Erectile dysfunction

Erectile dysfunction is the repeated inability to get or keep an erection firm enough for sexual intercourse

Due to the sensitive nature of the erectile dysfunction, it’s difficult to estimate how many men it affects. However, recent studies show 22 per cent of 40-year-old men and up to 49 per cent of 70-year-old men may have the condition.


Causes and risk factors of erectile dysfunction
The most common cause of erectile dysfunction is damage to the tissues, either the arteries, nerves, muscles or fibrous tissue. Physical diseases account for around 70 per cent of cases of erectile dysfunction, including :
Cardiovascular disease (problems with the blood supply to the penis is by far the commonest cause of erectile dysfunction, especially in older men, smokers and those with high blood pressure - In fact erectile dysfunction may often be the first sign of serious heart or blood vessel disease):

Diabetes.
Kidney disease.
Obesity.
Nervous system condition such as multiple sclerosis (these are less common).
Hormonal problems, which include for example an underactivethyroid gland, or hypopituitarism after head injury, brain haemorrhage or tumour treatment.

In some cases the condition is caused by damage to the nerves and arteries near the penis which can occur during surgery, particularly for prostate and bladder cancer. Physical injury to the penis, spinal cord, prostate, bladder or pelvis can also be a factor. Erectile dysfunction is also a side effect of some common medications, including:
Blood pressure drugs.
Antihistamines.
Antidepressants.
Tranquilizers.

Recreational drug use, such as cocaine, can also cause erectile dysfunction.

Psychological factors are the main factor in up to 20 per cent of cases, especially among younger men. These include:
Stress.
Anxiety.
Guilt.
Depression.
Low self-esteem.
Fear of sexual failure or pregnancy


Symptoms of erectile dysfunction
The penis contains two chambers full of spongy tissue called the corpora cavernosa. When a man becomes sexually aroused impulses from the brain and local nerves cause muscles in the corpora cavernosa to relax, allowing blood to flow in and fill the spaces within the tissue. This creates pressure in the corpora cavernosa, making the penis expand. A membrane called the tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection.

The erection is lost when the muscles contract to stop blood flowing into the penis, and open outflow channels. A successful, sustained erection requires a sequence of events to occur in a precise fashion. Anything which disrupts this sequence can lead to problems either getting, or keeping an erection.

Some men wake up with an erection or can achieve one with masturbation but not with a partner – this may indicate underlying psychological causes rather than physical disease.


Treatment and prevention
There is a range of ways to treat erectile dysfunction. The first step is to look for a cause and, in particular, carry out a full screen for cardiovascular disease and diabetes, and check for blood flow to the penis.

The doctor will also explore the possibility of psychological factors, and if these are thought to be important may recommend sexual counselling for patients who are likely to benefit.

Underlying conditions may need treatment first and then a variety of therapies which may help to produce an erection can be considered. These include drugs, vacuum devices, and surgery. Sometimes some of these treatments are even recommended when psychological factors underlie the condition.


Drug therapy for erectile dysfunction
One drug in particular, sildenafil (‘Viagra’), has become an international phenomenon since its launch in the late 1990s because it’s one of the first drugs to offer a relatively simple safe drug treatment that helps the majority of men with erectile dysfunction – at least 70 per cent report improved erections. The drug does not directly give a man an erection but it works by boosting the natural mechanism that leads to an erection. When a man is sexually aroused, certain tissues in his penis relax, allowing blood to flow in and fill the penis. Viagra helps by elevating the levels of the chemical that causes the tissues to relax. These effects were discovered accidentally. The drug was originally developed to improve blood supply to the heart in angina sufferers.

In a small number of cases, people who have taken sildenafil have complained of headaches, flushing and stomach-ache. It can also cause some visual problems, including an increased sensitivity to light, blurred vision or an inability to tell the difference between blue and green. Men who are already taking medicines that contain nitrates, such as nitro-glycerine (usually for angina or heart disease), are strongly advised not to use Viagra as this is dangerous and may result in a heart attack.

Other similar drugs are tadalafil (‘Cialis’)and vardenafil (‘Levitra’).

Penile injections: The injection of drugs such as alprostadil directly into the tissues of the penis to trigger an erection was more common before the advent of new drugs such as sildenafil. The drugs relax muscles and increase blood flow to create an erection. They are also available as pellets to insert in to the urethra (the opening at the tip of the penis).

Vacuum Devices: These work by creating a partial vacuum around the penis, which draws blood into the organ. The devices have three components: a plastic cylinder, into which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis to maintain the erection after the cylinder is removed and during intercourse.

Surgery: There are different types of surgery. Implanted devices, known as prostheses, can restore erection in many men. These can come in different forms. For instance, paired rods can be inserted into the corpora cavernosa to enable the user to manually adjust the position of the penis. Alternatively, inflatable cylinders can be inserted inside the penis and expanded using pressurized fluid. In some cases doctors may attempt to repair blockages in damaged arteries. However, this usually only works if the blockages are not widespread.


Life style changes
There are a number of things you can do yourself to reduce your risk of erectile dysfunction. These include :
Stop smoking if you smoke (smoking damages the arteries and can reduce blood supply to the penis).
Lose weight if you are overweight.
Deal effectively with stress and anxiety – try meditation, counselling, exercise.
Moderate your alcohol consumption.
Avoid street drugs.
Take regular exercise (this improves your cardiovascular health).

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