Erectile dysfunction or male impotence is when a man has trouble getting and/or maintaining an erection. While erectile dysfunction (ED) is more common in older men, it is not a normal part of the aging process. Erectile dysfunction is the second most common form of sexual dysfunction.
An erection usually begins with sexual arousal from something that a man thinks, feels, hears, smells or tastes. Signals are transmitted from the brain to the penis, causing more blood to flow into the penis. It is the hydraulic effect of the blood entering and being trapped in the penis that results in an erection.
WHAT CAUSES ERECTILE DYSFUNCTION
The most common causes of erectile dysfunction are diabetes, high blood pressure, high cholesterol and smoking cigarettes. All of these cause atherosclerotic changes and/or vascular damage in one way or another. It is the vascular damage or damage to the blood vessels that supply the penis that is most often the cause of a man's ED.
Most surgery, radiation and procedures on the prostate cause some trauma or damage to the nerves and blood vessels that supply the penis, often causing erectile dysfunction.
Many medications result in erectile dysfunction. Some injuries to a man's groin or pelvis can cause ED.
Psychological problems like depression and anxiety can also cause erectile dysfunction, particularly in younger men.
Men who have had a stroke, brain or spinal cord injuries, and nerve disorders like Alzheimer's disease, multiple sclerosis and Parkinson's disease are more likely to have erectile dysfunction.
Any trauma to a man’s body, in particular to his head, neck, back or pelvis, can interfere with the normal flow of blood and neurological impulses that are necessary to get and maintain a solid erection.
Men who have sleep apnea or sleep disorders or who have been sexually abused as a child often have erectile dysfunction.
Men who are troubled by premature ejaculation sometimes have a high enough level of anxiety to cause some degree of erectile dysfunction.
Men who are obese, sedentary, smoke cigarettes and use drugs are more likely to have erectile dysfunction.
Men who do a large amount of bicycle riding on a narrow seat are more likely to have erectile dysfunction.
Men with low testosterone or other hormonal abnormalities often have erectile dysfunction.
DIAGNOSING ERECTILE DYSFUNCTION
A thorough history and physical examination is essential in diagnosing erectile dysfunction. An ultrasound examination of the penis will sometimes be used to evaluate penile blood flow. A vibration test, biothesiometry is used to evaluate sensitivity and nerve function. Blood tests are often performed to evaluate hormone levels and to check for diabetes.
TREATMENTS FOR ERECTILE DYSFUNCTION
Lifestyle recommendations are often made in the treatment of erectile dysfunction, such as not smoking, drug use and the excessive intake of alcohol. Regular aerobic exercise will go a long way to a healthier mind and body.
Making sure that underlying medical issues like high cholesterol, high blood pressure and diabetes are well controlled.
Men with a psychological component of their erectile dysfunction often improve after sex therapy, marriage therapy, or after seeing a psychologist or psychiatrist.
There are many medications used to treat erectile dysfunction. Oral medications like Viagra®, Cialis® and Levitra®. Urethral suppositories like MUSE®. Penile injection therapy with some combination of prostaglandin, papaverine and phentolamine.
Vascular surgery is sometimes an option for a recent onset of erectile dysfunction in a fairly young patient. This is particularly helpful if the erectile dysfunction is as a result of a recent trauma or accident.
Testosterone replacement therapy is sometimes effective if the cause of a man's erectile dysfunction is his low testosterone levels.
Vacuum therapy is when an external device called a vacuum constriction device or a penis pump is placed over the penis. This creates a vacuum and draws blood into the penis. A constriction band or ring then traps the blood in the penis after a man gets an erection.
Implant surgery is a an option when a patient either cannot tolerate other forms of erectile dysfunction treatment or if they do not work for him. This involves a malleable or inflatable device being surgically inserted into the shaft of the penis. We consider this surgery to be an appropriate choice for a patient if no other method of treatment is effective. While we do not perform implant surgery in our practice, there are several excellent surgeons who frequently perform this surgery in the NY metro area.
* While we
will certainly try to help all of our patients, as with
any medical treatment, there is no guarantee of specific results, as
results can and usually do vary from patient to patient.
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