Erectile dysfunction, often abbreviated to just its initials, ED, is said to affect as many as 30 million American men. It is clinically determined by its frequency – while most, if not all, men have problem getting or maintaining an erection from time to time, a clinical diagnosis of erectile dysfunction occurs when it happens more than 50 percent of the time.
There are as many causes of erectile dysfunction as there are commercials for the product, and pinpointing what’s causing it in any particular man requires health forensics of the highest order. The problem can stem from physical problems or emotional upsets, and it’s often a harbinger of serious underlying illnesses, such as high blood pressure, diabetes or heart disease. It also can be caused by aging or anxiety in a particular situation.
Whatever the cause, it’s disturbing when it happens and can lead to future stage fright (technically called “performance anxiety”) about it happening again. That leads to low self-esteem, depression and stress, which can be a self-fulfilling prophecy that inhibits future performance.
Erections: How They Happen
Sexual arousal in men occurs when signals from the brain release certain chemicals that stimulate blood flow to the penis. The blood enters two specific erection chambers in the penis filled with spongy tissue known as the corpus cavernous. When the blood fills the tissue, it produces the erection. When the male experiences an orgasm, the process reverses, with the blood flowing out of the chambers and deflating the penis.
The problem caused by erectile dysfunction can be twofold: sending out the right signals from the brain or maintaining an erection that is firm enough for sex and remains in that state, allowing sexual intercourse.
Physical Causes of ED
If erectile dysfunction occurs more than half the time, it might be a sign of the following physical conditions, particularly if the man is older than 50: diabetes, high blood pressure, high cholesterol and cardiovascular disease. Lifestyle habits also play a role. If the patient is a smoker, drug or alcohol abuser, is obese and doesn’t exercise, then he may be a prime candidate for erectile dysfunction.
Most doctors will conduct a physical and an extensive interview to determine the root causes of erectile dysfunction. Particularly important is the timing of the onset and whether any work issues or other outside influences may contribute to the problem. The emotional roots of the issue are harder to pin down and may center on the relationship with a partner, satisfaction with sex life, and any history of mental illness or depression. The doctor also will ask about nocturnal penile tumescence or automatic erections during sleep, both signs that the physical tools are working properly.
It’s important for the doctor to understand whether medication may cause the issue and if there is any prior history of surgery or injury in the pelvic area, or if there are urinary problems. A blood test or urine sample may be necessary.
It is possible that an imaging test may be required. This will check inside the body for blood flow, leaks in the veins, scars in the erectile tissue areas and potentially clogged arteries. Sometimes, the imaging test is accompanied by an injection into the penis that will cause an erection. That way, the imaging will monitor the blood flow and other issues in the erect penis for comparison when it is flaccid.
Other Treatments
One of the treatments suggested for persistent erectile dysfunction is testosterone replacement therapy. Low testosterone may cause erectile dysfunction. But replacement therapy won’t work when normal testosterone levels are present.
In some cases, doctors may recommend the heavily advertised pharmaceuticals to help with erectile dysfunction. These include Cialis or Viagra, among others, and are taken orally before sex. These drugs are known as PDE-5 inhibitors and are used to relax penile muscles and improve blood flow. They work by boosting the chemicals that are generated by the brain and create erections that last longer. There are side effects, though, including headaches, flushing, stuffy nose and muscle aches, but none are long-lasting and weaken as the body gets used to the drugs. In some cases, one of the erectile drugs, sildenafil (brand name: Viagra), can cause users to see blue-green shades in their vision for a short period, but the symptom quickly fades.
There are also devices that may be affixed to the penis, such as a vacuum erection device, which is slipped over the penis and uses suction to create an erection. A rubber ring then maintains the trapped blood for about 30 minutes.
Surgery that can help with blockages is also a possibility. One potential surgery uses a tiny medicated pellet that is implanted in the urethra, the tube that urine flows through on its way out of the body. It doesn’t work for everyone, and in some cases, causes a burning in the penis or an erection lasting more than four hours.
Another surgery is penile implants, in which a penile prosthesis is inserted in the body. There are two types: a bendable implant, which uses two rods of silicone to maintain firmness, or an inflatable implant, in which fluid-filled cylinders are placed in the penis that can be connected to a pump in the scrotum. The pump pushes fluid into the penis, creating an erection.
A word of caution – while some over-the-counter herbal supplements claim to help with erectile dysfunction, be aware that their claims have not been verified by the Food and Drug Administration and are not subject to the scrutiny that controlled and prescribed substances undergo. It is wise to check with a physician before taking any over-the-counter supplement for erectile dysfunction, particularly if already taking other medications like nitrates for a heart condition.
Ultimately, no matter what is inserted or ingested, everything starts with the brain. Gaining confidence in whatever treatment used plays a big part in helping a patient overcome erectile dysfunction and resuming a normal sex life.