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Impotence - Erectile Dysfunction

Overview, Causes, & Risk Factors

Male erectile dysfunction is a condition in which a man cannot get or keep an erection long enough to have sexual intercourse.

What is going on in the body?

Erectile dysfunction can be caused by mental or physical problems, or a combination of both. Men who are depressed or have some other emotional problem may have no interest in having sex. There may also be physical problems with how blood flows into the penis and is kept there during an erection.

What are the causes and risks of the condition?

Erectile dysfunction is a common problem. It is a problem whose frequency increases with age, but it is not necessarily a consequence of aging. Roughly 25% of men over the age of 65 have some degree of ED. Erectile dysfunction is considered a medical problem if it lasts more than 3 months.

Causes of erectile dysfunction can include:

Conditions that cause changes in the way blood flows to the penis, such as:

  • hardening of the arteries, or atherosclerosis
  • high blood pressure
  • high cholesterol
  • Conditions that affect the nervous system, such as:

  • multiple sclerosis
  • Alzheimer's disease
  • Psychological conditions and social problems, such as:

  • depression
  • stress
  • unhappy relationships, such as a marriage
  • Endocrine and hormone imbalances, such as:

  • diabetes, caused by abnormalities in the production or use of insulin in the body
  • hyperthyroidism, or a high level of thyroid hormones
  • hypothyroidism, or a low level of thyroid hormones
  • hypogonadism, or a low level of testosterone
  • Habits that make blood flow worse, such as:

  • smoking cigarettes
  • abusing alcohol
  • using illegal drugs
  • Trauma or injury to the pelvis, such as:

  • spinal cord injury
  • prostate surgery, such as a transurethral resection of the prostate, simple prostatectomy, or radical prostatectomy
  • Some prescription medications, such as:

  • blood pressure medications including beta blockers, calcium channel blockers, or hydrochlorothiazide
  • antidepressants

  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    Men with erectile dysfunction have trouble getting and keeping an erection.

    Diagnosis & Tests

    How is the condition diagnosed?

    A medical evaluation is done when a man expresses concerns about erectile dysfunction to his healthcare provider. The evaluation may include a physical and psychological exam, and a written questionnaire on past sexual experiences. Lab tests are done to rule out certain diseases.

    Sometimes a test called nocturnal penile tumescence, or erection self test, is performed. This is done to see if erections occur during sleep. If the test shows that erections occur, it can indicate the problem is mental rather than physical.

    Another test, called color phase ultrasonography, also may be done. This evaluates blood flow to the penis.

    Prevention & Expectations

    What can be done to prevent the condition?

    The best way to prevent erectile dysfunction is to reduce the risks. For instance, a man with diabetes should try to control his blood glucose, blood pressure, and cholesterol as well as possible. It's also helpful to limit alcohol intake and stop smoking.

    What are the long-term effects of the condition?

    Ignoring the physical causes of erectile dysfunction may result in a permanent inability to achieve an erection.

    What are the risks to others?

    Erectile dysfunction can affect relationships between partners, especially if men don't talk about the problem. Men should discuss the issue with their partners and seek out solutions together, if possible.

    Treatment & Monitoring

    What are the treatments for the condition?

    First, any underlying conditions that may cause the erectile dysfunction should be treated. Treatment may include counseling or sex therapy for men whose erectile dysfunction stems from emotional problems. Treatments for physical causes of erectile dysfunction should progress from less to more invasive.

    Treatment may include:

  • using a vacuum pump device to draw blood into the penis
  • using oral prescription medications and herbal products, such as sildenafil, also known as Viagra, or Yohimbine
  • injecting the medication prostacyclin E into the penis
  • surgery to improve blood flow to the penis
  • implanting an inflatable prostheses into the penis
  • What are the side effects of the treatments?

    Each treatment has its own set of advantages and side effects. The vacuum pump is very safe. But one drawback is that the constriction band, which keeps the erection, cannot be left on for more than 30 minutes.

    Sildenafil or Viagra cannot be used in people who take nitroglycerine because the combination may cause severe low blood pressure and heart attack.

    Injections are relatively painless, but require careful dose adjustments by a healthcare provider.

    Surgery is an option that should be discussed with a healthcare provider. There are possible side effects with any surgery. These include bleeding, infection, and reactions to the medications used to control pain.

    What happens after treatment for the condition?

    Most treatments for erectile dysfunction are taken right before planned intercourse. Successful treatment restores sexual function to a satisfactory level for the man and his partner.

    How is the condition monitored?

    A man follow up with his primary healthcare provider or to a urologist about whether the treatment is working satisfactorily.

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