Erectile dysfunction

Simply stated, normal male sexual function can be divided into five events, each of which is under diverse regulation: libido, erection, ejaculation, orgasm, and detu-mescence.

The first, sexual desire or libido, is regulated by psychic factors and by testicular androgens. Castration produces a decline in libido that can be restored by treatment with testosterone.

The second phase, erection, is primarily a neurologic event that results in modification of the vascular supply to the penis, causing it to become engorged with blood. The neurologic aspect of erection is controlled by both reflex and psychic stimuli. The sensory portion begins with fibers that originate in pacinian corpuscles of the penis and pass via the pudendal nerve to the S2-S4 dorsal root .ganglia. The efferent limb begins with parasympathetic preganglionic fibers from S2-S4 which synapse in the perivesicular, prostatic, and cavernous plexuses. From there, postganglionic fibers pass to blood vessels of the corpora cavernosa. Efferent fibers from S3-S4 also travel in the pudendal nerve to the ischiocavernosus and bulbocav-ernosus muscles. Sympathetic innervation of the male genitalia originates in fibers from the lateral columns of T12 and LI, the so-called thoracolumbar erection center, that synapse in the pelvic and perivesicular plexuses. Postganglionic fibers innervate the smooth muscle of the vas deferens, seminal vesicle, and internal sphincter of the bladder. Sympathetic innervation can act synergistically with the sacral parasympathetics to mediate erection initiated by psychic stimuli but is not mandatory for erection, because most men have normal potency after bilateral complete sympathectomy. The central nervous system modulates erectile response via pathways thought to descend in the lateral columns of the spinal cord. The effect of the central nervous system on erection can either be stimulatory or inhibitory, thus the importance of psychic factors for erection.

While erection is controlled by the parasympathetic nervous system, the transformation of the penis from a flaccid to an erect state is a vascular phenomenon. Blood reaches the penis via terminal branches of the right and left internal pudendal arteries. The erectile tissue of the penis consists of two corpora cavernosa lying side by side on the dorsal aspect of the penis and the corpus spongiosum that surrounds the urethra. This erectile tissue consists of an irregular spongelike system of vascular spaces interspersed between arteries and veins.

Erection is initiated by a decrease in arterial resistance resulting in increased arterial blood flow with a subsequent decrease in venous outflow. The neurotransmitter responsible for these events has not been identified, but vascular or cavernosal smooth muscle relaxation may result from mediation by beta-adrenergic, cholinergic, or vasoactive intestinal polypeptide (VIP) mechanisms. Furthermore, alpha-adrenergic antagonists can cause increased blood flow to the corpus and hence erection.

The third phase, ejaculation, is under control of the sympathetic nervous system and consists of two processes, seminal emission and true ejaculation. Emission results from the contraction of the vas deferens, prostate, and seminal vesicles which causes seminal fluid to enter the urethra. True ejaculation results from contraction of the muscles of the pelvic floor including the bulbocavernosus and ischiocavernosus muscles. Retrograde ejaculation into the bladder is prevented by partial bladder neck closure mediated by the sympathetic nerves.

The fourth phase, orgasm, is a cortical sensory phenomenon in which the rhythmic contraction of the bulbocavernosus and ischiocavernosus muscles is perceived as pleasurable. It is purely psychic. The fact that orgasm can occur without either erection, ejaculation, or bladder neck closure explains why some drugs that prevent erection or ejaculation do not interfere with orgasm.

Detumescence after orgasm and ejaculation may be the result of vasoconstriction of the arterioles supplying blood to the erectile tissue, thus allowing venous drainage to empty the sinuses and the penis to become flaccid. Following orgasm, there is a refractory period that varies with age, physical condition, and psychic factors during which erection and ejaculation are inhibited.

What do you understand by Erectile Dysfunction (ED)?

Erectile dysfunction, also known as impotence, is the inability of a man to maintain or achieve erection of the penis so as to satisfy his sexual partner. This erectile dysfunction can lead to an unsatisfactory sexual life causing problems amongst others like:

• Depression
• Anxiety
• Low self esteem
• Embarrassment
• Problems in the Relationship

Erectile dysfunction is a condition which causes male infertility where a man is not able to impregnate and thus satisfy his partner. Erectile dysfunction is caused as a result of some underlying medical problems like:

• Alcoholism or some form of drug abuse
• Hypogonadism or low levels of testosterone
• Cardiovascular disease
• Diabetes
• Neurological diseases
• Obesity
• Smoking history

And for treating erectile dysfunction, oral medications are required to be taken. Eectile dysfunction tends to affect between 7 to 52 % men, and it entirely depends on age. People above 60 years of age have more than 50 % chance of experiencing erectile dysfunction. However, the number is low to upto 10 % in case of men below 60 years of age.

Symptoms of Impotence/ Erectile Dysfunction

The occasional inability for one in getting an erection is normal. However, when one of the following happens, and happens frequently, it is known as impotence:

• Difficulty in getting an erection
• Difficulty in keeping the erection
• Reduced desire to have sex

Causes of impotence/ Erectile Dysfunction

There are many things which go together in getting and erection and keep it. It involves psychological and physical factors and the causes for impotence might amongst other include:

• Atherosclerosis (a condition which involves narrowing or hardening of arteries)
• High cholesterol levels
• High blood pressure levels
• Diabetes
• Obesity
• Parkinson's disease
• Smoking
• Multiple sclerosis
• Substance abuse, which includes alcoholism and drug abuse
• Sleep disorders
• Injury to the spinal cord or the pelvic area
• Metabolic syndrome
• Prescription medicines suggested in case of treatment of enlarged prostate or prostate cancer
• Men suffering from diabetes or some condition of heart
• Men who are over weight or have been consuming a lot of tobacco
• Men taking antihistamines and antidepressants
• Men who would have taken a radiation cancer treatment
• Men suffering from some Injury to the penal area, or to the arteries or nerves that control the erection
• Stress, anxiety, depression

Treatment for Impotence/ Erectile Dysfunction

In order to treat erectile dysfunction, oral medications can be taken. These include:

• Viagra (sildenafil)
• Cialis (tadalafil)
• Levitra (vardenafil)

Though these medicines are safe as such, when taken with some other medicines like nitrates and nitroglycerin, they cause an irreversible drop in the pressure of the blood. The less serious side-effects for the same, include - vision changes, flushing, back pain,headache and upset stomach. Another treatment for erectile dysfunction is the injection of the Caverject into the male organ just before sex. Another treatment which can be used is the testosterone therapy. Some manual devices like pumps and vaccums can be used, though they can cause some amount of damage. Some surgical procedures also can a man undergo, where the penis is implanted with semi rigid rods.

Natural Remedies for treatment of erectile dysfunction

• Losing weight
• Completely quitting smoking
• Managing stress, mental conditions and anxiety
• Exercising

Erectile Dysfunction Therapy

Are you aware of the fact that the major root causes for ED in men are psychological circumstances like common anxiety disorder and depression? Several males opt for medicines but actually it is better to take a therapy for ED.

The therapy used to cure erectile dysfunction shares a similarity with the standard psychological treatment, recommended by a psychologist or psychiatrist. The unique thing due to which the treatment is made specific is the prime focus on the ED treatment and the mental disorder caused by it. Some of the people may also handle medicines differently as sometimes, few medicines can be used for both the type of disorders, while the others may not be compatible with one another. For an instance, SSRIs have been famous to show a very positive impact on anxiety, depression and erectile dysfunctions as well. Some other famous options for the treatment of erectile dysfunction can show very harmful impacts if they are combined with some specific medicines or alcohol.

Other treatment can comprise of physical workout sessions to strengthen and exercise the muscles of the influenced region. Some massage techniques and several other methods are also available which can create a big difference. One famous option is jelging which includes stroking the person which sequentially enhances the length along with the muscle strengthening which leads to ejaculation, and makes the Effects of erectile dysfunction less pronounced. Kegels is a technique which includes contraction and relaxation of the muscles which causes ejaculation. This technique works similar to any working muscle and will lead to a more toned and stronger muscle with time.

Treatment for ED is something which is opted by just 10% of men suffering from the dysfunction. There is no difficulty caused in the treatment and a high success rate is usually seen with this treatment of erectile dysfunction. Now it is high time for you to consult the doctor or a specialist who can trust about the information and respective therapy for the condition.

Sex Therapy for erectile dysfunction is a short-term counseling which usually includes 5-20 sessions with a sex counselor. A characteristic session could be 1 hour each week or alternative weeks.

When the session is performed, the counselor gives ‘assignments’ to the patients for home, like:

• Reading books related to sexuality.
• Practicing good sexual communication abilities.

Generally sex therapy is most efficient if the sexual partner of the man is eager to be a part of the therapy. Sex therapy could help in the treatment of ED in males if he is capable of having standard erection while sleeping, the physical exam results and blood tests are standard, and he is usually in a good health condition. Sex therapy may also prove to be helpful if stress is the cause of ED which results because of financial worries, work pressure, relationship issues and bad sexual communication. In such cases, sex therapy may be considered as the ideal method for the treatment of erectile dysfunction in men.

Can erectile dysfunction in men be treated using heart stents?

Getting an erection is a natural process in case of most men. They do not need to apply any special effort for the purpose of getting some erection. Though it should be noted that some men don’t get the required penile erection that can help them pleasure their partner, and this condition in men is known as sexual erectile dysfunction. A number of emotional & physical factors go into the process of getting & maintaining an erection, such that it is long enough, to sexually satisfy your partners while you have a sexual intercourse. Erectile dysfunction is the case when one of the factors does not function in the way it should ideally function.

A penile erection is the result of sexual stimulation which might be caused due to seeing something exciting or the rubbing & touching of the penis. In order to bring about stimulation, the brain sends a signal though the system such that the muscles are relaxed and blood is released in the micro veins present in the penis. And while this happens, testosterone is also released which gives men the libido. When this entire system works together in balance, a sexual stimulation is achieved and this causes the penile to gain an erection. If there is any problems with the muscle or some problem in the veins where the blood flows, or some psychological problem where the brain does not work in tandem with the muscles, erectile dysfunction can be experienced.

For the treatment of erectile dysfunction, one can either use medicinal gels or creams or they can use tablets like the Viagra. Some surgeons have now started thinking of using tools like the stents to widen the arteries which lead upto the penis in order to ensure the flow of blood, such that the problem of erectile dysfunction can be treated.

It has been observed that around 70 % of men who suffer from erectile dysfunction (impotence) have some or the other form of arterial blockage (atherosclerosis) that actually restricts their flow of the blood to their penis. According to doctors, with the help of stents, the blood flow would be better, and men can again enjoy their erection. Due to the issue of blood not reaching the right place, men face the issue of impotence. In the case of this stent treatment, when the cause of erectile dysfunction is identified the first step which the patient needs to take is to get an angiogram done for the pelvis area to identify the blockage. Once the blockage is identified, the stent can be inserted in the artery which is affected. This procedure is quick and takes less than an hour and since the stent is inserted in the pelvis area, patients can indulge in sex on the very same day of the treatment.

Though this treatment has its plusses, it is a costly affair. Also, not all the patients can benefit from this treatment. Sure this is a step in the right direction, but how much of an acceptance would this have is a answer to be seen!