erectile dysfunction: means,causes,treatment and Remedy

0

Description

Undernormalcircumstances,when a man is sexuallystimulated,hisbrainsends a messagedownthespinalcordandintothenerves of thepenis.Thenerveendings in thepenisreleasechemicalmessengers,calledneurotransmitters,thatsignalthearteriesthatsupplyblood to thecorporacavernosa(thetwospongyrods of tissuethatspanthelength of thepenis) to relaxandfillwithblood. As theyexpand,thecorporacavernosacloseoffotherveinsthatwouldnormallydrainbloodfromthepenis. As thepenisbecomesengorgedwithblood, it enlargesandstiffens,causing an erection.Problemswithbloodvessels,nerves, or tissues of thepeniscaninterferewith an erection.

Causes and symptoms

It is estimatedthat up to 30 millionAmericanmenfrequentlysufferfrom ED andthat it strikes up to half of allmenbetweentheages of 40 and70.Doctorsused to thinkthatmostcases of ED werepsychological in origin,buttheynowrecognizethat, at least in oldermen,physicalcausesmayplay a primaryrole in 60% or more of allcases. In menovertheage of 60,theleadingcause is atherosclerosis, or narrowing of thearteries,whichcanrestricttheflow of blood to thepenis.Injury or disease of theconnectivetissue,such as Peyronie’sdisease,maypreventthecorporacavernosafromcompletelyexpanding.Damage to thenerves of thepenisfromcertaintypes of surgery or neurologicalconditions,such as Parkinson’sdisease or multiple sclerosis, mayalsocauseED.Menwithdiabetesareespecially at riskforerectiledysfunctionbecause of theirhighrisk of bothatherosclerosisand a nervediseasecalled diabetic neuropathy.
Somedrugs,includingcertaintypes of bloodpressuremedications, antihistamines, tranquilizers(especiallybeforeintercourse),andantidepressantsknown as selective serotonin reuptake inhibitors (SSRIs,includingProzacandPaxil)caninterferewitherections. Smoking, excessivealcoholconsumption,andillicitdrugusemayalsocontribute. In somecases,lowlevels of themalehormonetestosteronemaycontribute to erectilefailure.Finally,psychologicalfactors,such as stress, guilt, or anxiety, mayalsoplay a role,evenwhenthe ED is primarilydue to organiccauses.

Diagnosis

Whendiagnosingtheunderlyingcause of erectiledysfunction,thedoctorbegins by askingtheman a number of questionsaboutwhentheproblembegan,whether it onlyhappenswithspecificsexpartners,andwhether he everwakes up with an erection.(Menwhosedysfunctionoccursonlywithcertainpartners or whowake up witherectionsaremorelikely to have a psychologicalcausefortheirED.)Sometimes,theman’ssexpartner is alsointerviewed. In somecases,domesticdiscordmay be a factor.
Thedoctoralsoobtains a thoroughmedicalhistory to findoutaboutpastpelvicsurgery,diabetes,cardiovasculardisease, kidney disease, andanymedicationsthemanmay be taking.The physical examination shouldinclude a genitalexamination,hormonetests,and a glucosetestfordiabetes.Sometimes a measurement of bloodflowthroughthepenismay be taken.

Treatment

Yearsago,thestandardtreatmentforerectiledysfunctionwas a penileimplant or long-termpsychotherapy.Althoughphysicalcausesarenowmorereadilydiagnosedandtreated,individual or maritalcounseling is still an effectivetreatmentfor ED whenemotionalfactorsplay a role.
Therearethreeprescriptionmedicationsavailable in theUnitedStates to treatthephysicalcauses of ED: sildenafil citrate (Viagra),vardenafil(Levitra),andtadalafil(Cialis).Theyhelpaboutthree-fourths of allmenwhotrythem in thegeneralpopulation.Severalstudieshaveindicatedthattheirsuccessrate in diabeticmenmay be slightlylower,averagingaround60-65%.Allthreepillswork by enhancingtheeffects of nitricoxide.Thischemicalrelaxesmuscles in thepenis to allowmoreblood to flowin.Thesepills do notcause an erection by themselves.Sexualstimulation is alsorequired.Sildenafil or vardenafilshould be takenabout an hourbeforesex.Each is effectiveforroughlyfourhours.Tadalafillastsfor up to 36 hours.Menshouldnothavesexmorethanonceevery 24 hoursafterusingthesedrugs.BeforeViagra’sapproval in 1998,drugtreatment of erectiledysfunctionwaslimited to alprostadil(prostaglandin[E.sub.1]),eitherinjectedintothepenis or inserted as a pelletintotheurethra.Sales of thethreenewer ED drugsreached$3.4billion in 2004,according to theresearchfirmIMSHealth. In 2004,Viagrahadabout66% of themarketsharefor ED drugscompared to 19%forLevitraand14%forCialis.

Viagra

Sildenafilcitratewasoriginallydeveloped in 1991 as a treatmentfor angina, or chest pain. Thedrug,marketedunderthenameViagra,receivedFDAapproval as a treatmentforerectiledysfunction in March1998,andsincethattime it hasbeenprescribedformorethen 20 millionmenworldwide. It wasthefirstoralmedicationapprovedfor ED treatment.Viagra is a vasodilator, a drugthathastheeffect of dilatingthebloodvessels. It works by improvingbloodcirculation to thepenis,and by enhancingtheeffects of nitricoxide,theagentthatrelaxesthesmoothmuscle of thepenisandregulatesbloodvesselsduringsexualstimulation,allowingthepenis to becomeengorgedandachieve an erection.
Theaveragerecommendeddose of Viagra is 50 mg. It comes in doses of 25 mg., 50 mg.,and100 mg to.Themedication is takenapproximatelyonehourbeforesexualactivity is planned,andmayremaineffectivefor up to fourhours.Onedrawback is that to be effective, it should be taken on an emptystomach.Also,high-fatfoodscaninterferewiththeabsorption of Viagra.Viagradoesnotincreasesexualdesire.Sexualstimulationandarousalarerequiredfor it to be effective.
Manyinsuranceplanscoverthecost of Viagra,provided it is prescribed to treaterectiledysfunction.Thepillscostapproximately$10each,andinsurersmaylimitcoverage to a specificnumber of pillseachmonth.
Theprimarydrawback to Viagra,whichworksabout an hourafter it is taken, it thattheFDAcautionsmenwithheartdisease or lowbloodpressure to be thoroughlyexamined by a physicianbeforeobtaining a prescription. At least130menhavediedwhiletakingViagra.However,theFDAsaidthemen—mostovertheage of 64—died of heart attack or stroke due to healthproblemsexaggerated by sexualactivity,notthedrugitself.

Levitra

In early2003, a secondprescriptiondrug to treaterectiledysfunction,Levitra,wasapproved by theFDA.LikeViagra,Levitrahelpsincreasebloodflow to thepenisandmayhelpmenwith ED getandkeep an erection.Once a manhascompletedsexualactivity,bloodflow to thepenisshoulddecreaseandtheerectionshould go away.Levitrashould be takenapproximately 60 minutesprior to sexualactivity. In clinicaltrials,mostpatientswereable to beginsexualactivitybeforethattime. A 2004studyshowedthatabout50% of mentakingLevitraexperienced a firmerectionwithin 25 minutesand a smallpercentage in as quickly as 10 minutes.StudiesalsoshowedthatLevitraimprovederectilefunction in menwhohadotherhealthfactors,such as diabetes or prostatesurgery.
Mentakingnitratedrugs,oftenused to controlchestpain(alsoknown as angina),shouldnottakeLevitra.Menwhousealpha-blockers,sometimesprescribedforhighbloodpressure or prostateproblems,alsoshouldnottakeLevitra.Suchcombinationscouldcausebloodpressure to drop to an unsafelevel.Levitra is available in 2.5mg, 5 mg, 10 mg,and 20 mg tabletsandshould be taken no morethanonce a day.Theaveragecostperpill is about$10and is covered by manyinsuranceplans.

Cialis

Cialis is thethirdoraldrugprescribed to treaterectiledysfunction,approved by theFDA in November2003.ItsmostnotabledifferencefromViagraandLevitra,whichworkforaboutfourhours, is thatCialisworksfor up to 36 hours.Cialishelpsincreasebloodflow in thepeniswhen a man is sexuallystimulated. It canhelpmenwith ED getandkeep an erectionsatisfactoryforsexualactivity.Once a manhascompletedsexualactivity,bloodflow to hispenisdecreases,andhiserectiongoesaway.Cialis is clinicallyproven to improveerectilefunction in mostmenwithED,includingthosewithmild,moderate or severeED.
ThemostcommonsideeffectswithCialisare headache, upsetstomach,backpain,andmuscleaches.Thesesideeffectsusually go awayafter a fewhours.Patientswhogetbackpainandmuscleachesusuallyget it 12 to 24 hoursaftertakingCialis.Backpainandmuscleachesusually go away by themselveswithin 48 hours.
Cialiscomes in 5 mg., 10 mg.(therecommendedstartingdose),and 20 mg.tablets.Theaveragecostpertablet is about$10and it is covered by manyinsuranceplans.Sincetheabsorption of Cialis is notaffected by food or high-fatfoods, it doesnotneed to be taken on an emptystomach.Studiesshowthat in mostmen,Cialisbeginsworking in about 30 minutesandmay be taken up to onceperday by mostpatients.
Priapism, a prolongederection, is a veryrarepotentialsideeffect of allprescription ED medications.PersonstakingViagra,Levitra, or Cialiswhohave a prolongederection,lastingmorethanfourhours,shouldseekimmediatemedicalattention.Priapismcancausedamage to thepenispotentiallyleading to thepermanentinability to have an erection.
Becausesexualactivitycanstresstheheart,menwhohaveheartproblemsshouldcheckwiththeirphysician to see if sexualactivity is recommended.Erectiledysfunctiondrugsmaytriggertemporary hypotension (lowbloodpressure)and is known to increasecardiovascularnerveactivity, so physiciansshouldprescribethemwithcaution in menwith a history of heartattack,atherosclerosis(hardening of thearteries),angina,arrhythmia,andchroniclowbloodpressureproblems. ED drugsarenotlabeled or approvedforuse by women or children, or by menwithouterectiledysfunction.Anyoneexperiencingcardiovascularsymptomssuch as dizziness, chest or armpain,andnauseawhenparticipating in sexualactivityaftertaking an ED medicationshouldstoptheencounter.Theyshouldalsonottakeany ED drugagainuntiltheyhavediscussedtheepisodewiththeirhealthcareprovider. It is recommendedthatmenwithkidney or liverimpairments,andmenoverage65,start at thelowestpossibledosage of ED medications.

Other treatment options

Althoughthecommercialavailability of Viagra,Levitra,andCialishasbeenuseful in manymen, prostate cancer patientsand ED caused by psychologicalproblemsoftenrequirealternativetreatment. A commonlyusedalternativeconsists of a three-druginjectioncontainingalprostadil,papaverinehydrochloride,andphentolaminemesylate.Though it is commonlyreferred to as the“Knoxvilleformula,”apparentlyforthecity of itsoriginalintroduction, a number of slightlyvaryingformulashavebeen in usearoundthecountry.Thethree-drugpreparation is administered by injectionintothecorporacavernosa to induceerection.
Othertraditionaltherapiesfor ED includevacuumpumptherapy,injectiontherapyinvolvinginjecting a substanceintothepenis to enhancebloodflow,and a penileimplantationdevice. In rarecases, if narrowed or diseasedveinsareresponsibleforED,surgeonsmayreroutethebloodflowintothecorporacavernosa or removeleakingvessels.
In vacuumpumptherapy, a maninsertshispenisinto a clearplasticcylinderanduses a pump to forceairout of thecylinder.Thisforms a partialvacuumaroundthepenis,whichhelps to drawbloodintothecorporacavernosa.Themanthenplaces a specialringoverthebase of thepenis to trapthebloodinsideit.Theonlysideeffectwiththistype of treatment is occasionalbruising if thevacuum is left on toolong.
Injectiontherapyinvolvesinjecting a substanceintothepenis to enhancebloodflowandcause an erection.TheFDAapproved a drugcalledalprostadil(Caverject)forthispurpose in 1995.Alprostadilrelaxessmoothmuscletissue to enhancebloodflowintothepenis. It must be injectedshortlybeforeintercourse.Another,similardrugthat is sometimesused is papaverine.Eitherdrugmaysometimescausepainfulerections or priapismthatmust be treatedwith a shot of epinephrine.Alprostadilmayalso be administeredintotheurethralopening of thepenis. In MUSE(medicalurethralsystemforerection),themaninserts a thintubethewidth of a spaghettinoodleintohisurethralopeningandpressesdown on a plunger to deliver a tinypelletcontainingalprostadilintohispenis.Thedrugtakesabout 10 minutes to workandtheerectionlastsabout an hour.Themainsideeffect is a sensation of painandburning in theurethra,whichcanlastaboutfive to 15 minutes.Theinjectionprocessitself is oftenpainful
Implantable penile prostheses areusuallyconsidered a lastresortfortreatingerectiledysfunction.Theyareimplanted in thecorporacavernosa to makethepenisrigidwithouttheneedforbloodflow.Thesemi-rigidtype of prosthesisconsists of a pair of flexiblesiliconerodsthatcan be bent up or down.Thistype of devicehas a lowfailureratebut,unfortunately, it causesthepenis to always be erect,whichcan be difficult to concealunderclothing.
Theinflatabletype of deviceconsists of cylindersthatareimplanted in thecorporacavernosa, a fluidreservoirimplanted in theabdomen,and a pumpplaced in thescrotum.Themansqueezesthepump to movefluidintothecylindersandcausethem to becomerigid.(Hereversestheprocess by squeezingthepumpagain.)Whilethesedevicesallowforintermittenterections,theyhave a slightlyhighermalfunctionratethanthesiliconrods.Mencanreturn to sexualactivitysix to eightweeksafterimplantationsurgery.Sinceimplantsaffectthecorporacavernosa,theypermanentlytakeaway a man’sability to have a naturalerection.

Alternative treatment

A number of herbshavebeenpromotedfortreatingerectiledysfunction.Themostwidelytouted is yohimbe(Corynantheyohimbe), derivedfromthebark of theyohimbetreenative to WestAfrica. It hasbeenused in Europeforabout 75 years to treatED.TheFDAapprovedyohimbe as a treatmentfor ED in thelate1980s. It is sold as an over-the-counterdietarysupplementand as a prescriptiondrugunderbrandnamessuch as Yocon,Aphrodyne,Erex,Yohimex,Testomar,Yohimbe,andYovital.
There is no clearmedicalresearchthatindicatesexactlyhow or whyyohimbeworks in treatingED. It is generallybelievedthatyohimbedilatesbloodvesselsandstimulatesbloodflow to thepenis,causing an erection. It alsopreventsbloodfromflowingout of thepenisduring an erection. It mayalsoact on thecentralnervoussystem,specificallythelowerspinalcordareawheresexualsignalsaretransmitted.Studiesshow it is effective to somedegree in 30-40% of menwithED. It is primarilyeffective in menwith ED caused by vascular,psychogenic(originating in themind), or diabeticproblems. It usuallydoesnotwork in menwhosedysfunction is caused by organicnervedamage. In healthymenwithoutED,yohimbe in somecasesappears to increasesexualstaminaandprolongerections.Theusualdosage of yohimbine(yohimbeextract) to treat ED is 5.4 mg threetimes a day. It maytakethree to sixweeksfor it to takeeffect.
GinkgoGinkgobiloba, is alsoused to treaterectiledysfunction,although it hasnotbeenshown to helpthecondition in controlledstudies,andprobablyhasmore of a psychologicaleffect. In addition,ginkgocarriessomerisk of abnormalbloodclottingandshould be avoided by mentakingbloodthinners,such as coumadin.Otherherbspromotedfortreating ED includetrueunicornrootAletriusfarinosa, saw palmetto Serenoarepens, ginsengPanaxginseng, andSiberianginsengEleuthrococcussenticosus. NuxvomicaStrychnosnux-vomicahasbeenrecommended,especiallywhen ED is caused by excessivealcohol,cigarettes, or dietaryindiscretions.Nuxvomicacan be verytoxic if takenimproperly, so it should be usedonlyunderthestrictsupervision of a physiciantrained in itsuse.
Therearequite a fewChineseherbalremediesforerectiledysfunctionusuallycombinations of herbsandsometimesanimalpartssuch as deerantlerandseahorse. Acupuncture is alsoused to treatED,althoughWesterndoctorsquestionitseffectiveness.
Share.

About Author

Leave A Reply

Call Now Button