Erectile Dysfunction or Impotence
Millions Affected
Understanding Erections
Causes of Erectile Dysfunction
Evaluating Patients
Millions Affected
"While Erectile Dysfunction affects millions of men, each patient is an individual for whom impotence is something not easy to talk about. By establishing a level of comfort so a patient can speak freely, my patients feel free to discuss their concerns."
J. Francois Eid
Erectile Dysfunction, also referred to as impotence, is the persistent inability to achieve and/or maintain an erection sufficient for satisfactory sexual activity (Journal of American Medicine, 1993). It is estimated that 18-20 million men in the U.S. suffer from Erectile Dysfunction According to the 1994 Massachusetts Male Aging Study, 52% of men who participated in the study reported some degree of erectile dysfunction.
In 1992, the National Health and Social Life Survey revealed that although 45 percent of the 3,000 men and women in the study reported sexual dysfunction of some sort, only one in ten patients sought medical attention. Thanks to new breakthrough treatments available, such as Viagra, men are more open to talk about their erectile difficulties and get help.
Understanding Erections
An erection begins with psychological arousal and/or physical stimulation. A substance called nitric oxide is then released into the muscle cells of the penis, causing the muscle tissue to relax and expand like a sponge into water. As the muscle tissue relaxes, inflow of blood into the penis increases, producing an increase in girth and length of the penis. This full relaxation results in trapping of blood that normally flows out of the penis back into the circulation. Disorders of blood circulation into the penis either from a blockage, obstructed blood vessel, or anatomical deformity of the penile anatomy can interfere with the normal erection process.
Causes of Erectile Dysfunction
The causes of impotence fall into two broad categories: physical and psychological. The overwhelming cause of erectile dysfunction is physical: most authorities now feel that at least three out of four men who describe difficulties with erection are affected by an underlying physical cause.
- Blood Vessel Problems
Diabetes, high blood pressure (hypertension), smoking and elevations in blood lipids or cholesterol have all been associated with Erectile Dysfunction The blood vessel abnormalities caused by these diseases affect vessels throughout the body and often produce other symptoms of vascular diseases. Diabetics and patients with hyptertension frequently have heart disease. Elevated cholesterol or serum lipids can interfere with the ability of nitric oxide to work properly in penile muscle tissue, which results in inadequate filling and trapping (venous leak) of blood in the penis.
- Prostate Cancer
Most prostate cancer treatment can cause erectile dysfunction. In the course of removing the cancerous prostate gland, due to their proximity, the nerves responsible for erection are often damaged. Additionally, radiation therapy for the disease can lead to blockage of blood flow into the penis. Hormonal therapy will cause lack of desire and arousal as well as the inability to obtain a full erection.
- Drug induced (medication)
Many prescription medications can cause problems with erections, but the ones that are the most commonly associated with this complaint are anti-hypertensive (blood pressure) medications, beta blockers, and anti-depressants. Tobacco is a major cause of erectile dysfunction; in my practice, over 68% of all of my patients either smoke or have a history of tobacco smoking.
- Peyronie's Disease (acquired penile curvature or bent penis)
Peyronie's disease is an inflammatory condition of unknown cause, and while typically affecting men in their 50's and 60's, is also seen in much younger men. Deformity or narrowing of the penile shaft is usually associated with this condition. In some circumstances, it can be subtle and will only be noted during an erection. Fibrosis/scarring of the penile tissue will cause erection problems by allowing blood to leak back into the circulation (venous leak).
Many patients report significant pain with an erection, which typically lasts for six to twelve months. Most treatments, including anti-inflammatory medication, Vitamin E, Verapamil, Colchicine, are unfortunately ineffective. For men also suffering from Erectile Dysfunction and Peyronie's Disease, insertion of the Internal Penile PumpTM is the best option. For most men, this should be considered early in order to prevent permanent penile shortening and deformity as well as to restore potency.
- Hormonal Problems
This is a rare cause of erectile dysfunction. It is natural for a man's hormone level to decrease with age, and studies show that hormonal replacement is rarely successful. Furthermore, hormonal replacement, more specifically testosterone, has a lot of side effects including stroke, sterility, prostate enlargement, and atrophy of the testicles.
- Nerve (neurologic) Problems
Patients with neurological diseases such as those caused by diabetes, Parkinson's disease, Alzheimer's, brain tumors, lumbar disc herniation, multiple sclerosis and spinal cord trauma can all have Erectile Dysfunction
- Psychological Problems
While most Erectile Dysfunction is physically caused, the psychological aspects are still present in many patients. It is normal for a man who suffers from erectile dysfunction to have a psychological reaction to a loss of a normal bodily function (erections). The primary problem, however, is physical, and for most men, restoring potency will do wonders for their psychological well-being.
Many men under stress may experience some performance anxiety and have unreliable erections on a temporary basis. If the condition persists, then the patient should be evaluated by an expert. Depression or anxiety disorders and the medications used to treat these conditions can also cause Erectile Dysfunction.
Evaluating Patients
Because the problem is deeply personal, the first step is to determine the exact cause of the patient's erectile difficulty. In order to assist the physician in diagnosing the cause of the erectile dysfunction, a detailed history of the patient's sexual, social, and medical background is necessary. The pattern and nature of a man's erectile dysfunction will give the clinician a clue as to the cause of the disease. Therefore, it is important for patients to keep a detailed diary of when and how an erection occurs as well as how it feels and lasts.
A complete patient history and a thorough physical examination will give the physician most of the information necessary to make a diagnosis. Additional tests may be required in certain circumstances, and will help confirm the diagnosis.
With a blood test, it is possible to evaluate blood sugar levels, cholesterol, triglycerides, and hormone levels.
The Penile Injection Test is a very useful examination tool. An erection is provoked with a medication in the doctor's office, allowing the physician to evaluate the penis' ability to become erect as well as to examine the penis during erection. The physician actually sees the problem in progress. A penile response to an injection will also help to classify the severity of the dysfunction as well as predict the response to medical treatment.
Duplex Sonography - Pulsed Doppler Study is a sophisticated diagnostic study, which will further pinpoint the cause of the erectile dysfunction. The penile arteries are visualized with ultrasound, measured before and after dilation, and at the same time, a doppler is used to measure blood flow. This determines whether or not there is an obstruction of the blood vessels, which interferes with blood flow into the penis, or whether the penis is inefficient at trapping and storing blood (venous leak).
Sleep monitoring is another diagnostic tool. During the dream portion of sleep (Rapid Eye Movement), most men experience at least 3 to 4 erections. If these normally occurring erections are persistently absent, this may indicate that a physical problem exists. This test is more appropriate for younger men in whom one suspects a psychological problem. The reliability of this test is not as good in older men.
Dynamic Infusion Cavernosometry-Cavernosography (DICC) evaluates the extent and location of abnormal leakage of blood from the erect penis (venous leak) by measuring the pressure inside the penis during erection. The test is performed in collaboration with a radiologist and usually involves X-ray pictures.
Data obtained from a DICC study is of limited use, however, since most patients have a trapping disorder (venous leak) as well as decreased blood circulation in the small penile arteries. Some believe that a venous leak may actually result from blocked penile arteries and therefore should be considered a symptom rather than a diagnosis of itself.
Arteriography involves imaging of the arteries of the penis. The test is only performed if vascular surgery is being considered and only on patients who are candidates for reconstructive surgery.
top of page
home page
|
