Erectile Dysfunction Contributions by FoundHealth

Erectile dysfunction, also called impotence, is the inability to attain or maintain an erection of the penis that is firm enough for penetration during sexual intercourse. To initiate and maintain an erection, the penis must fill with blood. Nerve signals stimulate this engorgement. They prompt the blood vessels in the penis to expand so blood can fill it. Meanwhile, other blood vessels constrict, trapping blood inside.

Male Genitourinary System

The following factors can cause erectile dysfunction:

Venous Leak:If the blood vessels (veins), which normally are compressed by the blood filling the penis during an erection, are not fully compressed, an erection may not be attainable, or may not last long. This can be caused by injury or diseases which prevent the full expansion of the vessels (arteries) which normally expand with blood.

Neurovascular Function:Erection cannot be attained if nerve signals do not prompt blood vessels to do their job or if blood flow to the penis is reduced. Nerve dysfunction can also diminish feeling in the penis, resulting in impotence. Many medications can cause erectile dysfunction by impairing either vascular or nerve function.

Medical conditions that can lead to neurovascular dysfunction include:

• Diabetes —can interfere with nerve signals
• Arteriosclerosis (hardening of the arteries)—can reduce blood flow
• Peripheral neuropathy , spinal cord injury, and surgery—can affect nerve function

Psychological Factors:Psychological factors account for 10%-15% of erectile dysfunction cases. The brain initiates many of the nerve signals required for a successful erection. Problems in your relationship, feelings of guilt associated with sex, depression , anxiety , and stress can all lead to erectile dysfunction

An estimated 25-30 million US men have erectile dysfunction. Erectile dysfunction increases with age, affecting about 20% of men aged 20 and older and 78% of men aged 75 and older.

What are the risk factors for erectile dysfunction?

[What are the symptoms of erectile dysfunction?

[How is erectile dysfunction diagnosed?

[What are the treatments for erectile dysfunction?][9]

Are their screening tests for erectile dysfunction?

[How can I reduce my risk of erectile dysfunction?

[What questions should I ask my doctor?

Where can I get more information about erectile dysfunction?

Erectile dysfunction, also called impotence, is the inability to attain or maintain an erection of the penis that is firm enough for penetration during sexual intercourse. To initiate and maintain an erection, the penis must fill with blood. Nerve signals stimulate this engorgement. They prompt the blood vessels in the penis to expand so blood can fill it. Meanwhile, other blood vessels constrict, trapping blood inside.

Male Genitourinary System

The following factors can cause erectile dysfunction:

Venous Leak:If the blood vessels (veins), which normally are compressed by the blood filling the penis during an erection, are not fully compressed, an erection may not be attainable, or may not last long. This can be caused by injury or diseases which prevent the full expansion of the vessels (arteries) which normally expand with blood.

Neurovascular Function:Erection cannot be attained if nerve signals do not prompt blood vessels to do their job or if blood flow to the penis is reduced. Nerve dysfunction can also diminish feeling in the penis, resulting in impotence. Many medications can cause erectile dysfunction by impairing either vascular or nerve function.

Medical conditions that can lead to neurovascular dysfunction include:

• Diabetes —can interfere with nerve signals
• Arteriosclerosis (hardening of the arteries)—can reduce blood flow
• Peripheral neuropathy , spinal cord injury, and surgery—can affect nerve function

Psychological Factors:Psychological factors account for 10%-15% of erectile dysfunction cases. The brain initiates many of the nerve signals required for a successful erection. Problems in your relationship, feelings of guilt associated with sex, depression , anxiety , and stress can all lead to erectile dysfunction

An estimated 25-30 million US men have erectile dysfunction. Erectile dysfunction increases with age, affecting about 20% of men aged 20 and older and 78% of men aged 75 and older.

What are the risk factors for erectile dysfunction?

What are the symptoms of erectile dysfunction?

How is erectile dysfunction diagnosed?

What are the treatments for erectile dysfunction?

Are their screening tests for erectile dysfunction?

How can I reduce my risk of erectile dysfunction?

What questions should I ask my doctor?

Where can I get more information about erectile dysfunction?

The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.

At this time, there are no screening tests or screening guidelines for erectile dysfunction.

References:

American Urological Association Foundation website. Available at: http://www.urologyhealth.org/ .

References:

DynaMed editorial team. Erectile dysfunction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated August 2, 2010. Accessed August 10, 2010.

Guay AT, Spark RF, Bansal S, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple’s problem. 2003 update. Endocr Pract.2003;9:77-95.

National Institute of Diabetes & Digestive & Kidney Diseases website. Available at: http://www2.niddk.nih.gov/ .

National Library of Medicine website. Available at: http://www.nlm.nih.gov/ .

Sivalingam S, Hashim H, Schwaibold H. An overview of the diagnosis and treatment of erectile dysfunction. Drugs.2006;66:2339-2355.

Webber R. Erectile dysfunction. Clinical Evidence.2005;13:1120-1127.

A risk factor is something that increases your likelihood of getting a disease or condition.

It is possible to develop erectile dysfunction with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing erectile dysfunction. If you have a number of risk factors, ask your healthcare provider what you can do to reduce your risk.

Risk factors include:

Age

The incidence of erectile dysfunction rises with age, with about 5% at age 40, to 15%-25% at age 65 and older.

Medical Conditions

Certain medical conditions can increase your risk of erectile dysfunction, including:

• Diabetes
• Cardiovascular disease
• Arteriosclerosis (hardening of arteries)
• Chronic kidney disease
• Cirrhosis
• Chronic obstructive pulmonary disease (COPD)
• Peyronie's disease (bending of the penis caused by scar tissue)
• Endocrine disorders (hypogonadism, hyperthyroidism , hypothyroidism , hyperprolatinemia, Cushing syndrome )
• Neurological disorders (such as multiple sclerosis , peripheral neuropathy , stroke )
• Myotonic dystrophy
• Hypertension (high blood pressure)
• Psychiatric disorders (such as anxiety , depression , schizophrenia )
• Psychological problems (stress, personal relationships, new partners)

Traumatic Conditions

Trauma, whether through an accident or surgery, can increase your risk of erectile dysfunction. Trauma includes:

• Vascular surgery
• Urologic surgery, such as prostate surgery
• Pelvic surgeries (particularly for prostate cancer)
• Spinal cord injury

Behaviors

Certain behaviors can increase your risk of erectile dysfunction, including:

• Alcohol use
• Illegal drug use (eg, heroin, marijuana)
• Anabolic steroid use
• Heavy smoking

Medications

Certain medications can increase your risk of erectile dysfunction, including:

• Antihypertensives
• Antihistamines
• Antidepressants
• Tranquilizers
• Antipsychotics
• Histamine blockers
• Nicotine

If you suspect a medication may be affecting your sexual functioning, talk with your doctor. Do not stop taking a medication without talking to your doctor first.

Deficiencies

Severe zinc deficiency is known to negatively affect sexual function. Since marginal zinc deficiency is relatively common, it is logical to suppose that supplementation with zinc may be helpful for some men. However, this hypothesis has only been studied in men receiving kidney dialysis.^1,2 The results were promising.

References:

American Urological Association Foundation website. Available at: http://www.urologyhealth.org/ .

Guay AT, Spark RF, Bansal S, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple’s problem. 2003 update. Endocr Pract.2003;9:77-95.

Sivalingam S, Hashim H, Schwaibold H. An overview of the diagnosis and treatment of erectile dysfunction. Drugs.2006;66:2339-2355.

Webber R. Erectile dysfunction. Clinical Evidence.2005;13:1120-1127.

1. Mahajan SK, Abbasi AA, Prasad AS, et al. Effect of oral zinc therapy on gonadal function in hemodialysis patients. A double-blind study. Ann Intern Med. 1982;97:357-361.
2. Brook AC, Johnston DG, Ward MK, et al. Absence of a therapeutic effect of zinc in the sexual dysfunction of hemodialysed patients. Lancet. 1980;2:618-620.

Penile erection is a complex interaction of both halves of your autonomic (automatic) nervous system, your blood circulation, and your emotions. Therefore, symptoms may suggest a psychological problem, such as depression , and/or a medical problem, such as diabetes . Any one of these conditions can lead to erectile dysfunction.

Symptoms include:

• A less firm penis
• Fewer erections
• Fewer spontaneous nighttime erections

Your penis is made up of cylinders with tough linings. These linings can hold large amounts of blood at sufficient pressure to keep it stiff for a period of time. Normally, when stimulated either locally or from your emotions, blood vessels that empty your penis constrict. This prevents blood from exiting. Blood vessels inside your penis open to accept more blood.

References:

Erectile dysfunction. National Institute of Diabetes & Digestive and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/ED/ . Accessed August 8, 2010.

Guay AT, Spark RF, Bansal S, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple’s problem. 2003 update. Endocr Pract. 2003;9:77-95.

Sivalingam S, Hashim H, Schwaibold H. An overview of the diagnosis and treatment of erectile dysfunction. Drugs. 2006;66:2339-2355.

Webber R. Erectile dysfunction. Clinical Evidence. 2005;13:1120-1127.

The doctor will ask about your symptoms and medical history, and perform a physical exam. Be prepared to identify every medication you are taking. As many as 25% of erectile dysfunction cases are due to medicines. Expect questions about the frequency, quality, and duration of your erections. Your answers may help determine if primarily psychological and/or physiological factors are causing your impotence.

The doctor will examine your penis, testes, and rectum. If a physical cause is suspected, laboratory tests may be ordered. The following factors will be evaluated:

• Routine laboratory tests—Blood count, urinalysis, and a battery of blood chemistry tests will evaluate your general health.

• Testosterone—If you are over 50 years old or if your doctor suspects hypogonadism (small testes and reduced bodily hair), a blood test for testosterone will be ordered.

• Endocrine tests—Other endocrine tests may be ordered, such as TSH, prolactin, and fasting blood sugar.

• Nocturnal erections—Potent men have spontaneous erections at night. If you do not remember them because you were asleep, there are devices that can measure and record them.

• Psychology—There are always psychological factors associated with sexual functioning, whether they are the cause or just a result. You and possibly your partner may be given a questionnaire to help determine what emotional and psychological factors may be contributing to your condition.

References:

Guay AT, Spark RF, Bansal S, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple’s problem. 2003 update. Endocr Pract.2003;9:77-95.

National Institute of Diabetes, Digestive, and Kidney Diseases. Erectile dysfunction. National Institute of Diabetes, Digestive, and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/ED /. Accessed August 8, 2010.

Sivalingam S, Hashim H, Schwaibold H. An overview of the diagnosis and treatment of erectile dysfunction. Drugs.2006;66:2339-2355.

Webber R. Erectile dysfunction. Clinical Evidence.2005;13:1120-1127.

References:

American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .

American Urological Association Foundation website. Available at: http://www.urologyhealth.org/ .

Guay AT, Spark RF, Bansal S, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple’s problem. 2003 update. Endocr Pract.2003;9:77-95.

Sivalingam S, Hashim H, Schwaibold H. An overview of the diagnosis and treatment of erectile dysfunction. Drugs.2006;66:2339-2355.

Webber R. Erectile dysfunction. Clinical Evidence.2005;13:1120-1127.

A risk factor increases your chance of getting a disease. Some risk factors can be avoided, such as smoking. Other risk factors you may have no control over, such as your genetic make-up. If you have a risk factor for erectile dysfunction that you can and do change, you may reduce your risk.

To reduce your risk of becoming impotent:

• Manage your medical conditions.

• Talk to your doctor about changing medications.

• Maintain a healthful diet and exercise program.

• Quit smoking.

• Do not use recreational drugs.

• Consider counseling.

Manage Medical Conditions

Some cases of erectile dysfunction are due to chronic diseases of the lungs, liver, kidneys, heart, nerves, arteries, or veins. With your physician’s help, you can manage conditions that could affect your ability to have an erection, such as high blood pressure , diabetes , cardiovascular disease, and depression.

Talk to Your Doctor About Medications

If you suspect that your medications may be the problem, ask your doctor about changing or adjusting them. Medications for the following conditions are most commonly associated with erectile dysfunction as a side effect:

• High blood pressure
• Depression
• Anxiety
• Schizophrenia

Maintain a Healthful Diet and Exercise Program

Eat a healthful diet , one that is low in saturated fat and high in fruits, vegetables, and whole grains.

Begin and stick to a regular exercise plan. Choose exercises you enjoy and will make a regular part of your day. Strive to maintain an exercise program that keeps you fit and at a healthy weight. For many people, this includes walking or participating in an aerobic activity for 30 minutes per day. Exercise also can help you manage stress. Check with your doctor before starting any exercise program.

For more information about beginning an exercise program, click here .

Quit Smoking

Excessive tobacco use can also damage penile arteries. Quitting smoking reduces your risk of erectile dysfunction.

For information about quitting smoking, click here .

Do Not Use Recreational Drugs

Chronic use of alcohol, marijuana, or other drugs, like cocaine, speed, or heroin, often causes erectile dysfunction, along with decreased sexual drive.

Consider Counseling

Psychological factors, such as stress, anxiety, and depression, account for 10%-15% of erectile dysfunction cases. Counseling can help you manage or prevent these emotions and interpersonal conflict. You may also want to try couples counseling.

Special Considerations

Before quitting any medications, and even alcohol or tobacco if you are addicted, consult with your doctor about the safest way to do it.

American Urological Association (AUA)

Address:

1000 Corporate Boulevard
Linthicum, MD 21090

Phone:

1-866-746-4282 (US toll free)
410-689-3700

Internet Address:

http://www.urologyhealth.org

Description of Services Provided:

The American Urological Association website provides information on patient support, urologist referrals, patient information, and references.

Impotence Information Center

Address:

PO Box 9
Minneapolis, MN 55440

Phone:

800-843-4315

Description of Services Provided:

Provides information on male sexual function and infertility.

References:

American Urological Association Foundation website. Available at: http://www.urologyhealth.org/ .

Guay AT, Spark RF, Bansal S, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple’s problem. 2003 update. Endocr Pract.2003;9:77-95.

Sivalingam S, Hashim H, Schwaibold H. An overview of the diagnosis and treatment of erectile dysfunction. Drugs.2006;66:2339-2355.

Webber R. Erectile dysfunction. Clinical Evidence.2005;13:1120-1127.

You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with erectile dysfunction. By talking openly and regularly with your doctor, you can take an active role in your care.

General Tips for Gathering Information

Here are some tips that will make it easier for you to talk to your doctor:

• Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
• Write out your questions ahead of time, so you do not forget them.
• Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
• Do not be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.

Specific Questions to Ask Your Healthcare Provider

About Your Impotence

• What is the cause of my erectile dysfunction?

• Is there more than one cause?

About Your Risk of Developing Erectile Dysfunction

• Do I have a medical condition that is affecting my sexual function? If so, how can we treat it?

• Are any of my medicines affecting my sexual function?

• If so, can we change them?
• Is there an alternative medicine that will not affect my sexual function?

• Could any of my lifestyle habits be affecting my sexual function, such as smoking?

About Treatment Options

• What are the possible treatments for erectile dysfunction?

• Which treatment is appropriate for me? Why?

• What should I do to prepare for treatment?

• What risks and side effects should I expect?

• Will treatment affect my normal activities?

• Will I be able to father children after treatment?

• What is likely to happen without treatment?

• What medicines are available to me?

• What are the benefits/side effects of these medicines?
• Will these medicines interact with other medicines, over-the-counter products, or dietary or herbal supplements that I am already taking?

• Are there any alternative or complementary therapies that will help me?

About Lifestyle Changes

• Can you recommend a counselor to help with this problem?

• Can you recommend a program to help me quit smoking?

• Can you recommend a program to help me stop using recreational drugs?

• Should I stop drinking alcohol?

• Should I change my diet? If so, what dietary changes should I make?

About Your Outlook

• What are my chances of returning to satisfying sexual function?