Impotence Information
Erectile
Dysfunction is defined as the inability to achieve or maintain
an erection sufficient for mutually satisfying intercourse.
Per the diagram adjacent diagram one can see that the incidence
of Erectile Dysfunction correlates with an individuals age effects
some 67% of men by the age of 70 years old. Erectile Dysfunction
impacts more than a man's sexual activity. The emotions and uncertainties
that coincide with this condition often have a significant
effect
on a man's self-esteem, as well as, his relationship with his
partner. Although the incidence of Erectile Dysfunction
increases with age, it is not an inevitable result of aging.
Erectile Dysfunction is a secondary condition linked to many medical
conditions.
The
first step in treating Erectile Dysfunction is that the individual
understands the psychology, physiology and anatomy responsible
for the ability to achieve and maintain an erection. If
we can comprehend these events than we can better understand the
factors that are responsible for ED and address the questions
concerning treatment.
Normal
Erectile Function
For
something that appears so natural, an erection is a rather complicated
process involving the coordination of the psychological, neurological
and cardiovascular systems. The penis becomes erect following
a series of events. First, the nerves are stimulated, a
sensation known as arousal. No matter what the nature of
the stimulus, visual, mental or physical the brain coordinates
the following series of events:
- Nerve impulses
transverse the length of the spinal cord to the pudendal nerve
and on to the penis. Smooth muscle within the walls of
the penile arteries respond by relaxing. Subsequently,
the penile arteries dilate allowing up to eight times more blood
to flow into the corpora cavernosum, (two parallel cylinders
that transverse the length of the penis).
- The cavernosum
become engorged with blood expanding and lengthening the penis.
The expanding tissue then exerts a positive pressure compressing
the veins that normally empty the blood from the penis, maintaining
the blood in the penile tissue. When
ejaculation occurs or when arousal is discontinued the penis
returns to its non-erect state.
Causes of
Impotence
Historically,
when an individual consulted his physician concerning Erectile
Dysfunction he was usually informed there were no known physiological
answers concerning his condition. Today, a generation of
research has resulted in significant advances in both the diagnosis
and treatment of Erectile Dysfunction . Physicians now understand
that approximately 85% of Erectile Dysfunction is attributable
to physical/organic conditions while only 15% is due to psychological
or mixed origin (both psychological and organic). Some important
causes of physiological Erectile Dysfunction are as follows:
Vascular
Disease
Vascular
Disease is the leading cause of Erectile Dysfunction. Vascular
disorders include arteriosclerosis (hardening of the arteries),
hypertension, hyper-cholestremia and other conditions which interfere
with the blood flow to the penis. Additionally, "venous
leakage", a condition occurring when the penile veins are
unable to constrict efficiently during an erection, also contributes
to poor erections. When these veins "leak", blood
escapes to the periphery resulting in a poor erection.
Diabetes
is another common cause of Erectile Dysfunction. Approximately
50% of men with insulin dependent diabetes experience some degree
of ED after 55 years old. Diabetes results in poor circulation
and/or peripheral neuropathy. When the nerves are involved,
sexual stimuli are not transmitted appropriately to or from the
brain and Erectile Dysfunction develops.
Neurological
diseases such as multiple sclerosis, Parkinson's disease,
spinal cord injuries and long term effects of diabetes can also
result in the disruption of the normal sequence of events necessary
for an erection to occur.
Endocrine
System
Deficiencies in the Endocrine System are another source of Erectile
Dysfunction. Low levels of testosterone or thyroid hormone can
interfere with the stimulation process necessary in the erection
sequence. Excessive production of prolactin by the pituitary
gland may contribute to decreased levels of testosterone resulting
in a lack of desire. Diabetes once again enters the scenario
as it is classified as an endocrine disorder.
Prescription
medications often cause Erectile Dysfunction as a side
effect. Some two hundred known medications fall into this
category including:
Antihypertensives
medications specifically:
- beta-blockers
e.g. Atenolol, Propanolol and Tenorium.
- Diuretics
medications e.g. HydroDiuril and Lasix.
- Ace Inhibitors/Calcium
Channel Blockers medications e.g. Vasotec®, Lotension®,
Cardizem® and Norvasc® periodically cause Erectile
Dysfunction , however, they are generally represent an excellent
alternative medication for individuals with drug induced Erectile
Dysfunction.
Antidepressant/Antipsychotic
medications -of almost any label can also result in
Erectile Dysfunction e.g. Prozac®, Elavil®, Zoloft®,
Thorazine® and Haldol®. Note: Many other medications
in a variety of classes can periodically cause ED. If
you take a prescription medication or an over-the-counter medication,
regularly, please consult with your physician. However,
never alter a dosage or discontinue a medication without the
advice of your physician.
Smoking
Smoking as
been linked to Erectile Dysfunction in numerous clinical studies.
The most common
causes of the organic component in erectile dysfunction or impotence
are vascular abnormalities associated with atherosclerosis and
diabetes mellitus. Atherosclerosis causes 40% of cases of erectile
dysfunction, and in cases of diabetes mellitus the prevalence
of erectile dysfunction is 50%. Smoking is significantly associated
with the development of both atherosclerosis and diabetes mellitus.
The
Epidemiology and Pathophysiology of Erectile Dysfunction.
The Journal of Urology 1999 Jan; 161(1):5-11
After smoking two cigarettes, the diameter of the internal pudendal
artery narrows and the penile arteries almost completely close.
This evidence suggests that smoking can cause an acute vasospastic
constriction of the arteries in the penis. These observations
are supported by physiological evidence that nicotine causes acute
peripheral vasoconstriction. Acute Vasospasm of Penile
Arteries in Response to Cigarette Smoking. Urology 1990; 36(1):99-100
Researchers
at Wake Forest University in Winston Salem, North Carolina concluded
that male smokers who suffer from long standing hypertension are
26 times more likely to be impotent than those individuals
who do not smoke. January 2000, The Journal of Family
Practice.
Aside from
impotence, smoking as also been linked to the following negative
effect concerning male sexual health:
- Reduced
volume of ejaculation
- Lowered
sperm count
- Abnormal
sperm shape
- Impaired
sperm motility
LH-RH
Analogs/Antiandrogen medications e.g. Lupron Depot®,
Eulexin®, Nilandron®, Casodex®, etc. are medications
are used in the treatment of prostate cancer. They function
by decreasing the production of testosterone in the testes and
adrennal glands, which decrease in testosterone often results
in Erectile Dysfunction.
Chemotherapy/Radiation
therapy is also a significant contributors to Erectile Dysfunction.
These drugs/treatments are used in the treatment of cancer.
Substance
Abuse can also negatively effect male potency.
The chronic use of cocaine, marijuana, alcohol, steroids etc.
often results in Erectile Dysfunction, as well as a decrease in
desire. Excessive tobacco use can also attribute to Erectile
Dysfunction by accentuating the effects of other risk factor such
as vascular disease or hypertension.
Radical
Pelvic Surgery also result in Erectile Dysfunction. Surgical
procedures involving the prostate gland, bladder or colon may
interfere with the nerves involved in the erectile response.
Radiation therapy for cancer may also effect the erectile process.
Psychological
ED is usually diagnosed when no physical causes can be
defined. Pure psychological Erectile Dysfunction usually
occurs suddenly without warning as opposed to physical ED that
may gradually develop over the years.
Some common
causes of psychological Erectile Dysfunction are as follows:
- Performance
anxiety is one of the most common causes of psychological Erectile
Dysfunction. When a man feels pressured to achieve or
maintain an erection, he will commonly become anxious and nervous
when in a sexually demanding situation. Stress increases
the body's production of catecholamines such as adrenaline and
nor- adrenaline, which act as erection inhibitors. The
release of these inhibitors further contributes to failure resulting
in more anxiety. Therefore, the cycle begins, increased
stress resulting in increased catecholomines that further inhibits
the erectile process.
- Depression
is another cause of psychogenic Erectile Dysfunction.
Unfortunately, many of the popular antidepressant medications
(for a list see prescription medications in the next section)
have side effects which include erectile failure.
Anatomical
Deviation of the Penis
Anatomical Deviation of the Penis, known as Peyronie's Disease,
may also cause Erectile Dysfunction. This condition usually develops
from an inflammatory process and results in fibrous scaring of
the penis. The cause of this process is not yet understood;
however, when an erection does occur, there is a bending of the
penis secondary to the scar tissue. This curvature may interfere
with erectile capacity and/or ejaculation.
