Erectile dysfunction is inability to achieve and maintain erection sufficient for sexual intercourse performance – one of the most common sexual disorders among men.
Most often failures in sexual sphere men call impotence. However, this is not entirely correct, the word «impotence» is not used by doctors nowadays.
The term «erectile dysfunction» was proposed by US National Institute of Health instead of «impotence». In 1992, it was approved by international urology and andrology organizations. Broadly speaking erectile dysfunction includes not only inability to hold penis in erected state, but also orgasm such disorders as decreased libido – sexual attraction.
According to World Health Organization (WHO), worldwide one men out of ten over 21 years old complains on impotence. And at the age of 40 – 70 years erection disorders according to statistics appear at about 50% of men.
It is considered that over time this figure will increase and during the next 25 years it can double – it is influenced by spread of cardiovascular diseases, diabetes and general population aging in developed countries.
It is believed that erectile dysfunction is elderly men problem. But it also happens that problems in the sexual sphere appear at young and adult men. The most common cause is fatigue, physical illness, psychological problems. In this case, it is important to not be shy and promptly seek for medical attention.
There is primary and secondary erectile dysfunction. Primary (congenital) is characterized by the fact that a man never in his life could perform intercourse. This is extremely rare. Secondary is the most common, when for some period of time everything was fine in sexual life of a man, and then there appeared problems with erection.
Most often men complain on weak erection, which does not allow performing sexual intercourse. Sometimes there is a sufficiently strong erection, but when you try to come to contact with partner, it quickly disappears.
Who Faces Erectile Dysfunction and How?
Several mechanisms are responsible for erection appearance. Firstly, reflex erection at direct contact with penis. Secondly, erotic stimulation, which acts through brain and nervous system. Further – circulatory system.
As it is known, penis consists of two cavernous and one spongy bodies. Moreover, each of them has separate vascular system, not connected to each other. Each penis body is supplied with blood through its arteries, and blood outflows through separate veins.
In their structure penis bodies remind a sponge – they contain many small cavities- lacunas (Latin – «caverns»). It is this structure that allows erection.
At sexually excitement arteries that bring blood to cavernous and spongy bodies, strongly expand. Veins which carry out blood outflow sharply narrowed. As a result, penis cavities accumulated significant amount of blood, there appear tension and erection.
This state of vessels remains throughout the whole period of erection. During all this time penis tissues, except skin, do not receive new portions of blood and are in a state of ischemia. Therefore, prolonged intercourse can lead to certain health problems.
Erectile dysfunction can be caused by physiological disorders – then we speak about organic form of the disease.
Causes of organic erectile dysfunction:
- endocrine disorders (hypogonadism, pituitary tumor, etc.);
- drug therapy side effects;
- local changes in penile tissues;
- neurological disorders (epilepsy, Parkinson’s disease, multiple sclerosis, trauma and surgery on brain and spinal cord, small pelvis and perineum);
- cardiovascular system diseases (hypertension, atherosclerosis), blood outflow disorders;
- chronic prostatitis.
Endocrine causes of erectile dysfunction include first of all hypogonadism – lack of sex glands activity and testosterone male hormone low production. In addition to erectile dysfunction a man faces other signs of low testosterone level: change in voice tone to a higher, slowing or stopping of hair growth on face and body, fat accumulation in breasts, hips, buttocks. But such changes are evident at severe violations of hormonal system, it is better to consult a doctor before this happens.
Another possible cause of erection problems can be pituitary tumor. This most important endocrine glands of human body is located in brain. If pituitary gland secretes hormone called prolactin – persistent erectile dysfunction appears. For pituitary tumors diagnosis there conducted computer brain tomography. And, as in the case of any endocrine disorder, hormonal status investigated as a whole.
Side effects of drug therapy is seen in adverse impact of certain drugs on erection. Such drugs are often prescribed only for severe diseases (prostate cancer), when it comes to human life. Also erection is weakened by all substances with depressing effect on cerebral cortex, including alcohol, narcotic drugs. Despite the fact that short-term effect may shows otherwise, at prolonged and frequent use of such substances every man is at risk of erection problems.
There are other drugs that have negative effect on erection, including many antihistamines. This effect is explained by their property to block peripheral nerves. Therefore, many of medicinal products are not recommended to take more than for a specified period.
Local changes in penile tissues lead to penis cavernous bodies sclerosis. At the same time delicate and elastic cavernous bodies’ tissue is partially or completely replaced by a rough solid connective tissue. It is not able to stretch and cause erection.
The reason for such sclerosis may be injury, multiple injections into penis, priapism (painful and prolonged erection, not associated with sexual excitement). As it was mentioned, during erection penis cells do not get enough blood supply. So erection lasting for many hours in case of priapism leads to dangerous changes in penile tissues. Prolonged sexual intercourses, lasting more than 4 hours, are also dangerous.
In expressed penile cavernous tissues sclerosis prognosis is unfavorable. Only penile implantation can help in this situation.
Neurological causes of erectile problems are epilepsy, Parkinson’s disease, trauma and surgery on brain and spinal cord, small pelvis and perineal. Most often in these cases not problems with erection are more important, but a question of human life. But during recovery period after surgery sudden erectile dysfunction can be a very unpleasant event for men.
Since erection is directly related to penis circulatory system, it is affected by any violations of blood outflow. With insufficient arterial blood flow erection appears long and slowly, rarely quality – penis is in «intermediate» state between rest and excitement.
Reverse reason is also possible: too rapid venous blood outflow. In this case, excitement comes quickly, erection can be quality, but fast and quickly disappears – not allowing completing and sometimes beginning sexual intercourse.
These vascular disorders may develop in case of endarteritis, aortic and large arteries atherosclerosis, aortic aneurysm, varicosity and other problems of cardiovascular system.
Men suffering from hypertension, atherosclerosis and diabetes are especially at risk. They have erection problems occurring most often. Vascular and neurological changes also have effect, and often drugs reception consequences.
Erectile dysfunction can be accompanied with chronic prostatitis – nerve endings responsible for erection occurrence pass through prostate gland itself. And with inflammatory process development they are also affected. To restore erectile function it is necessary to cure chronic prostatitis, or at least to achieve stable remission stage.
Erectile dysfunction of psychogenic origin stands out separately and this is the most common variety of this disorders type. Problems in sexual sphere in this case are caused solely by psychological state. Depression, severe fatigue, stress, general poor health, dissatisfaction with oneself or partner, conflict situations can cause erectile dysfunction.
Often erection does not occur in cases when a man finds environment not suitable enough for sex (parents’ home, unlocked door to the room, need to have sexual intercourse as quiet as possible so as not to awake children and so on).
Psychological causes also underlie selective erectile dysfunction. The so-called inability of having sexual intercourse with one partner, at constant success with others. Simply saying, a man is faced with lack or poor quality of erection during sex with his wife, but with his lovers such problems do not occur. Rarely, but there are also reverse situations.
A special type of erectile dysfunction – the so-called syndrome of first date. Erection problems arise only during first contact with partner, but in future everything is fine. The reason is that excitation of a man is so great that by the time it comes to sexual intercourse body is already tired of it – and erection disappears. In this case it is especially important correct partner’s behavior.
Psychological reasons also cause erectile dysfunction during sexual intercourse with condom. Contrary to popular belief, not always condom is acceptable – it also happens that it is not compatible with normal erection. As a rule, solution is quite simple, it is just necessary to choose another method of contraception.
Finally, mental state of man can provoke sexual dysfunction. One random failure in sex causes great excitement before intimacy with another partner. As a consequence – excitement interferes with success in future. And the most negative role is played by thoughts about self-deficiency. In this case it is much more useful to distract from problems and forget about it. If the cause is fatigue or agitation, and you are able to remove it – the next time everything will be as it should.
A characteristic feature of psychological erectile dysfunction – preserving erections in early morning hours or during sleep, during masturbation. But at any other time erection emergence and maintenance is difficult. Only complete absence of erection allows talking about organic causes.
How to Determine Erectile Dysfunction?
If a man could not perform sexual intercourse one or more times – it does not mean that we are talking about erectile dysfunction. But if erection problems are observed within 3 – 6 months – doctors diagnose this disorder.
To assess blood flow in penis cavernous bodies ultrasound is used. It allows to determine arterial and venous blood flow amount, to see signs of atherosclerosis, erectile tissue scarring. During examination safe dose of prostaglandin hormone are introduced into the body – it stimulates erection like a natural counterpart. Further, using ultrasound penile vessels are examined.
Functional state of penile nerves is assessed with bulbocavernous reflex testing. Doctor presses penis balanus – normally this should trigger instantaneous anus contraction. If there is a suspicion of nerve damage or its organic changes at diabetes – special tests are conducted.
To assess nerves sensitivity penis biothesiometry is also used – this method uses vibration: decrease in sensitivity to it points to possible nerve damage.
An important feature of preserving erectile function are nocturnal erections. At average, a healthy male erection occurs during night about five or six times. Complete absence of nocturnal erections indicates problem with nerve signals to penis reception or pathological changes in its vascular system.
What can Cause Erectile Dysfunction?
At both organic and psychogenic erectile dysfunction psychological consequences of violations are of great importance. For male psychology it is very important to be able to perform fulfilling sexual life, and problems in this area are often very painful. Not to mention situations when a man wants to have children.
Much depends on woman – mutual understanding, respect and ability not to focus on the problem helps to establish sexual contact. But opposite behavior may lead to worsening of the situation and inability to perform full sexual intercourse.
How to Prevent Erectile Dysfunction?
The most important thing to preserve male sexual health – ability to easily accept possibility of failure in sexual terms. Do not take them close to heart, it is better to forget about it, and then try again without worries and disturbing thoughts. This is primary prevention of erectile problems. Of course, partner’s behavior is equally important.
In presence of psychological problems and expressed erectile problems it is better not to delay visit to competent sexologist.
If you have genital disease – always consult urologist or andrologist about disease impact an erection. And be sure to consult a specialist, if erection for a long time is absent not only when attempting sexual intercourse and masturbation, but also in the morning.
Among general recommendations, experts recommend to keep active lifestyle. Regular exercise activates blood flow and helps to prevent cardiovascular disorders. It is also very important to keep to healthy diet, control of blood pressure and cholesterol levels. Naturally, smoking, alcohol and drugs provoke erectile dysfunction development.
Regular sex life without long periods of abstinence and sexual misconduct is a great means of erectile dysfunction prevention. But just remember that doctors advise to abstain from too long sexual intercourses – more than 4 hours. Even if it does not take much effort, it is dangerous for penile erectile tissues, there is a risk of its sclerosis.
What to Do in Case of Erectile Dysfunction?
In the first place – calm down and analyze possible causes. If it’s fatigue and heavy loads, it is necessary to think about rest and review lifestyle. And best of all not to be shy and consult a doctor to clarify disease causes.
If erectile dysfunction is psychogenic, treatment will involve consulting a psychotherapist and physical therapy techniques. Ideally, treatment should be conducted by sex therapist – psychiatrist specializing in psychosexual disorders treatment.
Erectile dysfunction treatment caused by other diseases (diabetes, cardiovascular system diseases and so on) begins with their correction.
In the course of competent treatment it is not always possible to completely restore erection to the same level. However, in most cases, erection is restored to a level sufficient for sexual intercourse.
There are several specific methods of erectile dysfunction treatment which are prescribed only on individual basis – for example, treatment with local negative pressure. It includes special device with negative pressure reservoir. This pressure leads to erection sufficient for sexual intercourse. This method is painless and can be carried out at home. But not everyone can to use such device, there is a number of contraindications and they need be specified by doctor.
Also there used medications injected directly into penis before sexual intercourse (intracavernous injections). This method allows persistent erection, but only a doctor should choose the drug and evaluate possibility of using this technique. But this method is inconvenient to use – not every man will has moral courage to carry out injection into his own penis. In addition, injection can be carried out not more than once a week and is fraught with a lot of complications, including penile tissue sclerosis.
Intraurethral suppositories are analogue of such technique in action – they are administered 20 minutes before sexual intimacy into urethra. Normally, erection is provided for about 1 hour. The main drawbacks of this method – inconvenience of use and high cost of drugs. At the same time, its efficiency is usually high.
In extreme cases, there is conducted surgical treatment – joint replacement and rapid recovery of blood flow to penis cavernous bodies.
Drug therapy is prescribed only in individual cases, according to indications. Depending on causes of violations there are assigned additional drugs that enhance overall body tone and activate blood circulation in penile blood vessels. Tonic herbs extracts are also useful – ginseng, eleuterococcus, roseroot; antler preparations.
Do not abuse facilities for short-term erection. Their effectiveness, despite popular belief, often leaves much to be desired. And they do not affect erection violations cause.
It is much better to maintain a long-term and planned fight against erectile dysfunction. Healthy lifestyle, sufficient level of physical activity, good nutrition and calm attitude to the problem helps to solve it.
In case of concomitant diseases of genital organs simultaneous treatment at urologist is needed. If erectile dysfunction causes are covered with other pathologies, treatment should begin with their correction. So, diabetes and cardiovascular pathologies frequent consequence manifest in inability to achieve erection. Diseases of male sex gland and external genitalia trauma can also lead to erectile dysfunction.
In most cases, erectile dysfunction is transient and treatable, it is important to establish the cause and follow doctors individual recommendations.
Erectile dysfunction, in contrast with many other diseases and disorders, has a specific feature: sometimes it disappears by itself. Such spontaneous «recovery» often occurs at short-term erection problems – less than three years. Experts believe that this may be associated with stress levels reduction. It is still recommended to timely consult a doctor to exclude serious problems with health and restore it as quickly as possible.