Now that scientists know the causes, and have devised a number of treatments to deal with them, this age-old condition is something worth talking about, and that’s good news for the 30 million American men who have ED.
Simply put, erectile dysfunction (ED) is the inability of a man to get or maintain an erection firm enough for satisfactory sexual intercourse. It is, of course, a condition that’s been with us through the ages and, until relatively recently, the sort of problem that men (and their partners) suffered in silence. For centuries it was believed that ED was the result of supernatural activity, the anger of the gods or a witch’s curse. In later times, the cause was thought to be purely psychological or linked to some moral failing.
In the 21st century, the age of embarrassed silence about ED has ended. With scientists having achieved greater understanding of the physiological mechanisms involved in men’s sexual health, and with a number of treatment options now available, talking about ED has become the first step in resolving the condition.
As with most bodily functions, achieving an erection requires a precise sequence of events, and ED can occur when any of the necessary events is disrupted. At least 75% of ED is the result of a physical cause, such as disease, injury, or the side effects of drugs. While the condition is most common in older men, ED is not an inevitable part of aging. In fact, it is treatable at any age.
The mechanics of male sexual response
- An erection begins with sensory or mental stimulation, or a combination of both.
- Impulses in the brain, spinal column, and area around the penis cause the muscles of the corpora cavernosa to relax, allowing blood to flow in through the arteries and fill the spaces.
- The blood creates pressure in the corpora cavernosa, making the penis expand.
- The tunica albuginea helps trap the blood in the corpora cavernosa, which sustains the erection.
- The erection ends when muscles in the penis contract to stop the inflow of blood and open the veins for blood outflow.
Any disorder that causes injury to the involved nerves or impairs blood flow in the penis has the potential to cause ED. Diseases— such as diabetes, high blood pressure, nerve disease or nerve damage, multiple sclerosis, atherosclerosis, and heart disease—account for the majority of ED cases. The lifestyle choices that contribute to heart disease and vascular problems also raise the risk of ED. Smoking, excessive alcohol consumption, being overweight, and not exercising may also be causes of ED.
Many common medicines—such as blood pressure drugs, antihistamines, antidepressants,tranquilizers, appetite suppressants, and cimetidine, an ulcer drug—may disrupt the mechanics of erection and lead to ED. It’s estimated that less than 25% of ED is primarily caused by psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure. Yet, even when ED has a mainly physical cause, it’s possible for psychological factors to make the condition worse.
Fixing the machinery
Treatment begins with the taking of a medical/sexual history. This is important for defining the degree and nature of the ED and gaining insight into the diseases or medications that may be causing it. A physical exam and sometimes simple laboratory tests may reveal systemic problems behind ED. A blood test to measure the amount of available testosterone in the blood, for example, may yield information about an endocrine problem (low testosterone) that could explain why a patient has decreased sexual desire.
Some men may be able to regain sexual function by making healthy lifestyle changes such as quitting smoking, reducing alcohol consumption, losing weight, and increasing physical activity. Others may be counseled on cutting back or replacing medicines that could be causing ED. Most will find help in one of the medicines that have become the mainstay of ED treatment.
Sildenafil (Viagra®)—the first oral medication to treat ED—was approved for use by the FDA in 1998. Hudson Valley Urology, a division of Premier Medical Group, took part in the clinical trials gauging its safety and effectiveness, as well in the clinical trials for vardenafil HCI (Levitra®) and tadalafil (Cialis®), which were approved in 2003.
These three medications belong to a class of drugs called phosphodiesterase-5 (PDE-5) inhibitors. They all work by enhancing the effects of nitric oxide, a chemical created in the body that relaxes smooth muscles in the penis in response to sexual stimulation and allows the increased blood flow needed for erection. The drugs are equally effective — helping about 70 percent of men who take them —but differ in the standard dose, length of the effect, how they interact with food and other medications, and the side effects that can accompany them.
Managing the motivation
Successful as the PDE-5 inhibitors may be in solving physical problems, a history of ED can leave a patient anxious about performance. It’s not uncommon to need to try ED medication a few times before feeling comfortable enough to fully respond. And it’s important to remember that the medications will not result in erection without the presence of sexual stimulation. They are not designed to treat a lack of sexual desire, a different situation than experiencing desire but being unable to maintain an erection.
In such situations, a low testosterone level (low-T) could be the culprit. The National Institute of Health estimates that about 5 million American men have low T. In medical studies, about 70 percent of men with low-T reported experiencing ED, and more than 60 percent reported a low sex drive. As Dr. Goldfischer observes, “if you’re brain isn’t bathed in testosterone, you won’t experience satisfactory erections.”
Testosterone, produced mainly in the testes, is the most important male sex hormone. Testosterone levels naturally decrease with age. Disease, accidents and certain drugs also affect production of the hormone. Men with type 2 diabetes are twice as likely as the rest of the male population to have low testosterone.
Since the symptoms of low testosterone are similar to many other conditions — including ED, depression, and lack of energy—it often goes undiagnosed. Yet a simple blood test gives definitive results and there are several treatment options available—such as gels, patches or injections—that increase the amount of testosterone in your body.
Your physician will help you decide if you’re a good candidate for testosterone replacement and, if so, advise on the pros and cons of the different treatments.
For the minority of men for whom oral medication isn’t sufficiently helpful, and for those who prefer a non-pharmacological solution, there are several additional treatment options that Premier Medical Group can provide.
Many men will be able to achieve stronger and more immediate erections by injecting drugs into the penis, causing it to become engorged with blood. Mechanical vacuum devices cause an erection by creating a partial vacuum, which draws blood into the corpora cavernosa. An elastic ring around the base of the penis maintains the erection during intercourse by preventing blood from flowing back into the body.
Significant advancement in the development of prosthetic devices that can be surgically implanted now provides several different options. Each of these approaches require some getting used to and have varying degrees of side effects. Usually, the men who opt for them are pleased with the results.