologist or psychiatrist.

What are the treatment options for erectile dysfunction?

If there are any underlying health conditions the doctor will make sure the patient gets the right treatment for those. Sometimes, just treating the underlying condition resolves the ED.

Erectile dysfunction has several possible treatments. Which one(s) the doctor recommends depends on several factors, including the severity of the ED, any underlying health conditions, the patient's age, what medications he might be on, and some other factors.

A good doctor should clearly explain the risks and benefits of any treatment that is offered. Some experts say the man's partner should become involved in the treatment choices.

Lifestyle changes

Some lifestyle changes can improve ED symptoms, and sometimes cure the impotence completely. These may include:

• Bodyweight - if the patient is overweight/obese, losing weight can help considerably
• Exercise - doing exercise at least four times a week can significantly help men regain the erectile function
• Smoking - smoking is a common cause of erectile dysfunction. Giving up may make an enormous difference
• Alcohol - if the patient drinks a lot, either giving up completely or cutting down may help
• Stress - reducing mental stress and anxiety has been shown to improve ED symptoms

These lifestyle changes will not only most likely improve the patient's ED, but will also improve his overall health. Losing weight, doing more exercise, giving up smoking, and reducing alcohol intake have huge general health benefits.

If you are on medication - if your current medication(s) is causing your ED, your doctor may suggest alternative drugs. Never stop taking your prescription medicines without talking to your doctor first.

Oral medications - the most common medications for treating erectile dysfunction are known as Phosphodiesterase-5 (PDE-5) inhibitors, and include:

• Viagra (Sildenafil) - should be taken approximately from 30 minutes to one hour before having sex. The effects usually last up to 8 hours.
• Levitra (Vardenafil) - take about 30 minutes to 1 hour before sex. The effects should last up to 8 hours.
• Cialis (Tadalafil) - as with the other two, take from 30 minutes to 1 hour before sex. However, the effects last for up 36 hours.

All three medications mimic the effects of nitric oxide, which our body produces; it relaxes the penis muscles, resulting in greater blood flow and an erection. They come in different dosages and have side effects.

Sometimes the patient may have to alter dosages and change medication before obtaining the desired results.

Only take these oral medications after discussing with your doctor. They are not suitable for all men. PDE-5 inhibitors are not suitable for patients:

• Who have had a stroke
• Who have uncontrolled hypertension (high blood pressure)
• Who have hypotension (very low blood pressure)
• Who are taking nitrate drugs, such a nitroglycerin
• Who have uncontrolled diabetes
• Who have heart failure
• With heart disease

Do not take more than one tablet in any 24-hour period. Remember that they only work if the man is sexually stimulated - he needs to be sexually aroused.

Vacuum pumps - a plastic tube is connected to a pump. The man places his penis inside and the air is pumped out of the tube either by batteries or with the use of a manual pump. The vacuum draws blood to the penis, bringing about an erection. The man then places a rubber ring at the base of his penis so that the blood stays there. In most cases, an erection can be sustained for about 30 minutes.

Vacuum pumps are usually effective for about 90% of men with ED. Initially, it may take the patient a while to know how to use it properly.

If you have a bleeding disorder or are taking an anticoagulant medication you should not use the pump.

Injection or pellets - a synthetic hormone called alprostadil can either be injected into the penis (intracavernosal injection), or a pellet is placed inside the urethra (the opening at the end of the penis). This medication helps improve blood flow to the penis. An erection will usually occur within 15 minutes.

The doctor needs to teach the patient how to use alprostadil. If the female sexual partner is pregnant and the man uses a pellet, he should use a condom.

According to the NHS (National Health Service), UK, 85% of males who did not respond to oral medications responded well to alprostadil intracavernosous injections, while two-thirds responded well to the pellets.

Surgery - doctors will only recommend surgery if nothing else works, or if a young man has had serious injury to the pelvic area. Surgery may also be required if the man has a serious structural problem with his penis.

Penile implants may come in two forms:

• Semi-rigid implants - two malleable rods surgically implanted within the erection chambers of the penis. The penis is permanently rigid, but bendable.
• Inflatable implants - produces a natural erection. When not having sex, the penis is not erect. There is a button (pump) placed inside the scrotum, when squeezed a small container (reservoir) implanted under the groin muscles empties liquid hydraulically into cylinders which have been implanted in the erection chambers of the penis and create an erection. After sex, the penis can be deflated by pressing on a deflation valve at the base of the pump.

The inflatable implant generally provides a harder erection than the semi-rigid implant.

In about 5% of cases, mechanical problems with the devices occur within five years. However, the vast majority of patients and their partners are satisfied with the results.

Written by Christian Nordqvist

Original article date: 5 Feb 2004
Article updated: 17 August 2011
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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