Erectile dysfunction (ED) is also called impotence and simply means the inability of a penis to get an erection or sustain an erection for a sufficient duration of time to complete sexual intercourse. Erections occur from the inflow of blood to the penile tissue until it is engorged and hard. Sometimes, body signals fail, and the penis remains soft or flaccid. While erectile dysfunction is very common in older men, even younger men can experience ED. Medications are the main course of treatment for ED once other medical conditions have been ruled out.
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Written by Dr Kimberly Langdon, MD
Information last reviewed 06/21/19
It takes more than a penis and a willing partner to make an erection. Erectile dysfunction, or the inability to get an erection or sustain one, can be the result of multiple underlying conditions that affect your brain, nerves, heart, hormones, penis, prostate, testicles, and how they interact and depend on each other. That takes a lot of coordination, physically, hormonally, and mentally.
Overall, there are four body systems needed to get and maintain an erection:
Besides the psychological function of the brain which is dependent on neurotransmitters or ‘happy hormones’ such as serotonin, norepinephrine, dopamine, and GABA, the electrical or conduction system known as the nervous system must be fully operational for an erection to occur.
So, it is TRUE that the brain is the largest sexual organ or erogenous zone and directly impacts sexual function--- both desire and performance. Now that we have one basis for understanding about the brain’s role in an erection, the rest of the organs must cooperate as well. It is a complex interplay of timing, reactions, responses, and feedback that result in a fully erect penis.
Let’s start with the normal erectile process which starts with visual, olfactory (smell), and touching sensations that cause the release of neurotransmitters (hormones) and chemicals that cause relaxation of the blood vessels of the penis. Relaxed or dilated blood vessels fill with blood and expand the penile tissue until it is rigid.
The reason the penis stays filled with blood is due to the vessels being compressed to prevent outflow or more inflow. The amount of blood is key and being well-hydrated maximizes blood volume.
The mechanism that underlies ED is blood vessel dysfunction and/or nerve dysfunction.
One serious disorder that can cause ED is diabetes due to the poorly controlled glucose levels in the blood. Glucose is inflammatory to both nerve and blood vessels making the tiny vessels of the penis even more susceptible to damage that may be irreversible.
Healthy nerves are needed to interact with the vessels so damage to both magnifies the effect. High cholesterol, high blood pressure, and smoking can all lead to similar damage to the delicate blood vessels of the penis. Damaged blood vessels mean that they cannot expand and fill with enough blood to create an erection.
Before getting into specific details of an erection, a diagnosis of ED must be based upon the following medical criteria (DSM-5):
Heart attacks, atherosclerosis, blood vessel trauma from excessive bike riding, medications for vascular diseases
Diabetes, Kidney failure, Liver failure, cancer, high blood pressure, autoimmune disease, high cholesterol
Stroke, seizures, multiple sclerosis, Alzheimer’s, Head trauma
Chronic obstructive pulmonary disease, chronic smoking or asthma, sleep apnea
Hypogonadism-low testosterone, elevated or low thyroid levels, diabetes
PTSD, Performance anxiety, Depression
Malnutrition, alcoholism, zinc deficiency, Vitamin D deficiency
Leukemia, sickle cell disease
Prostate surgery, Bladder surgery, Aneurysm surgery, brain or spinal cord surgeries
Peyronie’s disease, epispadias, priapism
Blood pressure meds, antidepressants, antipsychotics, antiulcer, cholesterol-lowering agents, hair preservation drugs like finasteride, methadone, antihistamines
In general, our doctors can suggest one of the common ED meds such as:
These safe and effective oral medications may be all that you need to rid yourself of ED for good. They are called PDE5 inhibitors and were discovered accidentally to treat ED due to the vasodilating [TN5] side effects noted when used to treat another condition known as pulmonary hypertension, a condition that causes the lung blood vessels to constrict.
Our doctors will assess which PDE5 best suits your lifestyle. According to the Princeton Consensus Panel [1,5], men with ED should be categorized as having cardiac or vascular disease until shown otherwise and placed in low, intermediate, or high-risk categories.
However, this does not mean that they must avoid PDE5 inhibitors. Men who make the modifications in their lifestyles can safely use medications to treat ED and improve their sex life . Even patients with significant symptoms such as exercise-induced chest pain can be placed on PDE5 inhibitors since several studies show no adverse events. Consultation with a cardiologist is suggested in symptomatic men [3,4].
Despite its complexity, erectile dysfunction (ED) is readily corrected with medications to treat the underlying cause because ED serves as a gauge of overall health and fitness. Recurring ED may be a sign of underlying diseases such as diabetes, high cholesterol, high blood pressure, or depression. These systemic diseases impact the ability of blood vessels to dilate in every organ in the body, including the penis.
50% or 1 in 2 men 40 years and older suffer from ED and young men are affected as well.
Cardiovascular disease is the most common cause for ED which of course, can lead to psychological distress.
ED may be the first warning sign that something more serious is going on with your health. ED itself will not harm you but the underlying cause could.
It’s possible, especially if it’s your first encounter with the person or it could be due to performance anxiety. However, if ED occurs with an established partner on a regular basis, it’s unlikely the primary reason.
Anything that helps with massaging the penis will help erectile dysfunction, but a recent study showed that having olive oil in your diet helps even more and can raise testosterone levels. It seems that 9 tablespoons or more of olive oil were most helpful to reduce ED by about 40%.
Yohimbe. There’s not a lot of evidence that it helps and the side effects such as elevated heart rate, blood pressure, tremor, and irritability can be dangerous.
Before deciding that medications to correct ED are in order, it is first necessary to correct the conditions listed above and strive for a healthy lifestyle. Exercising, losing weight, reducing alcohol intake, getting plenty of sleep, and stopping smoking are the first behaviors that will lead to a reduction in blood pressure, reduction in inflammation, increased well-being, and longer life. Once you make these healthy decisions, you may still benefit from medication to treat ED and our doctors are here to make sure that you are safe to do so.
Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.
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