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Erectile dysfunction or impotence

Erectile dysfunction (ED) or impotence is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual activity. A penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis. The process is most often initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis. The most important organic causes are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects.

Penis anatomy

Is impotence the same as erectile dysfunction?

Yes, the terms mean the same. Premature ejaculation is often confused with erectile dysfunction. Premature ejaculation is a condition in which the entire process of arousal, erection, ejaculation, and climax occur very rapidly, often in just a few minutes or even seconds, leaving both the sexual partner and the one experiencing premature ejaculation unsatisfied. Premature ejaculation may accompany an erection problem such as ED but is generally treated differently.

Erection problems will usually produce a significant psychological and emotional reaction in most men. This is often described as a pattern of anxiety and stress that can further interfere with normal sexual function. This “performance anxiety” needs to be recognized and addressed by your doctor.

Types

  • Psychological Erectile Dysfunction
  • Priapism

What causes erectile dysfunction?

Currently, virtually any man who wishes to have an erection can obtain it, regardless of the underlying cause of his problem. Many reasonable treatment options exist. Your first step is to find a well-trained, experienced, and compassionate doctor who is willing to take the time to understand you and fully examine you to discover the cause and discuss the treatments available to you. Your doctor will want to rule out any other causes for your concern such as high blood pressure, prostate cancer, vascular disease, and diabetes. By seeing your doctor, you may very well be saving your life if the doctor detects – and treats – a life-threatening illness. Often, you can restore your sexual health by treating a condition such as high blood pressure with diet and exercise or controlling your diabetes. For some men, erectile dysfunction develops with age or may be related to depression or another psychological cause. In these cases, psychological counseling with you and your sexual partner may be successful. Medications can cause ED, especially drugs you might take to control blood pressure or depression (antidepressants) (see Impotence/Erectile Dysfunction for a list of medications that may cause ED). Anti-ulcer drugs can be a cause, as can alcohol or drug abuse. ED is a side effect. Talk with your doctor about medications that might not cause this side effect. Do not just stop taking your prescribed medication. Other causes include damage to the erection bodies in the penis; diabetes; various hormonal disorders; blood flow problems; psychological factors, such as depression; and surgical complications from abdominal, pelvic, or back surgery.

What are the symptoms of erectile dysfunction?

Being unable to have or keep an erection adequate for sexual activity is the defining mark of erectile dysfunction. The problem may manifest itself in several ways. If the dysfunction:

  • Is transient or appearing only occasionally, the problem is not likely to be serious; all men experience problems with erections at some time in their lives.
  • Develops gradually and persistently, there is probably a physical cause; this is generally the case with chronic impotence.
  • Develops abruptly but you still have early-morning erections and are able to have an erection while masturbating, the problem is likely to have a psychological component, perhaps with an underlying physical factor.

Call your doctor about erectile dysfunction if:

  • Erectile dysfunction is linked with anxiety or threatens your sexual relationship. At a minimum, your doctor can help clear up misinformation, which commonly exacerbates sexual problems. Sometimes a short course of medication can get you through a rough patch.
  • Erectile dysfunction persists. Physical causes can be early warning signs of more general, potentially dangerous conditions; for example, narrowing of the penile artery may indicate coronary artery disease or diabetes. For the dysfunction itself, a doctor may suggest a medication that will allow for normal erections or might advise the use of a mechanical device or penile injection therapy. But the underlying medical condition must be addressed and treated.
  • Erection problems are associated with pain or penile curvature (a condition called Peyronie’s disease).

Tests and diagnosis

For many men, a physical exam and answering questions (medical history) are all that’s needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist. Tests for underlying conditions might include:

  • Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.
  • Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.
  • Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
  • Ultrasound. This test is usually performed by a specialist in an office. It involves using a wandlike device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems.

This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.

  • Overnight erection test. Most men have erections during sleep without remembering them. This simple test involves wrapping a special device around your penis before you go to bed.

This device measures the number and strength of erections that are achieved overnight. It can help to determine if your erectile dysfunction is related to psychological or physical causes.

  • Psychological exam. Your doctor might ask questions to screen for depression and other possible psychological causes of erectile dysfunction.

Treatments and drugs

The first thing your doctor will do is to make sure you’re getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.

Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner’s preferences also might play a role in your treatment choices.

Oral medications

Oral medications are a successful erectile dysfunction treatment for many men. They include:

  • Sildenafil (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra, Staxyn)
  • Avanafil (Stendra)

All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.

Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing men to function normally. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in men who get normal erections.

The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.

Your doctor will consider your particular situation to determine which medication might work best. These medications might not fix your erectile dysfunction immediately. You might need to work with your doctor to find the right medication and dosage for you.

Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor’s OK. Medications for erectile dysfunction might not work or might be dangerous if you:

  • Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Minitran, Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Dilatrate-SR, Isordil)
  • Have very low blood pressure (hypotension) or uncontrolled high blood pressure (hypertension)
  • Have severe liver disease
  • Have kidney disease that requires dialysis

Other medications

Other medications for erectile dysfunction include:

  • Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include papaverine, alprostadil and phentolamine.

Each injection generally produces an erection that lasts about an hour. Because the needle used is very fine, pain from the injection site is usually minor.

Side effects can include bleeding from the injection, prolonged erection (priapism) and formation of fibrous tissue at the injection site.

  • Alprostadil urethral suppository. Alprostadil intraurethral (Muse) therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra.

The erection usually starts within 10 minutes and lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra and formation of fibrous tissue inside your penis.

  • Testosterone replacement. Some men have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step.

Penis pumps, surgery and implants

If medications aren’t effective or appropriate in your case, your doctor might recommend a different treatment. Other treatments include:

  • Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis.

Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device.

The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.

If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it’s made by a reputable manufacturer. Penis pumps available in magazines and sex ads might not be safe or effective.

  • Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or semirigid rods. Inflatable devices allow you to control when and how long you have an erection. The semirigid rods keep your penis firm but bendable.

Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among men who have tried and failed more-conservative therapies. As with any surgery, there’s a risk of complications, such as infection.

  • Blood vessel surgery. Rarely, leaking or obstructed blood vessels can cause erectile dysfunction. In this case, surgical repair, such as vascular stenting or a bypass procedure, might be needed.

Psychological counseling

If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counselor.

Prevention

The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions. For example:

  • Work with your doctor to manage diabetes, heart disease or other chronic health conditions.
  • See your doctor for regular checkups and medical screening tests.
  • Stop smoking, limit or avoid alcohol, and don’t use illegal drugs.
  • Exercise regularly.
  • Take steps to reduce stress.
  • Get help for anxiety, depression or other mental health concerns.

Source
http://www.webmd.com/erectile-dysfunction/
http://www.emedicinehealth.com/erectile_dysfunction_faqs/article_em.htm
http://www.medicinenet.com/erectile_dysfunction_ed_impotence/article.htm
http://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/basics/definition/con-20034244
https://en.wikipedia.org/wiki/Erectile_dysfunction
http://www.jbbardot.com/8-natural-remedies-to-overcome-erectile-dysfunction-and-impotence/

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M A Samad

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