Mesothelioma Info

Erectile dysfunction (ED) is the inability to achieve or maintain an erection on a regular basis. In order to have an erection, a series of events must occur, including signals from the brain and spine to the muscles and veins of the penis. When this series of events is disrupted by physical damage, disease, drug side effects, or psychological conditions, erectile dysfunction or impotence can result. Erectile dysfunction may occur with every sexual encounter, or may occur intermittently. A man is considered to be impotent if he cannot get or maintain an erection sufficient for intercourse in 25% of attempts. Aside from the inability to get or maintain an erection, ED also may be linked to the inability to ejaculate.
The incidence of ED increases with age. In men between the ages of 40 and 70, 25% have at least a moderate degree of ED. An estimated 30% of men have had erectile dysfuntion at some point in their lives.
Many treatments exist for improving erectile dysfunction. Once the cause of ED is identified, medications or other treatments are available to help men have and maintain their erections. Doctors usually start with the least invasive treatment before trying the more invasive ones. First, a doctor might recommend that a patient cut back on drugs that may have erectile dysfunction as a side effect (e.g., nicotine from cigarettes; anti-depressives; and many other medications). A visit to a psychotherapist may be needed to address any psychological or emotional issues, depending on the individual situation. Other therapies such as vacuum devices, oral drugs, injected drugs, or surgery to repair damaged tissue or implant devices may be also recommended.
Extensive diagnostic testing is usually not necessary, as effective medications are now available. The most widely known of these is sildenafil citrate (Viagra, Cialis, and Levitra), which is used by 90% of men with ED.
Figure 1. Male reproductive anatomy
Causes

A surgical procedure that damages blood vessels and tissues can cause erectile dysfunction. Prostate or spinal surgery may injure important nerves, blood vessels, and surrounding tissues that are important in generating or maintaining an erection. As long as at least some of these important structures remain intact, therapies can restore erectile function.
Erectile dysfunction is more prevalent in men who take certain drugs or medications. Examples include alcohol and tobacco, or medications used to treat diabetes, depression, anxiety, high blood pressure, or heart disease. Antihistamines or antacids (specifically cimetidine) may also contribute to ED.
Symptoms

Men who are regularly unable to have or maintain an erection suitable for sexual intercourse are suspected of having erectile dysfunction. Normally, aroused men receive impulses from the brain and spine that prompt the penis to fill with blood, causing an erection. If these signals are blocked, men are unable to get or maintain an erection.
Risk Factors

Certain diseases may make men more likely to suffer from erectile dysfunction. Some diseases can damage the blood vessels, tissues, and muscles that are involved in maintaining signals from the brain and spine to the penis. A common example is diabetes mellitus, which can damage both the nerve and blood supply to the penis. Between 35% and 50% of diabetic men have ED.
Diseases that may cause erectile dysfunction include:

• Diabetes
• Kidney disease
• Chronic alcoholism
• Multiple sclerosis (MS)
• Atherosclerosis
• Heart disease

Mental or emotional states may predispose men to ED. In 10% to 20% of cases, mental or emotional factors cause ED. Men who experience stress, anxiety, guilt, depression, low self-esteem, and/or fear of sexual failure may have erectile dysfunction. These factors usually cause impotence in younger men.
Smoking is a risk factor of ED. Smoking may damage blood vessels. These damaged blood vessels may block signals from the brain and spine to the penis—signals that are needed for having and maintaining an erection.
Older men may be more likely to have ED. Between the ages of 40 and 65, the incidence of ED rises from 5% to nearly 25%.
In some cases, hormonal abnormalities such as low testosterone can predispose men to ED. In general, men with testosterone deficiency, even if it is severe, are still able to get and maintain erections. However, their nighttime erections are likely to be reduced in both frequency and intensity. Nevertheless, unless there is a contraindication, testosterone replacement therapy is always offered to men with low testosterone levels.
Diagnosis

Your physician will conduct a complete physical examination and sexual history. The sexual history, although personal, will indicate the onset of the dysfunction as well as the frequency, quality, and duration of any erections. The physical examination will indicate whether or not there are prostate or penis abnormalities or any medical conditions that may be causing the problem.
You may need to undergo some tests to evaluate your condition. In most cases, a complete physical examination and blood tests are all that is necessary, and can usually be arranged by your primary care physician. The blood tests evaluate your cell counts, blood sugar, kidney/liver function, thyroid hormone, and testosterone levels. A referral to a urologist and additional testing is limited to those people who do not respond to medication or have a history of penile injury or scarring that may require surgical intervention.
Table 1. Tests Available to Evaluate Erection

TestDescriptionPhysical examinationLooks at any abnormalities (e.g., swelling, cysts) in testicles and surrounding areas Digital rectal examinationChecks the tone of the rectum and anus, the prostate, and rectal or anal lesions and tumorsBloodMeasures hormones, blood cells, and enzymes and identifies infectionsPrevention and Screening

Tell your doctor about any medications you are taking, as some may cause ED. Usually, limiting or replacing those medications that are known to cause erectile dysfunction may minimize the problem.
Seek prompt treatment if you suspect that you have a disease that may be contributing to ED. In some cases, ED may be the first symptom of another disease such as diabetes or heart disease. Certain diseases may cause damage to muscles, blood vessels, and tissues in the body that are involved in having or maintaining an erection. This damage may block a signal traveling from the brain and spine to the penis, which could make a man unable to have or maintain an erection suitable for sexual intercourse.
Treatment

Self Care

Reduce stress or anxiety as much as possible. Mental or emotional states such as stress or anxiety may cause erectile dysfunction. Yoga or meditation may help to decrease stress.
Eat a low-fat diet. A high-fat diet is a risk factor for hardening and/or blockage of the blood vessels (atherosclerosis). Just as in the heart, the blood vessels supplying the penis may also be affected. A low-fat diet improves blood flow to all parts of the body. Reducing cholesterol levels heightens sexual potency.
Reduce alcohol intake, as it may increase sexual desire while decreasing sexual performance.
Avoid smoking. Smoking affects the blood vessels that are involved in having and maintaining an erection.
Drug Therapy

Your doctor is the best source of information on the drug treatment choices available to you.
Other Therapies

Men who are experiencing mental or emotional issues may benefit from psychotherapy. Psychotherapy may address the mental or emotional issues underlying the physical causes of erectile dysfunction. The techniques involved in psychotherapy are aimed at decreasing the anxiety associated with intercourse. Patients and their partners focus on developing intimacy.
Certain medical devices, such as a vacuum pump, help some men to get and maintain an erection. If used properly, vacuum erection devices can be effective in 70% of couples who use them. Vacuum devices mechanically help you get and maintain an erection by producing a partial vacuum around the penis. This vacuum draws blood into the penis, engorging it, and causing it to expand and become erect. The three parts to the vacuum are: 1) the plastic cylinder into which the penis is placed; 2) a pump that draws air out of the cylinder; and 3) an elastic band which is placed around the base of the penis to maintain the erection and prevent the blood from flowing back into the body. One variation of this vacuum pump uses a semi-rigid rubber sheath that remains on the erect penis during intercourse.
Figure 2. Vacuum pump device
Surgery

If you are a young man with a single blockage in a blood vessel, surgery may correct your ED. Blockages in blood vessels due to an injury in the groin area or fractured pelvis are best addressed by surgery in younger men. This type of surgery is less successful in older men because their blockage may be more extensive.
You may opt to have surgery to correct your erectile dysfunction. Surgical techniques are used to treat erectile dysfunction for three reasons:

• to implant a device that allows the penis to become erect
• to repair damaged blood vessels and increase the blood flow to the penis
• to block blood vessels that allow blood to leak from the tissues in the penis.

Success rates for repairing blood vessels and restoring blood flow to the penis range from 50% to 75%. Success rate for blocking blood vessels is 40% to 50% initially, but eventually drops to 15%.
Figure 3. Inflatable penile implant
Table 2. Surgical Procedures Used to Treat Erectile Dysfunction

ImplantsDescriptionProsthesisRestore erection; side effects include mechanical breakdown and infectionMalleablePaired rods inserted into the two chambers of the penis to be adjusted by the user for penis position; does not affect width or length of penisInflatablePaired cylinders inserted into the penis and expanded using pressurized fluid; user inflates the cylinders by pressing a small pump located under the skin in the scrotum; expands length and width of penis to an extent; penis is in more natural state when not inflatedAlternative Medicine

Some men try alternative therapies that claim to increase bloodflow to the penis. However, these treatments are unproven, and may cause serious side effects.
Table 3. Unproven Alternative Therapies for Erectile Dysfunction

TherapyDescriptionSide effectsAphrodisiacs (e.g., spanish fly and foods like chilis, chocolate, licorice, lard, scallops, oysters, and anchovies)Increase sexual driveSome foods (e.g., licorice and lard) may be harmful in large doses; spanish fly causes urinary and genital tract irritation as well as infection, scarring, and burning of the mouth and throat, and can be life-threateningGinkgoImproves blood flow to the brainHeadache, fever, tremors, irritability, loss of breathGinsengStimulates sexual functionIncreased blood pressure, headache, sleeplessness, skin rash, nervousness, upset stomach Prognosis

Erectile dysfunction is usually correctable. There is a variety of effective treatments for ED. Sildenafil citrate (Viagra, Cialis, and Levitra) has been shown to have a high success rate when combined with erotic stimulation. Other drugs such as alprostadil help men to maintain their erections for 30 to 60 minutes. Vacuum pumps produce erections that last for up to an estimated 30 minutes. Penile implants allow men to get and maintain erections at any time and for as long as they want.
Table 4. Prognosis for Erectile Dysfunction Treatments

TreatmentPercentage of men who achieve erectionViagra70%Alprostadil (penile injection)95%Alprostadil (MUSE)25% to 65%Alprostadil (topical)75% Vacuum devices56% to 67%Surgery40% to 75%Depending on the cause of the blockage and nature of the surgery
Follow-up

Contact your physician if erectile dysfunction does not resolve with treatment. Usually, doctors start by limiting or replacing drugs that cause erectile dysfunction. If those treatments do not work, they may try more extensive therapies such as medications or surgical procedures. In certain circumstances, psychotherapy may be recommended.
Report any drug side effects or complications to your doctor promptly. Some side effects are associated with drug and other therapies prescribed for erectile dysfunction. To avoid any complications, report any symptoms of side effects to your physician.