Erectile dysfunction, sometimes called
"impotence," is the repeated inability to get or keep an erection firm
enough for sexual intercourse. The word "impotence" may also be used to
describe other problems that interfere with sexual intercourse and
reproduction, such as lack of sexual desire and problems with
ejaculation or orgasm. Using the term erectile dysfunction makes it
clear that those other problems are not involved.
Erectile dysfunction, or ED, can be a total
inability to achieve erection, an inconsistent ability to do so, or a
tendency to sustain only brief erections. These variations make
defining ED and estimating its incidence difficult. Estimates range
from 15 million to 30 million, depending on the definition used.
According to the National Ambulatory Medical Care Survey (NAMCS), for
every 1,000 men in the United States, 7.7 physician office visits were
made for ED in 1985. By 1999, that rate had nearly tripled to 22.3. The
increase happened gradually, presumably as treatments such as vacuum
devices and injectable drugs became more widely available and
discussing erectile function became accepted. Perhaps the most
publicized advance was the introduction of the oral drug sildenafil
citrate (Viagra) in March 1998. NAMCS data on new drugs show an
estimated 2.6 million mentions of Viagra at physician office visits in
1999, and one-third of those mentions occurred during visits for a
diagnosis other than ED.
In older men, ED usually has a 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. But it is not an inevitable part of aging.
ED is treatable at any 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
treatments for ED. Urologists, who specialize in problems of the
urinary tract, have traditionally treated ED; however, urologists
accounted for only 25 percent of Viagra mentions in 1999.
How does an erection occur?
The penis contains two chambers called the
corpora cavernosa, which run the length of the organ (see figure 1). A
spongy tissue fills the chambers. The corpora cavernosa are surrounded
by a membrane, called the tunica albuginea. The spongy tissue contains
smooth muscles, fibrous tissues, spaces, veins, and arteries. The
urethra, which is the channel for urine and ejaculate, runs along the
underside of the corpora cavernosa and is surrounded by the corpus
spongiosum.
Erection begins with sensory or mental
stimulation, or both. Impulses from the brain and local nerves cause
the muscles of the corpora cavernosa to relax, allowing blood to flow
in and fill the spaces. The blood creates pressure in the corpora
cavernosa, making the penis expand. The tunica albuginea helps trap the
blood in the corpora cavernosa, thereby sustaining erection. When
muscles in the penis contract to stop the inflow of blood and open
outflow channels, erection is reversed.
What causes erectile dysfunction (ED)?
Since an erection requires a precise
sequence of events, ED can occur when any of the events is disrupted.
The sequence includes nerve impulses in the brain, spinal column, and
area around the penis, and response in muscles, fibrous tissues, veins,
and arteries in and near the corpora cavernosa.
Damage to nerves, arteries, smooth muscles,
and fibrous tissues, often as a result of disease, is the most common
cause of ED. Diseases—such as diabetes, kidney disease, chronic
alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and
neurologic disease—account for about 70 percent of ED cases. Between 35
and 50 percent of men with diabetes experience ED.
Lifestyle choices that contribute to heart
disease and vascular problems also raise the risk of erectile
dysfunction. Smoking, being overweight, and avoiding exercise are
possible causes of ED.
Also, surgery (especially radical prostate
and bladder surgery for cancer) can injure nerves and arteries near the
penis, causing ED. Injury to the penis, spinal cord, prostate, bladder,
and pelvis can lead to ED by harming nerves, smooth muscles, arteries,
and fibrous tissues of the corpora cavernosa.
In addition, many common medicines—blood
pressure drugs, antihistamines, antidepressants, tranquilizers,
appetite suppressants, and cimetidine (an ulcer drug)—can produce ED as
a side effect.
Experts believe that psychological factors
such as stress, anxiety, guilt, depression, low self-esteem, and fear
of sexual failure cause 10 to 20 percent of ED cases. Men with a
physical cause for ED frequently experience the same sort of
psychological reactions (stress, anxiety, guilt, depression). Other
possible causes are smoking, which affects blood flow in veins and
arteries, and hormonal abnormalities, such as not enough testosterone.
How is ED diagnosed?
Patient History
Medical and sexual histories help define the degree and nature of ED. A
medical history can disclose diseases that lead to ED, while a simple
recounting of sexual activity might distinguish among problems with
sexual desire, erection, ejaculation, or orgasm.
Using certain prescription or illegal drugs
can suggest a chemical cause, since drug effects account for 25 percent
of ED cases. Cutting back on or substituting certain medications can
often alleviate the problem.
Physical Examination
A physical examination can give clues to systemic problems. For
example, if the penis is not sensitive to touching, a problem in the
nervous system may be the cause. Abnormal secondary sex
characteristics, such as hair pattern or breast enlargement, can point
to hormonal problems, which would mean that the endocrine system is
involved. The examiner might discover a circulatory problem by
observing decreased pulses in the wrist or ankles. And unusual
characteristics of the penis itself could suggest the source of the
problem—for example, a penis that bends or curves when erect could be
the result of Peyronie's disease.
Laboratory Tests
Several laboratory tests can help diagnose ED. Tests for systemic
diseases include blood counts, urinalysis, lipid profile, and
measurements of creatinine and liver enzymes. Measuring the amount of
free testosterone in the blood can yield information about problems
with the endocrine system and is indicated especially in patients with
decreased sexual desire.
Other Tests
Monitoring erections that occur during sleep (nocturnal penile
tumescence) can help rule out certain psychological causes of ED.
Healthy men have involuntary erections during sleep. If nocturnal
erections do not occur, then ED is likely to have a physical rather
than psychological cause. Tests of nocturnal erections are not
completely reliable, however. Scientists have not standardized such
tests and have not determined when they should be applied for best
results.
Psychosocial Examination
A psychosocial examination, using an interview and a questionnaire,
reveals psychological factors. A man's sexual partner may also be
interviewed to determine expectations and perceptions during sexual
intercourse.
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Horny Goat Weed – Herbal Plant That Would Make You Horny?
Behind the funny name of horny goat weed stands a time-tested aphrodisiac
that increases libido in men and women, and improves erectile function in men.
Known also as Epimedium or Yin Yang Huo...
Horny Goat Weed (Epimedium sp.) has a two thousand year history of use as a
sex-enhancer. Behind the funny name of horny goat weed stands a time-tested
aphrodisiac that increases libido in men and women, and improves erectile
function in men. Known also as Epimedium or Yin Yang Huo, horny goat weed was
first described in ancient classical Chinese medicinal texts. Today, horny goat
weed holds an important place in Traditional Chinese Medicine and is gaining
popularity around the world as it becomes incorporated in Western medicine.
The leaves of Horny Goat Weed contain a variety of flavonoids,
polysaccharides, lignans, sesquiterpenes, phenolic and penethylol glycosides,
ionones, sterols, and an alkaloid called magnaflorine. Used by practitioners for
over 2,000 years, horny goat weed is several species of epimedium, a leafy plant
which grows in the wild, most abundantly at higher altitudes. And while the
exact way that horny goat weed works is still being researched, the plant has
long been employed to restore sexual fire, boost erectile function, allay
fatigue and alleviate menopausal discomfort.
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