Erectile dysfunction, or ED, can refer to a total inability to achieve erection, firm enough for sexual intercourse, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining ED and estimating its incidence difficult. In older men, ED usually has an underlying physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED. Incidence increases with age; about 5 percent of 40-year-old men and between 15 and 25 percent of 65-year-old men experience ED. However, it is not an inevitable part of aging.
ED is treatable, irrespective of the age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatment of ED.
Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence of events includes generation of nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues as well as vasculature in and around the corpora cavernosa. Causes of ED include the following:
The diagnosis of erectile dysfunction (ED) involves the following steps:
Erectile dysfunction (ED) can be treated by employing non-surgical methods and surgical methods. Conservative treatment measures to treat erectile dysfunction are always considered before invasive measures such as surgery.
Some conservative treatment measures include the following:
Lifestyle Changes: For some men, making a few healthy lifestyle changes may solve the problem. Abstinence from smoking, weight loss, and increased physical activity may help some men regain sexual function.
Medication Changes: The next step is cutting back on any drugs with harmful side effects. For example, drugsfor high blood pressure work in different ways. If you think a particular drug is causingproblems with erection, tell your doctor and ask whether you can try a different class of antihypertensive medicine.
Psychotherapy: Experts often treat psychological factors for ED using techniques that decrease the anxietyassociated with intercourse. Such techniques also can helprelieve anxiety when ED from physical causes is being treated.
Drug Therapy: Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. A system for inserting a pellet of alprostadil into the urethra is marketed as MUSE. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra and an erection will begin within 8 to 10 minutes and may last 30 to 60 minutes.
Vacuum Devices: Mechanical vacuum devices cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. 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 by preventing blood from flowing back into the body. One variation of the vacuum device involves a semi rigid rubber sheath that is placed on the penis and remains there after erection is attained and during intercourse.
Surgical Therapy: Surgical Treatment for ED usually has one of three goals:
The most common surgery performed for ED is Penile Implant surgery. Implanted devices, known as prostheses, can restore erection in many men with ED.