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- What is ED?
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Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Medical professionals often use the term "erectile dysfunction" to describe this disorder and to differentiate it from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. Impotence can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining impotence and estimating its incidence difficult. Erectile dysfunction (ED) should be distinguished from other male sexual functioning difficulties sometimes erroneously referred to as impotence, such as premature ejaculation, male orgasmic disorder (delay or absence of orgasm) and hypoactive sexual desire disorder (lack of or diminished sexual interest or desire). Men with ED may or may not suffer from these other problems. ED can occur at any age and is not limited to a specific ethnic group. Occasional episodes are considered normal.
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Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Medical professionals often use the term "erectile dysfunction" to describe this disorder and to differentiate it from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. Impotence can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining impotence and estimating its incidence difficult. Erectile dysfunction (ED) should be distinguished from other male sexual functioning difficulties sometimes erroneously referred to as impotence, such as premature ejaculation, male orgasmic disorder (delay or absence of orgasm) and hypoactive sexual desire disorder (lack of or diminished sexual interest or desire). Men with ED may or may not suffer from these other problems. ED can occur at any age and is not limited to a specific ethnic group. Occasional episodes are considered normal.
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What are the symptom of ED?
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Inability to have an erection at any time, either alone or with a sexual partner. Inability to maintain an adequate erection until completion of the sexual activity. If impotence is only temporary or occasional, the problem is probably not serious; all men go through periods of erection problems. Develops gradually and persistently, a physical cause is likely; 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 probably has a psychological cause. Develops abruptly but you still have early-morning erections and are able to have an erection while masturbating, the problem probably has a psychological cause.
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Inability to have an erection at any time, either alone or with a sexual partner. Inability to maintain an adequate erection until completion of the sexual activity. If impotence is only temporary or occasional, the problem is probably not serious; all men go through periods of erection problems. Develops gradually and persistently, a physical cause is likely; 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 probably has a psychological cause. Develops abruptly but you still have early-morning erections and are able to have an erection while masturbating, the problem probably has a psychological cause.
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How does an erection occur?
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The penis contains two chambers, called the corpora cavernosa, which run the length of the organ. A spongy tissue fills the chambers. A membrane, called the tunica albuginea, surrounds the corpora cavernosa. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa. Erection begins with sensory and mental stimulation. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the open spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps to trap the blood in the corpora cavernosa, thereby sustaining erection. Erection is reversed when muscles in the penis contract, stopping the inflow of blood and opening outflow channels.
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The penis contains two chambers, called the corpora cavernosa, which run the length of the organ. A spongy tissue fills the chambers. A membrane, called the tunica albuginea, surrounds the corpora cavernosa. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa. Erection begins with sensory and mental stimulation. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the open spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps to trap the blood in the corpora cavernosa, thereby sustaining erection. Erection is reversed when muscles in the penis contract, stopping the inflow of blood and opening outflow channels.
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How many people are infected with ED?
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ED affects millions of men, although too often a hidden problem. It is estimated that at least 10% of men over the age of 21 suffers from impotence and that 52% of men over 40, worldwide suffer from erection problems, but less than 15% of these men seek or receive therapy for their condition. In South Africa, a recent survey of primary health care clinics in the Western Cape, found that seven out of 10 men between the ages of 35 and 70 years had some degree of ED. In Africa 11,5 million men suffer from erection problems. Impotence affects an estimated two million British men between 21 and 75. A 1998 study showed that 38 percent of Thai men aged 40 to 70 years were impotent, which if extrapolated to the whole nation indicated that three million Thai men have the problem. Nineteen percent of those surveyed had mild problems, 14 percent moderate and five percent severe. Yet only two percent have sought medical treatment. The incidence goes up with age: half of all men over 40 have some erection difficulties - and smokers are twice as likely to be among them. As men age, they typically report some loss of sexual desire as well, although neither loss of desire nor ED is an unavoidable feature of ageing. ED was found to increase with age with 54% of men between 65 and 70 years old reporting some degree of impotence.
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ED affects millions of men, although too often a hidden problem. It is estimated that at least 10% of men over the age of 21 suffers from impotence and that 52% of men over 40, worldwide suffer from erection problems, but less than 15% of these men seek or receive therapy for their condition. In South Africa, a recent survey of primary health care clinics in the Western Cape, found that seven out of 10 men between the ages of 35 and 70 years had some degree of ED. In Africa 11,5 million men suffer from erection problems. Impotence affects an estimated two million British men between 21 and 75. A 1998 study showed that 38 percent of Thai men aged 40 to 70 years were impotent, which if extrapolated to the whole nation indicated that three million Thai men have the problem. Nineteen percent of those surveyed had mild problems, 14 percent moderate and five percent severe. Yet only two percent have sought medical treatment. The incidence goes up with age: half of all men over 40 have some erection difficulties - and smokers are twice as likely to be among them. As men age, they typically report some loss of sexual desire as well, although neither loss of desire nor ED is an unavoidable feature of ageing. ED was found to increase with age with 54% of men between 65 and 70 years old reporting some degree of impotence.
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What are the causes of ED?
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An erection problem can occur if any of the events in this sequence are disrupted: the problem may involve mental processes, nerve impulses, or responses in muscles, fibrous tissue, veins and arteries in the penis.
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An erection problem can occur if any of the events in this sequence are disrupted: the problem may involve mental processes, nerve impulses, or responses in muscles, fibrous tissue, veins and arteries in the penis.
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What are the physical causes of ED?
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The most common cause of ED is damage to arteries, smooth muscles and fibrous tissues. Problems with the blood vessels (vascular problems) make up 48% of erection problems. Problems with the nerves (neurological problems): 14%. Problems with the structure of the penis or surrounding tissues: 3%.
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The most common cause of ED is damage to arteries, smooth muscles and fibrous tissues. Problems with the blood vessels (vascular problems) make up 48% of erection problems. Problems with the nerves (neurological problems): 14%. Problems with the structure of the penis or surrounding tissues: 3%.
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Causes of ED are effected by which factors ?
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Diabetes. Between 35 and 50% of men with diabetes have erection problems. About half of men with diabetes develop erection problems within five years of being diagnosed with diabetes. Multiple sclerosis. Atherosclerosis or "hardening of the arteries" can prevent adequate blood from entering the penis. Low levels of the hormones needed for the normal development and function of the sex organs (hypogonadism). This leads to low levels of testosterone, the hormone necessary for erections, but does not affect the nerves or blood vessels. Thyroid problems may also increase the risk of erection problems. Injury to the penis, spinal cord, prostate, bladder or pelvis: such injury can be the result of sports or car accidents, or even riding on hard bicycle seats. Complications of surgery or radiation (e.g. for prostate cancer): these can interfere with nerve impulses or blood flow to the penis. When the nervous system cannot transmit arousal signals, or when the blood vessels in the penis cannot fill or stay filled with blood, you cannot have an erection. Side effects of common medication: these include drugs taken for high blood pressure, anti-depressants, anti-histamines, tranquilizers, appetite suppressants, and the ulcer drug cimetidine. Substance abuse: chronic use of alcohol, marijuana or other drugs often causes impotence, which may be aggravated by decreased sexual drive. Excessive tobacco use can also block penile arteries. Zinc deficiency. Erection problems in men over 50 are more likely to have physical causes. Yet, it is not an inevitable part of aging. Impotence is treatable in all age groups, and awareness of this fact has been growing. More men have been seeking help and returning to near-normal sexual activity because of improved, successful treatments for impotence. Urologists, who specialize in problems of the urinary tract, have traditionally treated impotence-especially complications of impotence.
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Diabetes. Between 35 and 50% of men with diabetes have erection problems. About half of men with diabetes develop erection problems within five years of being diagnosed with diabetes. Multiple sclerosis. Atherosclerosis or "hardening of the arteries" can prevent adequate blood from entering the penis. Low levels of the hormones needed for the normal development and function of the sex organs (hypogonadism). This leads to low levels of testosterone, the hormone necessary for erections, but does not affect the nerves or blood vessels. Thyroid problems may also increase the risk of erection problems. Injury to the penis, spinal cord, prostate, bladder or pelvis: such injury can be the result of sports or car accidents, or even riding on hard bicycle seats. Complications of surgery or radiation (e.g. for prostate cancer): these can interfere with nerve impulses or blood flow to the penis. When the nervous system cannot transmit arousal signals, or when the blood vessels in the penis cannot fill or stay filled with blood, you cannot have an erection. Side effects of common medication: these include drugs taken for high blood pressure, anti-depressants, anti-histamines, tranquilizers, appetite suppressants, and the ulcer drug cimetidine. Substance abuse: chronic use of alcohol, marijuana or other drugs often causes impotence, which may be aggravated by decreased sexual drive. Excessive tobacco use can also block penile arteries. Zinc deficiency. Erection problems in men over 50 are more likely to have physical causes. Yet, it is not an inevitable part of aging. Impotence is treatable in all age groups, and awareness of this fact has been growing. More men have been seeking help and returning to near-normal sexual activity because of improved, successful treatments for impotence. Urologists, who specialize in problems of the urinary tract, have traditionally treated impotence-especially complications of impotence.
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Are there any Psychological factors that cause ED?
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Psychological problems interfere with the erection process by distracting the man from things that would normally arouse him. These problems cause between 10 and 40% of erectile problems. Even in cases where the underlying problem is physical, these factors can play an important secondary role, for example when a man who has had some erectile difficulty starts to anticipate and fear sexual failure. As a result, psychological factors play some causal role in at least 80% of cases of ED. These factors include: Depression: ED is twice as likely among men suffering from depression as it is among those without depressive symptoms. Relationship problems: a man who loses sexual interest in or desire for a particular partner may develop erection problems. Anxiety and stress including recent major life changes (birth of child, retirement, job change, loss or death of partner, divorce, marriage). Low self-esteem. Erection problems in men under 50 are more likely to be due to psychological causes.
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Psychological problems interfere with the erection process by distracting the man from things that would normally arouse him. These problems cause between 10 and 40% of erectile problems. Even in cases where the underlying problem is physical, these factors can play an important secondary role, for example when a man who has had some erectile difficulty starts to anticipate and fear sexual failure. As a result, psychological factors play some causal role in at least 80% of cases of ED. These factors include: Depression: ED is twice as likely among men suffering from depression as it is among those without depressive symptoms. Relationship problems: a man who loses sexual interest in or desire for a particular partner may develop erection problems. Anxiety and stress including recent major life changes (birth of child, retirement, job change, loss or death of partner, divorce, marriage). Low self-esteem. Erection problems in men under 50 are more likely to be due to psychological causes.
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How Is Impotence Diagnosed?
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Determining the cause of erection problems is often the key to reversing them. Since both physical and psychological factors are often involved, it can be complicated to make an exact diagnosis. As part of the initial evaluation, your doctor may do the following:
Patient History He may ask about your sex life, diseases you’ve had and drugs prescribed to you. Medical and sexual histories help define the degree and nature of impotence and to review risk factors. A medical history can disclose diseases that lead to impotence. A simple recounting of sexual activity might distinguish between problems with erection, ejaculation, orgasm, or sexual desire. A history of using certain prescription drugs or illegal drugs can suggest a chemical cause. Drug effects account for 25 percent of cases of impotence. Cutting back on or substituting certain medications often can alleviate the problem. Physical Examination A complete physical exam (including the abdomen, penis, prostate, rectum, and testicles) that can give clues for systemic problems. For example, if the penis does not respond as expected to certain touching, a problem in the nervous system may be a cause. Abnormal secondary sex characteristics, such as hair pattern, can point to hormonal problems, which would mean the endocrine system is involved. A circulatory problem might be indicated by, for example, an aneurysm in the abdomen. And unusual characteristics of the penis itself could suggest the root of the impotence - for example, bending of the penis during erection could be the result of Peyronie's disease.
Laboratory Test Several laboratory tests can help diagnose impotence. Tests for systemic diseases include blood counts, urine analysis, lipid profile, and measurements of creatinine and liver enzymes. If sexual desire is low, the levels of testosterone in the blood may be measured to determine if there are any endocrine abnormalities.
Other Test Nocturnal penile tumescence testing. This test, which monitors if you have erections while asleep, can often help to determine whether the cause is predominantly psychological or physical. Physically healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then the cause of impotence is likely to be physical rather than psychological. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results.
Psychosocial Examination A psychosocial examination, using an interview and questionnaire, reveals chological factors. The man's sexual partner also may be interviewed to determine expectations and perceptions encountered during sexual intercourse.
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Determining the cause of erection problems is often the key to reversing them. Since both physical and psychological factors are often involved, it can be complicated to make an exact diagnosis. As part of the initial evaluation, your doctor may do the following:
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When to seek Help?
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Seek help if erection problems occur with: Any type of injury to the back, legs, buttocks, groin, penis, or testicles. A loss of pubic or armpit hair and breast enlargement. See a health professional within a week or two if erection problems occur more than 25% of the time and the problem. Occurs with a persistent backache. Occurs after you start taking a new medication or change your dosage. Affects your self-image or sense of well-being. Has not improved despite self-care. Watch and wait if you’ve had a single episode of an erection problem. It could be a temporary, easily reversible problem. Do not expect it to recur. If possible, forget about it and anticipate a more successful experience next time. Discuss the problem and fears or anxieties with your partner. However, if you are having persistent, bothersome erection problems, seek help. Men wait an average of five years before seeking treatment for erection problems, and this is unnecessary. Seek medical care immediately if an erection lasts longer than four hours after you use an erection-producing medication. This problem, called priapism can cause permanent damage to your penis.
Psychotherapy Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient's partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated.
Drug Therapy Drugs for treating impotence can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration approved sildenafil citrate as the first oral pill to treat impotence. Taken 1 hour before sexual activity, sildenafil works by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation, allowing increased blood flow. While sildenafil improves the response to sexual stimulation, it does not trigger an automatic erection as injection drugs do. Oral testosterone can reduce impotence in some men with low levels of natural testosterone. Patients also have claimed effectiveness of other oral drugs-including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone. Many men gain potency by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marked as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection and scarring. Nitro-glycerine, a muscle relaxant, sometimes can enhance erection when rubbed on the surface of the penis. A system for inserting a pellet of alprostadil into the urethra is marketed as MUSE. The system uses a pre-filled applicator to deliver the pellet about an inch deep into the urethra at the tip of the penis. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects of the preparation are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness of the penis due to increased blood flow; and minor urethral bleeding or spotting.
Vacuum Devices Mechanical vacuum devices cause erection by creating a partial vacuum around the penis, which draws blood into the penis, engorging it and expanding it. The devices have three components: a plastic cylinder, in 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 by preventing blood from flowing back into the body.
Surgery Surgery usually has one of three goals: To implant a device that can cause the penis to become erect. To reconstruct arteries to increase flow of blood to the penis. To block off veins that allow blood to leak from the penile tissues. Implanted devices, known as prostheses, can restore erection in many men with impotence. Possible problems with implants include mechanical breakdown and infection. Mechanical breakdown and infection. Mechanical problems have diminished in recent years because of technological advances.
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Seek help if erection problems occur with: Any type of injury to the back, legs, buttocks, groin, penis, or testicles. A loss of pubic or armpit hair and breast enlargement. See a health professional within a week or two if erection problems occur more than 25% of the time and the problem. Occurs with a persistent backache. Occurs after you start taking a new medication or change your dosage. Affects your self-image or sense of well-being. Has not improved despite self-care. Watch and wait if you’ve had a single episode of an erection problem. It could be a temporary, easily reversible problem. Do not expect it to recur. If possible, forget about it and anticipate a more successful experience next time. Discuss the problem and fears or anxieties with your partner. However, if you are having persistent, bothersome erection problems, seek help. Men wait an average of five years before seeking treatment for erection problems, and this is unnecessary. Seek medical care immediately if an erection lasts longer than four hours after you use an erection-producing medication. This problem, called priapism can cause permanent damage to your penis.
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Is Smoking linked to impotence?
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Smoking can sap the sizzle out of your sex life. Men who smoke more than a pack of cigarettes a day had a 60 percent higher risk of impotence than those who never smoked, according to new research. The Tulane University study, presented March 7 at an American Heart Association conference in Miami, focused on 4 764 men involved in a national health survey conducted in China.
Dr Jiang He, the lead researcher, says most people know smoking causes cancer and cardiovascular disease. "But very few people know smoking is also harmful for the sex life," He adds. "Hopefully, our study will remind people smoking is not only bad for the heart and lungs, but also bad for your sex life. This study should provide an additional reason to stop smoking." He, a professor of epidemiology and medicine at the US Tulane University School of Public Health and Tropical Medicine, notes that other studies have documented links between smoking and impotence, or ED, But unlike some other research, the Tulane study adjusted figures to take into account other factors that could contribute to impotence, such as blood pressure, diabetes, cholesterol levels and age. "After it was adjusted for all of those important risk factors, cigarette smoking was still very strongly associated with ED," He says.
The study found the likelihood of impotence was lower in men who smoked fewer cigarettes, but still much higher than that of non-smokers. After accounting for possible causes other than smoking, current smokers had a 31 percent overall higher risk of impotence than men who had never smoked, the study says. Men who smoked fewer than 10 cigarettes a day had a 16 percent higher risk of impotence, compared with those who never smoked, the study found. Those who smoked 11 to 20 cigarettes daily had a 36 percent higher risk, and those who smoked more than 20, a 60 percent higher risk. The men averaged 47 years old, and all of them reported having sexual relations within the previous six months. The researchers looked at impotence during that time. He notes that impotence is often linked to arteriosclerosis, the build-up of plague that can reduce blood flow in arteries.
Dr John Spangler, an associate professor of family and community medicine at Wake Forest University School of Medicine, USA, says the new study reinforces the message that smoking isn't good for your sex life. "I don't know whether men out there really understand that very well," adds Spangler, who has studied links between smoking, high blood pressure and impotence. "It is a wonderful teaching moment if you say, 'you know if you smoke, that greatly increases your risk of ED.' That's a powerful motive for him to quit," Spangler says. Smoking, he says, can cause clogging of the arteries in the pelvis area and reduce blood flow to the genitals, which in turn cuts blood flow to the penis, causing impotence. In a 2001 study, Spangler found that men who smoke and have high blood pressure are 26 more times likely to be impotent than non-smokers. Former smokers with high blood pressure were 11 times more likely to suffer impotence than non-smokers, the study of 59 men also found. Research from the human laboratory confirms clinical observation: one study showed erotic films to men aged 18 to 44 years, and measured the diameter of their penises. Smoking two high-nicotine cigarettes in immediate succession significantly decreased the rate of penile diameter change.
It is not just the diameter - new research shows that smokers, on average, have shorter erect penises than comparable non-smokers. Impotence is now emerging as a possible early warning of heart disease developing about a decade later. The same process of narrowing arteries by which smoking causes heart disease and stroke is responsible for impotence. In a sense, the penis is like a canary in a coal mine. Because it is more sensitive to the effects of tobacco, it can provide a warning before more serious - if not fatal - consequences occur. Men's erection difficulties can be a very real problem for women too. Women often reach their sexual peak at a later age than men do, by which time the cumulative effects of smoking can have started to affect their men's ability to get or maintain an erection. This can cause distress, and problems within a relationship. A 1998 study reported in the journal Psychosomatic Medicine says just as the penis depends on good circulation, so does the clitoris. Preliminary studies show that female smokers are just as likely to have sexual problems as male smokers as they get older.
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Smoking can sap the sizzle out of your sex life. Men who smoke more than a pack of cigarettes a day had a 60 percent higher risk of impotence than those who never smoked, according to new research. The Tulane University study, presented March 7 at an American Heart Association conference in Miami, focused on 4 764 men involved in a national health survey conducted in China.
