What is erectile dysfunction (ED)?
Erectile dysfunction (or ED), also called male impotence, is described as a consistent failure to achieve and maintain an erection sufficient for mutually satisfactory sexual intercourse with its partner. ED itself is not a disease, but rather a signal that something else may be a problem. Erectile dysfunction is a common disease, affecting more than half of men aged 40 to 70 years.
Sexual dysfunction can sometimes be caused by diseases such as diabetes, high blood pressure, vascular diseases, heart disease, nervous system disorders, and depression, as well as an undesirable side effect from certain medications. Male sexual dysfunction can be a symptom of such disorders, which primarily lead them to the doctor’s office.
Sexual health and function are important for determining the quality of a person’s life. As Americans age, disorders such as erectile dysfunction (ED) become more apparent. Since this subject is widely discussed in the media, men and women of all ages seek guidance to improve their relationships and experience sexual satisfaction.
Successful treatment of ED has been shown to improve sexual intimacy and satisfaction, improve the sexual aspects of quality of life, as well as the overall quality of life, and alleviate the symptoms of depression.
How does a person achieve an erection?
For a person who has an erection, a complex process takes place in his body.
An erection includes the central nervous system, the peripheral nervous system, hormones, psychological and stressful factors, local problems with the penis itself, as well as blood flow or blood circulation. The penile part of the process leading to an erection is just one component of a very complex cascade of events.
Erections occur in response to touch, smell, and visual stimuli that cause pathways in the brain. Information travels from the brain to the nerve centers at the base of the spine, where the primary nerve fibers connect to the penis and regulate blood flow during and after erection.
Sexual stimulation causes the release of chemicals from the nerve endings in the penis, which cause a series of events that ultimately cause muscle relaxation in the erection organs of the penis. Smooth muscle in the organs of erection controls the flow of blood into the penis. When a smooth muscle relaxes, the blood flow rises sharply, causing the erection bodies to become full and stiff, leading to an erection. Venous canals, usually depleting blood, contract and close as the erection bodies increase.
Weakening (when the penis is no longer in an erection state) when muscle-relaxing chemicals are no longer released. Ejaculation leads to the fact that the smooth muscle tissue of the erection organs in the penis restores muscle tone, which allows you to open channels of blood drainage. As the excess blood drains from the erection bodies, the erection loses its stiffness and the penis returns to its original sluggish state.
ED occurs when this process is not progressing normally. And arousal and erection are physical and mental activity, so it is important to remember that the sexual partner plays an integral role. Effective management of erection problems and erectile dysfunction is often more successful if the sexual partner participates in the evaluation and treatment.
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 occurs very quickly, often within a few minutes or even seconds, leaving both the sexual partner and the person experiencing premature ejaculation unmet. Premature ejaculation may accompany an erection problem, such as ED, but is usually done differently.
Erection problems usually cause a significant psychological and emotional reaction in most men. This is often described as a picture of anxiety and stress, which can further interfere with normal sexual function. This “performance concern” should be recognized and addressed by your doctor.
What causes erectile dysfunction?
For some men, erectile dysfunction develops with age or may be associated with depression or another psychological cause. In these cases, psychological counseling with you and your sexual partner can be successful.
Medications can cause ED, especially medicines that you can take to control blood pressure or depression (antidepressants) (see Impotence / Erectile Dysfunction for a list of drugs that can cause ED). Anti-ulcer drugs can be a cause, as well as alcohol or drug addiction. ED is a side effect. Talk to your doctor about medicines that may not cause this side effect. Do not stop taking prescribed medications.
Other causes include damage to the erection organs in the penis; diabetes; various hormonal disorders; blood flow problems; psychological factors such as depression; and surgical complications of abdominal, pelvic or posterior surgery.
How is erectile dysfunction treated?
Treatment options include sexual counseling, medications, external vacuum devices, hormonal therapy, penile injections or insurethral suppositories (see Impotence / Erectile Dysfunction for treatment options). In highly selected cases, combined therapy using several of these methods can be used under the supervision of a urology specialist in the field of ED. If none of these treatments is satisfactory, you can consider the possibility of implanting the penis through surgery.
Most patients start with Viagra and other similar drugs. No one could miss all the advertisements of drug users to help with ED. You see advertisements for these drugs in magazines and on television. Of course, there are a lot of jokes about Viagra and similar drugs, but ED is not funny if you experience it.
How do drugs like Viagra work?
Viagra (sildenafil citrate), a drug for treating erectile dysfunction, is the first available pill that has proven to improve erection in most men with impotence.
Since its introduction in March 1998, no other therapy for ED has received such widespread public acceptance. Viagra does not improve an erection in normal men, only in those who barely achieve or maintain an erection sufficient for intercourse due to a true medical problem. It is not an aphrodisiac (sexual stimulant) and will not increase sexual desire. Unlike other treatments for erectile dysfunction, Viagra requires sexual stimulation to function. Without this stimulation, Viagra will have no effect.
Viagra works by blocking an enzyme found mainly in the penis, which destroys the chemicals produced during sexual stimulation, which usually produce erections. Viagra allows these chemicals to wake up longer and improves erectile function. That is why sexual stimulation is necessary for the work of Viagra.
In general, Viagra successfully works in about 65-70% of all powerless men.
Viagra works best if you take it about 30-60 minutes before sexual activity. Only 1 tablet should be taken per day. It should be taken on an empty stomach. Increasing the dose of Viagra beyond the recommended amounts will not improve the response and will only lead to greater side effects.
Several drugs, very similar to Viagra, have recently been approved by the FDA. These drugs, called vardenafil (Levitra), Stendra (avanafil) and tadalafil (Cialis), have essentially the same activity and general precautions as Viagra. Levitra can be taken with food, where Viagra needs to be taken on an empty stomach. Cialis has a much longer duration of improving erectile function (up to 24-36 hours) compared to Viagra and Levitra (up to 4-6 hours). Cialis in the daily dose is now FDA approved for the treatment of patients with benign prostatic hyperplasia and erectile dysfunction for clinical situations where treatment of both conditions has been proven from a medical point of view. Stendra is effective when taken with or without food, and it works for 15 minutes. Stendra has moderate consumption of alcoholic beverages.
Do ED drugs have side effects?
The most common side effect of Viagra and similar drug use are a headache, affecting about 16% of users. A drop in blood pressure, transient dizziness and facial flushing (red face) are reported in 10%. Stomach upset occurs in 7%, and nasal congestion in 4%. From 3% to 11% of users report some visual problems during Viagra. This visual impairment is described as blurred vision, increased photosensitivity, bluish durability, and a temporary loss of the ability to distinguish between blue and green.
Precautionary measures: Viagra, Levitra, and Cialis are absolutely not taken by men with heart disease who take nitrates, such as nitroglycerin or isosorbide (Isordil, Ismo, Imdur). Some street drugs, such as poppers, can also cause serious problems if taken with Viagra, Levitra or Cialis. Ecstasy is a street drug that can increase sexual desire but interferes with execution. This prompted some men to combine ecstasy with Viagra, Levitra or Cialis. This mixture (a combination sometimes called “sextasis”) can improve erection ability, but also causes severe headache and priapism. (Priapism is an abnormally long erection that becomes extremely painful and can permanently damage the erection mechanism.)
What are penile implants?
Two types of devices are available: semi-rigid and multi-component inflatable systems.
With a semi-rigid device, two matching cylinders are implanted in the penis. These devices provide sufficient rigidity for penetration and rarely break. The main disadvantages are the cosmetic appearance of the penis, the need for surgical intervention and the destruction of the natural erectile mechanism during implantation of the device.
Inflatable devices consist of two cylinders inserted into the penis, a pump placed in the scrotum to inflate the cylinders, and a reservoir that is contained either inside the cylinders or in a separate reservoir located below the lower abdomen tissue. An inflatable prosthesis usually remains functional for 7-10 years before replacement may be required.
Is the operation rather abrupt?
Previously, the placement of prostheses in the penis was the only effective therapy for men with certain types of erectile dysfunction. Now, this is the last option, which is considered when all other treatments are unacceptable or unsuccessful. However, surgery remains a reliable form of therapy (see Impotence / Erectile Dysfunction for surgical options). After a surgical implant has been made, the normal structure of the penis is constantly changing, which means that the operation is not reversible.
What if I hesitate to talk about it?
This is a delicate subject, and your doctor should be sensitive and caring so that you can comfortably share these intimate details of your personal life. Schedule enough time with your doctor to conduct a full interview and physical examination. The first step in the medical treatment of erectile dysfunction is a thorough sexual, medical and psychosocial history.
Your doctor will ask you if you have erection problems if an erection is suitable for penetration if an erection can be maintained until a partner reaches orgasm if ejaculation occurs and if both partners have sexual satisfaction.
The doctor will want to know all the medicines that you have taken during the past year, including all the vitamins and other nutritional supplements.
Tell your doctor about your tobacco use, alcohol and caffeine consumption, as well as any use of illegal drugs.
Your doctor will look for signs of depression. You will be asked about libido (sexual desire), problems and tensions in your sexual relationships, insomnia, lethargy, moodiness, nervousness, anxiety and unusual stress from work or at home.
You will be asked about your relationship with your sexual partner. Does your partner know that you are looking for help in solving this problem? If yes, does your partner approve? Is this a serious problem with you? Is your partner willing to participate with you in the treatment process?
Your doctor will want your candid answers to such questions so that you can discuss the best treatment for you.
Physical examination is required. The doctor will pay special attention to the genitals and nervous, vascular and urinary systems. Your blood pressure will be checked because several studies have shown a link between high blood pressure and erectile dysfunction.
A physical examination will confirm the information you gave the doctor in your medical history, and can help identify unforeseen disorders such as diabetes, vascular diseases, penile plaques (scar tissue or hard lumps under the skin of the penis), testicular problems, low male hormones, injuries or diseases of the nerves of the penis and various disorders of the prostate gland.
You can achieve a satisfactory erection and sexual health, and working with your doctor or a specialist (urologist) is the best way to get help.