Last modified on May 26th, 2020
Causes of Erectile DysfunctionFor most men the causes of erectile dysfunction can be due to a psychological, neurogenic, vascular or drug-induced factor, or a combination of these factors.
Psychological Causes of EDThis accounts for about 15-20% of most reported cases of erectile dysfunction. Common causes of Psychological or ‘Psychogenic’ erectile dysfunction include performance anxiety, work stress, and strained personal relationships or reduced attraction for his partner (which may not be associated with a relationship problem). Also, past sexual trauma, misconceptions about normal sexual functions, childhood sex abuse, and suppressed feelings about sexuality are possible causes of psychogenic erectile dysfunction.
Neurogenic Erectile DysfunctionIf there is a possible physical problem with the nervous system, this can lead to the development of erectile dysfunction. The male erection system depends on an intact nervous system to function; therefore any injury to the nervous system involved in erections may cause erectile dysfunction.Diseases such as Parkinson’s disease, Alzheimer’s disease, stroke, or head injury can lead to erectile dysfunction by affecting the libido, or by preventing the initiation of the nerve impulses responsible for erections. Also men with a history of pelvic trauma, pelvic surgery such as radical prostatectomy, cystectomy or colectomy may have injury to the cavernous nerves that control erection. Peripheral neuropathy due to, for example, diabetes or excessive alcohol consumption may also affect some nerves as well as causing erectile dysfunction. This cause of erectile dysfunction accounts for about 10% to 15% of cases.
Endocrinologic/Hormonal Causes of EDDiseases and conditions which decreases the level of circulating testosterone in the body, such as castration or hormonal therapy used to treat prostate cancer, will decrease libido and impair erections. Androgen and prolactin levels are of particular concern here as a high level of circulating prolactin causes inhibition of gonadotrophin releasing hormone which lowers the level of testosterone.
Vascular Causes of EDHigh blood pressure, diabetes mellitus, hypertension and hyperlipidaemia are underlying causative factors for vascular impairment. These conditions lead to the partial or complete loss of the ability to not only achieve but also maintain an erection long enough for it to be useful to its owner and his partner. Also, high triglyceride and cholesterol, pelvic irradiation treatment of prostate, bladder and rectal cancers may damage blood vessels to the penis over time.
Drugs and Erectile DysfunctionThe usage of street drugs such cannabis, cocaine, amphetamines, and heroin can lead to decreased erectile function. Also certain anti-depressants or anti-psychotics have been associated with erectile dysfunction, especially those drugs that regulate serotonin, noradrenaline and dopamine. Excess alcohol intake has also been acknowledged to affect erectile dysfunction.With regard to the causes of erectile dysfunction listed above, The Mayo Clinic has this to say: “The physical and nonphysical causes of erectile dysfunction commonly interact. For instance, a minor physical problem that slows sexual response may cause anxiety about attaining an erection. Then the anxiety can worsen your erectile dysfunction.”
Treatment of Erectile DysfunctionIn order to effectively treat erectile dysfunction, it needs to be identified early, diagnosed and managed properly. Whatever treatment is to be embarked upon will depend on the diagnosed cause of the problem, but mostly on the patient and his partner based on their expectations and preferences, and also on the judgment of the treating physician based on his/her experience.
Herbal Male Enhancement SupplementsFor thousands of years the issue of erectile dysfunction has existed with men and it would be noteworthy that before the advent of prescription drugs, NATURAL cures were used. Today there is an apparent inclination and crave by most people to want to use natural solutions in solving their health problems including erectile dysfunction. Generally, not only can they increase libido; they can also improve overall health and well being.There are certain rejuvenating products or sexual stimulants such as Asian ginseng, L-arginine, and Ginkgo biloba that increases sexual desire, facilitate penile microcirculation, and/or raise the penile concentration of Nitric Oxide (NO). Other products in this category include horny goat weed (several species of Epimedium), and a combination of fenugreek and ginseng.However to most professional researchers, no true aphrodisiacs, herbal or otherwise, have been proven to exist. This opinion is mostly held because the effects of herbal supplements tend to have no definitive studies regarding their efficacy, relatively nonspecific, limited, and associated with unpredictable or unknown side effects. There is therefore need for randomized, controlled, double-blinded studies to assess their efficacy and prevent their abuse for commercial gain.
Oral Medication / Selective Enzyme InhibitorsSince its release in March 1998, sildenafil (Viagra) has become the drug of choice for treating erectile dysfunction. Viagra improves erections by working locally on the penis by inhibiting an enzyme phosphodiesterase-5 (PDE-5). Men taking Viagra reported a higher satisfaction rate in overall sexual function, orgasm, penile rigidity and maintenance of erections.Other oral agents similar to Viagra that have been approved for the treatment of erectile dysfunction include vardenafil (Levitra) and tadalafil (Cialis). These drugs basically work in the same way with Viagra but while Levitra has very similar duration of action compared to Viagra, Cialis may be active for longer periods up to 36 hours.However certain precautions should be taken before consideration of an oral medication as treatment of choice for erectile dysfunction. Points to consider are the facts that they have certain side effects like Viagra and Levitra causing blurry vision and Cialis causing joint and back pains; they are not effective in patients who have prostatectomy; they cannot be used in some patients and cannot be taken with some other medications.
Urethral Suppository – MUSEProstaglandin E1 (alprostadil) placed inside the penile urethra, medicated urethral system for erection (MUSE), has been used when oral medications have been unsuccessful. Large studies from Europe and the United States demonstrated that MUSE was effective in 43 percent of men with erectile dysfunction from various causes. The major advantage of MUSE therapy is that it is applied locally and has few side effects. The major drawbacks are that it may cause moderate penile pain, and it can have an inconsistent response rate.
Penile InjectionWhen oral medication fails, penile injections to induce erection are another alternative to treat erectile dysfunction. The most commonly used agents include alprostadil or a combination of papaverine, phentolamine and alprostadil (Trimix). The response rate for the Trimix solution is as high as 90 percent and most men and their partners find that injection therapy is easy and are very pleased with the results.Men must have appropriate training and education before beginning home injection therapy. However there might be occasional fainting, dizziness, low blood pressure as side effects and also pain, infection, bruising and scarring if patients are not trained properly (however they are rare).
Vacuum Erection DeviceIn patients who only have partial erections or who either do not respond to other treatments or prefer not to use them, a vacuum device maybe useful. The device consists of a plastic cylinder connected to a pump and a constriction ring. The vacuum pump uses either manual or battery power to create suction around the penis and bring blood into it; the constriction device is then released around the base of the penis to keep blood in the penis and maintain the erection.
Penile prosthesisFor men with erectile dysfunction who have failed or cannot tolerate other treatments, a penile prosthesis offers an effective, but more incursive alternative. Prostheses come in either a semi-rigid form or as an inflatable device. Most men prefer the placement of the inflatable penile prosthesis.The placement of the prosthesis within the penis requires the use of an anaesthetic through a surgical procedure. Patients and partners satisfaction rates are as high as 85 percent. Nonetheless, rare side effects include infection, pain and device malfunction or failure.Treatment for erectile dysfunction generally should start with the simplest methods. The first method of treatment should be the primary use of an orally administered PDE-5 inhibitor. If this fails (which occurs in about 30% to 50% of cases), reinstruction as to proper administration or switching to another PDE-5 inhibitor may be attempted. Further failure may necessitate resorting to a second line of treatment which might include a vacuum device, intraurethral inserts, intracorporeal injections, and some natural products and herbs. These treatments may be tried in combination with each other or with a PDE-5 inhibitor. If no progress has been made to this point, a penile prosthesis could then be opted for.However, you need to realize that the PDE-5 inhibitors, vacuum devices, intraurethral inserts, intracorporeal injections, and penile prostheses do not cure the original disease or disorder causing the erectile dysfunction and are not without their side effects. Other than not yet having clinical and standard organisations certification, the herbal supplement treatment options which have been around for centuries are an effective alternative for the treatment of erectile dysfunction.
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