What is erectile dysfunction?

Erectile dysfunction (ED, in short) is a problem or condition wherein there is the inability in a man to get and maintain a firm erection of the penis to perform sexual intercourse. It is common with a prevalence that is globally increasing.

In the United States, erectile dysfunction affects 20-30 million American men. Most of these men are over 50 years of age.

In a UK-based study, 32% of British men had difficulty obtaining an erection, 20% with maintaining an erection.

Worldwide, 152 million men suffer from sexual dysfunction.

Also referred to as male impotence or erection failure or male sexual dysfunction, it can also happen on a temporary or short-term basis due to certain passing reasons such as a stressful situation, exhaustion, weakness, or too much alcohol. Removal of these causes will bring your erection back.

It is the development of long-term ED that should cause worry. This usually happens due to a medical condition that interferes with the nerves or the blood circulation that control and maintain an erection.

Such a situation usually arises as you approach your later years. For men in their 50s, the chance of developing long-term ED is only about 4% while after the age of 65 years it rises to 25%. However, you should know that erectile dysfunction can be treated.

Erectile dysfunction usually sets in gradually. However, in some cases, it can develop suddenly. This usually happens due to psychological reasons such as the development of severe mental stress, anxiety, and/or de[ression caused by an unforeseen unfortunate incident. It can also happen abruptly due to trauma to the genital area.

ED should not be confused with other sexual disorders such as a poor sex drive or ejaculation problems. Poor sex drive refers to a poor sexual desire or decreased libido. Ejaculation problems can be premature or delayed ejaculation.

You may have a good sexual desire to have sex with no ejaculation problems but if you suffer from ED, you will have no erection.

How does a male get an erection and orgasm? Pathophysiology

A sensory stimulation due to touch or sight or a mental stimulation due to a thought, or both, causes the brain to release some chemical and send an impulse through the spinal cord.

When a man is sexually aroused either by a visual stimulus, thought, or by touch, a chemical called nitric oxide is released into the bloodstream from the endothelium present in most blood vessels of the brain, skin, lung, heart, and muscle.

This nitric oxide causes the arteries and the muscles of the penis to relax (expand). This leads to more blood flowing into the penis causing it to become erect.

The corpora cavernosa in the penis has two chambers made of spongy muscle tissue. Due to this impulse, the spongy muscle tissue of the corpora cavernosa relax and the two chambers of the corpora cavernosa expand and get filled with blood.

Due to the pressure of the blood, your penis becomes erect. Note here therefore, that an erect penis is a vascular organ filled with blood.

During an orgasm, another set of nerve impulses reach the penis, which stimulate the penis muscles to contract. This causes the blood in the penis to be released into the blood circulation draining it of blood.

Causes and risk factors

It is the stimulation of the brain, release of hormones, emotions, the stimulation of the concerned nerves, muscles, and blood vessels that contribute to an erection.

At times, in some individuals, the process that leads to male erection fails and causes erectile dysfunction.

The function of penile erection fails when there is damage to the body tissues required for a proper erection. These tissues include nerves and arteries that supply the penis and the smooth muscles and fibrous tissue of the penis. Erectile dysfunction in young men can occur due to these causes.

Likewise, emotional stress and mental health problems can cause or worsen erectile dysfunction.

Neurological causes

The process of erectile dysfunction is a neurovascular event. Any disease or condition affecting the brain, spinal cord, cavernous nerves innervating the penis and each corpus cavernosum, and pudendal nerves supplying the external genitalia can induce dysfunction.

Nerve conditions such as diabetic neuropathy and multiple sclerosis give rise to neuritis, due to which the impulses are not properly transmitted by the concerned nerves.

Vascular diseases

As mentioned above, the penis becomes erect due to the blood flow filling the corpora cavernosa in the penis. The erect penis is a vascular organ filled with blood. Therefore, any condition or disease that affects the blood flow to the penis will have an adverse impact on the erection development.

Vascular (relating to blood vessels) diseases affect the natural blood flow through the blood vessels leading to reduced blood flow to the body organs including the penis. Vascular diseases account for ED in 50% to 70% of the people with this condition.

Some common health conditions that are associated with vascular disease and clogged arteries include:

  • Coronary artery disease: One of the first consequences of coronary heart disease is endothelial dysfunction, a condition in which the blood vessels cannot dilate, as they should. Endothelial dysfunction often affects the blood vessels of the penis early on, which leads to improper penile erection.
  • Untreated high blood pressure is a major cause of erection failure. About 50% of men with high blood pressure between the ages of 40 to 80 years suffer from erection failure.
  • Diabetes that is poorly controlled can damage the blood vessels and the nerves including those that supply the penis. This damage is in the form of weakened walls of the blood vessels, their reduced elasticity, which impedes the blood flow to the penis. Damage to the nerves due to diabetes leads to diabetic neuropathy and interferes with their ability to send impulses. Diabetes mellitus is the most common risk factor. Diabetic men are three times more prone to developing ED than men without diabetes.
  • High cholesterol levels lead to the deposits of cholesterol plaques on the inner walls of the arteries causing the lumen of the blood vessels to narrow and reduce blood flow. This is called atherosclerosis. A reduced blood flow to the penis interferes with its erection leading to its dysfunction.
  • Obesity can lead to complications such as hypertension, diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia. Each of these can independently cause erectile failure. Obesity also causes low testosterone levels and a general state of inflammation in the body, both of which can cause erectile dysfunction.
  • Peripheral artery disease (PAD) adversely affects blood flow to the arms, hands, legs, and feet. If blood flow to the penis is reduced due to PAD, it can cause erectile dysfunction.

Certain lifestyle habits

Unhealthy lifestyle habits such as eating junk food, no or very little physical activity, wrong sleeping habits, smoking, drinking excessive alcohol are a cause of many diseases.

They include diabetes, hypertension, atherosclerosis, metabolic syndrome, that lead to poor sexual performance due to reduced sexual drive and erectile dysfunction.

Stress, anxiety, and depression

Mental health problems such as chronic stress, anxiety, and depression can affect our daily routine activities. In men, this can translate into reduce sexual performance and erection failure.

Chronic stress leads to high cortisol hormone levels. Cortisol constricts the blood vessels in the penis thereby reducing blood flow to it. Since penile erection is directly proportionate to the amount of blood flowing into the penis during sexual arousal, the man with stress suffers from erectile dysfunction.

Depression causes your mind to be in a state that shows no interest in anything. In depressed individuals, sex is the last thing of interest, and getting an erection is almost impossible.

High levels of cortisol reduce the secretion of testosterone in the body. This is common in men with mental health issues such as anxiety and depression and who suffer from erectile dysfunction.

Additionally, anxiety and a feeling of guilt or fear of inability to perform sex can cause clouding of the mind, which prevents the brain from sending out the signal or impulse that ultimately leads to an erection of the penis.

Certain medicines

Certain medication that cause erectile dysfunction are those given for

  • Hypertension such as diuretics and beta-blockers,
  • Antidepressants, anti-anxiety drugs, and antiepileptic drugs such as Selective serotonin reuptake inhibitors (SSRIs),  Serotonin-norepinephrine reuptake inhibitors (SNRIs), Benzodiazepines, Antipsychotics, Tricyclic antidepressants (TCAs), Diazepam, Lorazepam, and more
  • Antihistamines (anti-allergy) such as Diphenhydramine, Promethazine
  • Non-steroidal anti-inflammatory drugs such as Naproxen and Indomethacin
  • Peptic ulcer medications such as Cimetidine and Ranitidine
  • Antiarrhythmics such as Disopyramide
  • Muscle relaxants such as Cyclobenzaprine
  • Chemotherapy drugs such as Busulfan and Cyclophosphamide

Surgical trauma

Surgical injury to the concerned nerves or arteries or tissues around the penis during surgery on the prostate or the urinary bladder, can occur and give rise to erection failure.

Chronic alcoholism

Chronic overindulgence in alcohol causes myositis (inflammation of muscles) and neuritis, which results in impotence.  Studies show that men who suffer from alcohol dependence have a 60 to 70 percent enhanced risk of suffering from sexual problems such as erectile dysfunction, premature ejaculation, and loss of sexual desire.

Alcoholism can cause peripheral neuropathy, which can lead to permanent nerve damage. This causes permanent erectile dysfunction or impotence.

It was Shakespeare who once said: “Alcohol provokes the desire, but takes away the performance”.

Old age

Erectile dysfunction can occur at any age but it is more common in men that are older. As you age, testosterone levels decline and so does sexual function.

About 25% of men between the ages of 50 to 59 years started experiencing erection problems. About 40% said they started having problems between age 60 and 69.

Here are the stats for ages of men who suffer from complete erectile dysfunction.

  • 40 years old – 5%
  • 70 years old – 15%

An erectile dysfunction of mild to moderate degree affects approximately 10 percent of men per advancing decade.

For example,

  • about 40% of men complain of erection problems at age 40,
  • about 50% of men in their 50s,
  • 60% of men in their 60s
  • And, nearly 70% of men are affected by ED problems by the time they turn 70 years of age.

However, though the number in comparison to youngsters is small, many seniors continue to enjoy their sex life into their 80s and beyond.

Risk factors

Certain factors increase your risk and make you prone to develop erectile dysfunction. Many patients who suffer from ED harbor a combination of these risk factors, thus worsening the ED further. These risk factors include:

  • diabetes
  • cardiovascular disease
  • spinal cord injury
  • smoking
  • depression
  • atherosclerosis
  • hypertension
  • pelvic surgery
  • pharmacological medications
  • arthritis
  • peripheral vascular disease
  • substance abuse eg. Amphetamines. Barbiturates, Cocaine, Marijuana
  • endocrine abnormalities such as hypogonadism, and hyperprolactinemia
  • peptic ulcer disease

Symptoms

If you suffer from erectile dysfunction, symptoms may present in the following ways depending on the magnitude of the problem:

  • You may be able to get an erection sometimes but not all the time.
  • You may get an erection but may not be able to maintain it long enough to have sexual intercourse.
  • You may not be able to get an erection at all.
  • Your interest to have sex is reduced.

Other symptoms that accompany erectile dysfunction include:

  • Premature ejaculation
  • Delayed ejaculation
  • Anorgasmia is a type of sexual dysfunction in which the man is unable to get an orgasm even after sufficient stimulation.

If these symptoms present only occasionally, the problem is not likely to be serious. Most men face this problem occasionally in their lives.

If the problem slowly gets worse over time, then it is likely due to a physical reason(s) such as obesity, diabetes, hypertension, clogged arteries due to athelosclerosis, etc. This can lead to chronic impotence.

If the erction problem happens during sex while being able to maintain a stiff when masturbating, then it suggests a psychological reason.

If these symptoms have lasted for more than 3 months, you should consult your doctor. ED could be due to an underlying cause, which if treated may cure you of this problem.


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