Erectile dysfunction (ED) is a fairly common condition affecting men worldwide. Though the term ED covers a wide range of disorders, it commonly refers to having trouble getting or maintaining an erection. ED is not uncommon and its incidence increases with progressive age. It was formerly called impotence and its incidence increases in ages above 65.
Persistent ED has a significant impact on the man's self-image as well as on his partner's sex-life. Indeed for many men & their partner this can be a frustrating problem as the penis is unable to become sufficiently rigid and performing intercourse may seem impossible.
Most often the symptoms of erectile dysfunction are:
Inability to achieve an erection or maintaining it to complete the act of sexual intercourse
Complete inability to achieve an erection.
Though once considered a taboo, more men are now seeking information regarding ED as well as volunteering to share valuable information about it. Current estimates state that Chronic ED affects about 5% of men in their 40s and 15-25% of men by the age of 65. Transient ED and inadequate erection affect as many as 50% of men between the ages of 40 and 70.
To understand ED, it is essential to understand the normal process of achieving an erection. The anatomy of the penis is worth understanding in this aspect.
Anatomy of penis
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.
Causes of Erectile Dysfunction:
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.
The most common cause of erectile dysfunction is damage to the tissues, either the nerves, arteries, muscles or fibrous tissue.
Conditions such as
Underactive thyroid disorder
Arterial Disorders (peripheral vascular disease, hypertension; reduced blood flow to the penis). Cardiovascular disease
Other factors to be thought of are:
Neurogenic Disorders (spinal cord and brain injuries, nerve disorders such as Parkinson's disease, Alzheimer's disease, multiple sclerosis, and stroke.)
Damage to the nerves and arteries near the penis during surgery, particularly for prostate and bladder cancer.
Physical injury to the penis, spinal cord, prostate, bladder or pelvis.
Common medications, including blood pressure drugs, antihistamiines, antidepressants and tranquilizers can precipitate erectile dysfunction.
Psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause up to 20% of cases.
Lifestyle: alcohol, drugs and smoking.
Illness of the tissue of the penis itself (cavernosal disorders)
Hormonal Disorders (pituitary gland tumor; low level of the hormone testosterone).
Diagnosis of Erectile dysfunction
Erectile dysfunction has many predisposing factors. One of the basic aims of diagnosing this condition is to acertain whether the undrelying cause of ED stems from psychological factors or whether there are indeed any physiological causes. More often both these factors co-exsist in the same person.
A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection.
If never, the problem is likely to be physiological; if sometimes (however rarely), it could be physiological or psychological.
Clinical Tests Used to Diagnose ED
AThere are no tests per se which diagnose erectile dysfunction. Many laboratory investigations are conducted to primarily rule out conditions like diabetes, arterial diseases [disorders of blood vessels supplying the heart (Coronary Aretery Disease), increased lipid(fats) in bloodstream, disorders of peripheral blood vessels etc.]
AYet, other tests are performed to measure the severity of erectile dysfunction. These tests also provide an insight to the possible cauuse of ED. Some of these tests have been outlined:
Duplex ultrasound: A chemical which induces an erection (prostaglandin) is injected in the penis. Once an erection is achieved the ultrasound is used to study the degree of dilatation of the penis as well as to measure the blood pressure within the organ. This test identifies any structural or functional inadequacy within the penis.
Penile nerve function:> the physician squeezes the head (glans) of the penis. This generally causes simultaneous contraction of the musclea of the anus. The time period between the stimulus and contraction is a good indicator of the activity of the nerves supplyin the penis. Certain conditions like diabetes, and many nerve diseases causing ED can be the cause of an abnormal penile nerve function.
Nocturnal penile tumescence (NPT): Commonly a man can have five to six erections in the night during sleep (REM phase). Thus, ther absence indicates trouble with the blood supply, the nerve functions or with both. This study concentrates on studing the rigidity of the penis, by recording the circumferance. However, this test can often give ambiguous results since, with some men, it is normal to not have as many erections.
Penile Biothesiometry: This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis. A decreased perception of vibration may indicate nerve damage in the pelvic area, which can lead to impotence.
Dynamic Infusion Cavernosometry: (Abbreviated DICC),it gives a measurement of the vascular pressure in the corpus cavernosum during an erection. Fluid is pumped into the penis at a known rate and pressure.. To do this test prostaglandin E-1, which causes dilatation of the blood vessels, is injected to measure the rate of infusion required to get a rigid erection and to help find how severe the venous leak is.
Other similar tests one may hear of are:
Digital Subtraction Angiography
Magnetic resonance angiography (MRA)
Treatment of Erectile dysfunction
Due to the sensitive nature of this condition, the conventional modes of treatment give a lot of emphasis to
Daily exercises; these increase blood flow to all parts of the body, increase levels of male hormones, increases levels of certain neurohormones which are mood elevators.
When psychotherapy fails to bolster the person's self-image interventional modes are applied.
Vacuum devices - these work by drawing blood into the penis. It must be used just before intercourse.
Surgery - as a last measure when all other methods fail to better ED. Prosthetic implants (artificial rods) are inserted into the penis and allowed to remain there. However, these are very expensive and also irreversible.
All treatments aim at helping the individual achieve an erection and maintaining it long enough to perform intercourse. However, no treatment can provide a permanent cure for this condition.
Homeopathic Treatment for Erectile Dysfunction
Homeopathy offers remarkable results in the cases of Erectile Dysfunction, which may have arisen from both physical and psychological causes. Both, the mental as well as physical component of the disorder can be addressed using homeopathic treatment.Homeopathy is strongly recommended for the treatment of Erectile Dysfunctions.