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Erectile Dysfunction
Erectile dysfunction or impotence is a sexual dysfunction
characterized by the inability to develop or maintain an erection
of the penis for satisfactory sexual intercourse regardless of the
capability of ejaculation. There are various underlying causes,
such as diabetes, many of which are medically reversible.
The causes may be physiological or psychological. Psychological
impotence can often be helped by almost anything that the patient
believes in; there is a very strong placebo effect.
Due to its embarrassing nature and the shame felt by sufferers,
the subject was taboo for a long time, and is the subject of many
urban legends. Folk remedies have long been advocated, with some
being advertised widely since the 1930s. The introduction of perhaps
the first pharmacologically effective remedy for impotence, sildenafil
(trade name Viagra), in the 1990s caused a wave of public attention,
propelled in part by the news-worthiness of stories about it and
heavy advertising.
The Latin term impotentia coeundi describes simple inability to
insert the penis into the vagina. It is now mostly replaced by more
precise terms.
Contents
Medical symptoms
Erectile dysfunction is characterized by the inability to maintain
erection. Normal erections during sleep and in the early morning
suggest a psychogenic cause, while loss of these erections may signify
underlying disease, often cardiovascular in origin. Other things
leading to erectile dysfunction are diabetes mellitus (causing neuropathy)
or hypogonadism (decreased testosterone levels due to disease affecting
the testicles or the pituitary gland).
Medical diagnosis
There are no formal tests to diagnose erectile dysfunction. Some
blood tests are generally done to exclude underlying disease, such
as diabetes, hypogonadism and prolactinoma.
A useful and simple way to distinguish between physiological and
psychological impotence is to determine whether the patient ever
has an erection. If never, the problem is likely to be physiological;
if sometimes (however rarely), it is more likely to be psychological.
Clinical tests used to diagnose ED
Duplex ultrasound
Duplex ultrasound is used to evaluate blood flow, venous leak, signs
of atherosclerosis, and scarring or calcification of erectile tissue.
Injecting prostaglandin, a hormone-like stimulator produced in the
body, induces erection. Ultrasound is then used to see vascular
dilation and measure penile blood pressure. Measurements are compared
to those taken when the penis is flaccid.
Penile nerves function
Tests such as the bulbocavernosus reflex test are used to determine
if there is sufficient nerve sensation in the penis. The physician
squeezes the glans (head) of the penis, which immediately causes
the anus to contract if nerve function is normal. A physician measures
the latency between squeeze and contraction by observing the anal
sphincter or by feeling it with a gloved finger inserted past the
anus. Specific nerve tests are used in patients with suspected nerve
damage as a result of diabetes or nerve disease.
Nocturnal penile tumescence (NPT)
It is normal for a man to have five to six erections during sleep,
especially during rapid eye movement (REM). Their absence may indicate
a problem with nerve function or blood supply in the penis. There
are two methods for measuring changes in penile rigidity and circumference
during nocturnal erection: snap gauge and strain gauge.
Penile biothesiometry
This test uses electromagnetic vibration to evaluate sensitivity
and nerve function in the glans and shaft of the penis. A decreased
perception of vibration may indicate nerve damage in the pelvic
area, which can lead to impotence.
Pathophysiology
Penile erection is managed by two different mechanisms. The first
one is the reflex erection, which is achieved by directly touching
the penile shaft. The second is the psychogenic erection, which
is achieved by erotic stimuli. The former uses the peripheral nerves
and the lower parts of the spinal cord, whereas the latter uses
the limbic system of the brain. In both conditions an intact neural
system is required for a successful and complete erection. Stimulation
of penile shaft by the nervous system leads to the secretion of
nitric oxide (NO), which causes the relaxation of smooth muscles
of corpora cavernosa (the main erectile tissue of penis), and subsequently
penile erection. Additionally, adequate levels of testosterone (produced
by the testes) and an intact pituitary gland are required for the
development of a healthy male erectile system. As can be understood
from the mechanisms of a normal erection, impotence may develop
due to hormonal deficiency, disorders of the neural system, lack
of adequate penile blood supply or psychological problems. Restriction
of blood flow can arise from impaired endothelial function due to
the usual causes associated with coronary artery disease, but can
also include causation by prolonged exposure to bright light or
chronic exposure to high noise levels.
A few causes of impotence may be iatrogenic (medically caused).
Various antihypertensives (medications intended to control high
blood pressure) and some drugs that modify central nervous system
response may inhibit erection by denying blood supply or by altering
nerve activity. Antidepressants, especially SSRIs, can cause impotence
as a side effect. Surgical intervention for a number of different
conditions may remove anatomical structures necessary to erection,
damage nerves, or impair blood supply. Some studies have shown that
male circumcision may result in an increased risk of impotence,
while others have found no such effect, and another found the opposite.
Excessive alcohol use has long been recognised as one cause of
impotence, leading to the euphemism "brewer's droop";
Shakespeare made light of this phenomenon in Macbeth.
A study in 2002 found that ED can also be associated with bicycling.
The number of hours on a bike and/or the pressure on the penis from
the saddle of an upright bicycle is directly related to erectile
dysfunction.
Treatment
Treatment depends on the cause. Testosterone supplements may be
used for cases due to hormonal deficiency. However, the cause is
more usually lack of adequate penile blood supply as a result of
damage to inner walls of blood vessels. This damage is more frequent
in older men, and often associated with disease, in particular diabetes.
Treatments (with the exception of testosterone supplementation,
where effective) work on a temporary basis: they enable an erection
to be attained and maintained long enough for intercourse, but do
not permanently improve the underlying condition.
ED can in many cases be treated by drugs taken orally, injected,
or as penile suppositories. These drugs increase the efficacy of
NO, which dilates the blood vessels of corpora cavernosa. When oral
drugs or suppositories fail, injections (e.g. of apomorphine) into
the erectile tissue of the penile shaft may work.
When pharmacological methods fail, a purpose-designed external
vacuum pump can be used to attain erection, with a separate compression
ring fitted to the penis to maintain it. These pumps should be distinguished
from other "penis pumps" (supplied without compression
rings) which, rather than being used for temporary treatment of
impotence, are claimed to increase penis length if used frequently,
or vibrate as an aid to masturbation.
More drastically, inflatable or rigid penile implants may be fitted
surgically. Implants are irreversible and costly.
All these mechanical methods are based on simple principles of
hydraulics and mechanics and are quite reliable, but have their
disadvantages.
In a few cases there is a vascular problem which can be treated
surgically.
Uncontroversial treatments
PDE5 Inhibitors
The prescription PDE5 inhibitors sildenafil (Viagra®), vardenafil
(Levitra®) and tadalafil (Cialis®) are prescription drugs
which are taken orally. They work by blocking the action of PDE5,
which causes cGMP to degrade. cGMP causes the smooth muscle of the
arteries in the penis to relax, allowing the corpus cavernosum to
fill with blood.
Vacuum pump
An external vacuum pump will produce an engorged penis with success
approaching 90%; a penis ring will maintain this state, although
it should be removed after not more than 30 minutes. The erection
is not as rigid or hard as a natural erection; drugs or injections,
when they work, may be preferable. Various studies show the degree
of satisfaction of users and their partners to be vary variable,
even when drugs and injections do not work; in one study, about
20% of men who tried a (high-priced) pump decided to proceed to
purchase one. Other studies show higher percentages of satisfied
users.
In some cases frequent use of a vacuum pump can eventually improve
the degree of erection attainable without use of the pump. Claims
of cheap "penis pumps" to permanently increase maximum
penis size should be viewed with caution, however.
Some vacuum pumps, such as Osbon ErecAid, are sold at a higher price
with 100% refund within 90 days to dissatisfied users, with a somewhat
lower price with 50% refund guarantee. This pump is supported by
medical insurance schemes, including the UK's NHS and US Medicare
and private insurers. The better-known pumps sell for prices of
around 200 GBP/400 USD (2006). There is at least one vacuum pump
with rings which sells for around one-fifth of this price.
(Specific devices are mentioned for information only; mention should
not be taken as endorsement).
Inflatable implant
Rigid implant
Surgical treatment of certain cases
Controversial and unapproved treatments
Bremelanotide
The experimental drug Bremelanotide (formerly PT-141) does not act
on the vascular system like the former compounds but increases sexual
desire and drive in male as well as female. It is applied as a nasal
spray. Bremelanotide works by activating melanocortin receptors
in the brain. It is currently in Phase IIb trials.
Ginseng
A double-blind study appears to show evidence that ginseng is better
than placebo: see the ginseng article for links and more details.
Enzyte
Enzyte is a product that has been advertised by saturation coverage
on television channels such as CourtTV. However, the Center for
Science in the Public Interest (CSPI) has filed a complaint with
the Federal Trade Commission (FTC) about Enzyte for deceptive advertising.
It is manufactured by Berkeley Nutritionals, which is alleged to
be the subject of an investigation by the Attorney General of Ohio
and the defendant in class-action lawsuits.
Enzyte is a supplement that claims to increase the male libido
or frequency of erections of the penis. Commercials for Enzyte are
shown regularly on television. These commercials feature a man named
Bob who never stops smiling, apparently because he had taken Enzyte
and improved the size of his sex organs. The commercials are riddled
with symbolic phallic imagery, e.g. golf clubs, remarkably tall
glasses of iced tea, and a hose spraying barely a trickle of water
(carried by someone who doesn't use Enzyte).
The effectiveness of Enzyte is in dispute. Some medical professionals
in fact advise against taking Enzyte, saying that it can lead to
damage. The Center for Science in the Public Interest have urged
the Federal Trade Commission to disallow further television advertising
for Enzyte due to a lack of proper studies supporting claims. Enzyte
maker Berkeley Premium Nutraceuticals, Inc., is currently under
a class action lawsuit for false advertising.
Enzyte is said to contain: Tribulus terrestris; Yohimbe Extract;
Niacin; Epimedium; Avena sativa; Zinc Oxide; Maca; Muira Pauma;
Ginkgo biloba; L-Arginine; Saw Palmetto. Other ingredients: gelatin,
rice bran, oat fiber, magnesium stearate, silicon dioxide.
Herbal and other alternative treatments
These are generally ineffective when tested blind, but may be useful
for their psychological (placebo) effect: if a good result is expected,
any highly-praised, and often expensive, treatment can be effective.
Reputable drugs can also benefit from the same effect.
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Articles:
Erectile Dysfunction Medicine - kamagra (Apollo Movie Guide) Order cheap kamagra generic viagra sometimes have. What should i take this drug which health problems? We are an erection; become blocked. Check if the pharmacy market. To get an erection. Kamagra must not hold an erection at, all. Kamagra is a very expensive activity. Tablets. Sun, 07 Mar 2010 19:23:27 GMT
Urologist Dr. J. Francois Eid, MD Warns Against The Dangers Of Online Herbal Remedies For Erectile Dysfunction (ED) (Medical News Today) News reports coming out of the UK and Australia show evidence of prescription ingredients in many "natural" herb remedies sold on the Internet to treat erectile dysfunction (ED). These popular online supplements, which claim to consist only of homeopathic ingredients, are often improperly labeled and may actually contain dangerous ingredients. Dr. J... Fri, 05 Mar 2010 03:16:44 GMT
Urologist Dr. J. Francois Eid, MD Warns Against the Dangers of Online Herbal Remedies for Erectile Dysfunction (ED) (Marketwire via Yahoo! Finance) NEW YORK, NY--(Marketwire - 03/03/10) reports coming out of the UK and Australia show evidence of prescription ingredients in many "natural" herb remedies sold on the Internet to treat erectile dysfunction (ED) . These popular online supplements, which claim to consist only of homeopathic ingredients, are often improperly labeled and may actually contain dangerous ingredients. Dr. J. Francois ... Thu, 04 Mar 2010 00:55:00 GMT
Drugs for erectile dysfunction can help treat cancer (News 8 Austin) According to experts, the erectile dysfunction drug Cialis can be helpful in treating cancer. Sat, 27 Feb 2010 00:12:24 GMT
Erectile Dysfunction As A Predictor For Subsequent Atherosclerotic Cardiovascular Events: Findings From A Linked-Data ... (Medical News Today) UroToday.com - In permitting longitudinal data analyses of our study cohort of men with erectile dysfunction (ED) and without known previous history of cardiovascular (CV) disease, data linkage has provided us a novel methodological approach in our investigation on the role of ED as a predictor of atherosclerotic CV events. Based on hospital admissions and death registrations, findings from our ... Thu, 25 Feb 2010 11:43:51 GMT
Home Care Delivered, Inc. Launches a New Vacuum Therapy Category to Service Patients with Erectile Dysfunction (PRWeb) Virginia-based Home Care Delivered, Inc. announces the launch of the EliteCustom® Vacuum Therapy System (http://www.homecaredelivered.com/MedicarePatients/productBrowse/mp_product_detail.php?intItemID=6886) as a conservative treatment option for patients with Erectile Dysfunction (ED) (PRWeb Feb 22, 2010) Read the full story at http://www.prweb.com ... Mon, 22 Feb 2010 13:15:00 GMT
Home Care Delivered, Inc. Launches a New Vacuum Therapy Category to Service Patients with Erectile Dysfunction (PRWeb via Yahoo! News) Virginia-based Home Care Delivered, Inc. announces the launch of the EliteCustom® Vacuum Therapy System as a conservative treatment option for patients with Erectile Dysfunction (ED) Mon, 22 Feb 2010 12:00:00 GMT
Insurance fight over abortion, smoking, erectile dysfunction sent back to committee (Lawrence Journal-World) An amendment by state Rep. Peter DeGraaf, R-Mulvane, would require women to buy extra health insurance to cover abortions. Thu, 18 Feb 2010 08:07:26 GMT
Erectile dysfunction drugs used to treat a dozen other diseases (KING5 Seattle) More than 30 million men take them for erectile dysfunction, but the drugs marketed to treat male impotence are now being investigated for the treatment of more than a dozen diseases, including cancer. Thu, 18 Feb 2010 07:11:03 GMT
Insurance fight over abortion, smoking, erectile dysfunction sent back to committee (49 ABC News Topeka) A non-controversial insurance bill got loaded up Wednesday in the House with amendments on abortion, smoking and erectile dysfunction. Thu, 18 Feb 2010 02:16:40 GMT
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