Tuesday, 21 August 2012

Erectile dysfunction

What is erectile dysfunction?
Erectile dysfunction is the repeated
inability to get or keep an erection
firm enough for sexual intercourse.
Due to the sensitive nature of the
condition, it is difficult to estimate
how many men it affects. However,
recent studies show 22% of 40-year-
old men and up to 49% of 70-year-
old men may have the condition.
Causes and risk factors
The most common cause of erectile
dysfunction is damage to the tissues,
either the nerves, arteries, muscles
or fibrous tissue. This is often linked
either to disease. Conditions such as
diabetes, kidney disease, chronic
alcoholism, multiple sclerosis and
cardiovascular disease account for
around 70% of cases of erectile
dysfunction.
In some cases the condition is
caused by damage to the nerves and
arteries near the penis which can
occur during surgery, particularly for
prostate and bladder cancer. Physical
injury to the penis, spinal cord,
prostate, bladder or pelvis can also
be a factor. Erectile dysfunction is
also a side effect of some common
medications, including blood
pressure drugs, antihistamines,
antidepressants and tranquilizers.
Experts believe that psychological
factors such as stress, anxiety, guilt,
depression, low self-esteem, and
fear of sexual failure cause up to
20% of cases. Smoking, which affects
blood flow, has also been linked to
the condition.
Symptoms
The penis contains two chambers
full of spongy tissue called the
corpora cavernosa. When a man
becomes sexually aroused impulses
from the brain and local nerves
cause muscles in the corpora
cavernosa to relax, allowing blood to
flow in and fill the spaces within the
tissue. This creates pressure in the
corpora cavernosa, making the penis
expand. A membrane called the
tunica albuginea helps trap the
blood in the corpora cavernosa,
thereby sustaining erection.
The erection is lost when the
muscles contract to stop blood
flowing into the penis, and open
outflow channels. A successful,
sustained erection requires a
sequence of events to occur in a
precise fashion. Anything which
disrupts this sequence can lead to
problems either getting, or keeping
an erection.
Treatment and prevention
There are a range of ways to treat
erectile dysfunction. Doctors will
consider sexual counselling for
patients who are likely to benefit, but
alternatives include drugs, vacuum
devices, and surgery.
Drug Therapy
One drug in particular, sildenafil
(‘Viagra’), has become an
international phenomenon since its
launch in the late 1990s. The drug
does not directly give a man an
erection but it works by boosting the
natural mechanism that leads to an
erection. When a man is sexually
aroused, certain tissues in his penis
relax, as mentioned above. Viagra
helps by elevating the levels of the
chemical that causes the tissues to
relax. These effects were discovered
accidentally. The drug was originally
developed to improve blood supply
to the heart in angina sufferers.
In a small number of cases, people
who have taken sildenafil have
complained of headaches, flushing
and stomach-ache. It can also cause
some visual problems, including an
increased sensitivity to light, blurred
vision or an inability to tell the
difference between blue and green.
Men who are already taking
medicines that contain nitrates, such
as nitro-glycerine, are strongly
advised not to use Viagra as this is
dangerous and may result in a heart
attack.
Other similar drugs are tadalafil
(‘Cialis’)and vardenafil (‘Levitra’).
Penile injections: The injection of
drugs such as alprostadil directly into
the tissues of the penis to trigger an
erection was more common before
the advent of new drugs such as
sildenafil. The drugs relax muscles
and increase blood flow to create an
erection. They are also available as
pellets to insert in to the urethra (the
opening at the tip of the penis).
Vacuum Devices: These work by
creating a partial vacuum around the
penis, which draws blood into the
organ. The devices have three
components: a plastic cylinder, into
which the penis is placed; a pump,
which draws air out of the cylinder;
and an elastic band, which is placed
around the base of the penis to
maintain the erection after the
cylinder is removed and during
intercourse.
Surgery: There are different types of
surgery. Implanted devices, known
as prostheses, can restore erection
in many men. These can come in
different forms. For instance, paired
rods can be inserted into the
corpora cavernosa to enable the
user to manually adjust the position
of the penis. Alternatively, inflatable
cylinders can be inserted inside the
penis and expanded using
pressurized fluid. In some cases
doctors may attempt to repair
blockages in damaged arteries.
However, this usually only works if
the blockages are not widespread.

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