HEALTH TALK: Erectile dysfunction

I suspect that this is a major problem for many men. So let’s get a head start, so you know how to deal with it if or when it occurs.

WHAT IS ERECTILE DYSFUNCTION (ED)?

Once you’ve heard phrases like, “can’t get it up,” “can’t keep it up,” “fast Freddie,” and so on, you know what I’m talking about. Besides that though, it covers a range of other disorders, like a curvature (pronounced) of the penis during erection called Peyronie’s disease, prolonged painful erection not associated with desire for sex (priapism).  This latter one is often found in sicklers.

WHO GETS IT?

Men of any age can get it, but it is more common in men over 65.  Many of you normal virile young men will get an occasional episode, and that is perfectly normal.  ‘Occasional’ is the key word.  As you age, you should expect to have a little trouble more often.  It may take longer to get it up, it may not be so rigid (hard) as you, or your woman, would like, and it may need to be stimulated more directly to get up at all.  Orgasms (breaking, cumming) may be less intense, the amount you ejaculate will be less; and you will lake a longer time to recover and get it back up again, for another round.

We used to call it impotence, and it used to be taboo. But attitudes are changing, we’re understanding it better and finding new and better ways to treat it, and more and more men are seeking help.

SIGNS AND SYMPTOMS

Patterns may include:

Occasional inability to obtain a full erection.
Inability to maintain an erection throughout intercourse
Complete inability to achieve an erection

WHAT ARE THE CAUSES?

First, let’s look at how your penis is put together.  It contains two cylindrical sponge-like structures (corpus cavernosa and corpus spogiosum) running along its length parallel to the urethra (the tube that carries your semen and urine).  When a man gets sexually aroused, nerves are stimulated and cause blood flow to these cylinders to increase about seven times the normal amount.  This sudden influx of blood expands these sponge-like structures and causes an erection by stiffening and straightening – if you don’t have Peyronie’s – the penis.  Continued arousal and excitation maintain the higher rate of blood flow, keeping the hard going.  After ejaculation or when excitation passes, the excess blood drains out of the spongy tissue and returns to its regular size and shape.

STEPS TO GET AND SUSTAIN AN ERECTION

Arousal. Sexual arousal is the first step.  This comes from sight, touch, thoughts, hearing and smelling the opposite, and sometimes the same gender, for that matter.

Nervous system response. The brain relays the excitation to the body’s nervous system, which then leads to increased blood to the penis.  This is why I sometimes tell people sex is as much up here (head) as it is down there (penis, vagina).

Blood vessel response. Bloods vessels supplying the penis relax, allowing more blood to flow into the shaft to cause that rock to develop.

If any of these steps or the delicate balance between them are affected ED can occur.

So now we get to the real causes.  NON-PHYSICAL ones include:

Psychological problems.  The most common being stress, anxiety, and fatigue.  Depression is another one.

Negative feelings.  Feelings expressed from either partner to the other may affect the man – resentment, hostility, or lack of interest.

However, PHYSICAL causes account for the majority of cases, and these include:

Nerve damage from longstanding diabetes (diabetic neuropathy).  Men, how often have I told you to be serious about your diabetes!

Heart and blood vessel problems affecting blood supply to the pelvic area (below the waist).

Certain prescription drugs, AND non-prescription ones.

Operation for prostate problems.

Fractures that injure the spinal cord.

Multiple sclerosis.

Disorders of the hormones.

Alcoholism and other forms of drug abuse.

ED may be one of the first signs of an underlying medical problem.

Physical and non-physical causes of ED sometimes interact.  For example, a minor physical problem slows sexual response causing anxiety, which then worsens the problem.  Some of you men, I’ve told relax, avoid performance anxiety and spectatorship (watching yourself and putting undue pressure on yourself).  It just makes things worse.

RISK FACTORS

Physical and emotional risk factors contribute to ED, and include:

–          Physical disease and disorders, such as chronic diseases of the lungs, liver, kidneys, hearts, nerves, arteries, or veins.  Diabetes cannot be over-emphasized.  Accumulation of deposits (plaques) in your arteries (atherosclerosis) can prevent sufficient blood from entering the penis, in the same way that cholesterol plaques prevent free blood flow through the coronary arteries to your heart.  ED may also be caused by low levels of the male hormone, testosterone.

–          Surgery or trauma.  ED may result from an injury below the waist or the spinal cord.  Surgery on the bladder, rectum or prostate also does it.  Prolonged bicycle riding can cause a temporary problem.

–          Medications.  Antidepressants, antihistamines, blood pressure medications, some pain killers and prostate cancer medications can cause ED by interfering with nerve signals or blood flow to the penis.  Sleeping pills may also be a problem.

–          Substance Abuse.  Alcohol, ganja (marijuana), and other drugs, including tobacco, all cause ED.

–          Stress, anxiety, and depression have already been mentioned.

Seek medical advice if ED lasts longer that two months or is a recurring problem.

SCREENING AND DIAGNOSIS

How and when your ED developed, what medications you are taking, or what physical conditions you may have, are questions the doc will want to ask you.

If a physical cause is suspected blood tests may be done to check your hormones, or for diabetes.  Prescription drugs, if you’re taking any, may be eliminated by the doc one by one to see if any may be the cause of the problem.

Other tests include:

Ultra Sound Scan. This is really to detect the adequacy of blood flow to your genital organs

Neurologic assessment: Doctor will assess possible nerve damage by testing for normal touch sensation in your genital area.

Cavernosometry and Cavernosography. The former measures penile blood pressure.  The latter involves injecting a dye into your blood vessels to help doctor see any abnormality in blood flow in and out of your penis.

Suppose ED is suspected not to be caused by a physical problem, you may be asked if you get erect during masturbation, with a partner or while you sleep.  Most men get many erections during sleep, without remembering them.  Wrapping a special perforated tape around your penis before going to sleep can tell whether you get hard during the night.  If the tape is separated in the morning, you were hard during the night.  This will tell us your cause for ED is not physical, but psychological.

TREATMENT

Many options exist and which one is right for you depends on your preference, cause and severity of your problem.

Medications

Viagra. Which man in the world has not heard of this?
Cialis.
Levitra. We see these advertised on TV all the time.

What these drugs do is to enhance the effects of a certain chemical.  This chemical relaxes what are called ‘smooth’ muscles in the penis, thus allowing an increased amount of blood flow to the penis.  They do not automatically cause an erection but allow one to occur after physical and psychological stimulation.  Many men get erections using them whatever their cause of ED.

A lot of men get overzealous about these drugs, naturally, but some have died because they combine them with other drugs they don’t tell their doctor about, and they don’t mention conditions they have which make the drugs dangerous for them.  Always check with doctor and be honest with him.

PROSTAGLANDIN  E  (Alprostadil).

This is a hormone which also relaxes smooth muscle, as mentioned above.  There are two ways to use it.

Needle injection therapy.  You can inject this with a small needle into the base of the penis and get erect in five to twenty minutes and last for and hour. There is virtually no pain – the needle is so small.

Self-administered intra- urethral therapy.  An applicator is used to insert a tiny suppository, half the size of a rice grain, into the tip of the penis.  Placed about two inches down , the substance gets absorbed into the tissues that cause erection, again by increased blood flow.

Hormone Replacement Therapy.  It’s not just women but men too who sometimes need this.  If testosterone is deficient, it is simply replaced.

Penile implants.  A devise is surgically placed into the two sides of the penis, allowing erection to occur as often and for as long as desired.  The device is either an inflatable device or a semi-rigid rod made from silicone or polyurethane.  This is expensive and has risks, so it is used for severe cases.

Vascular surgery.  Surgery to correct blood vessel problems can also be done, usually to relieve blockage.

Psychological counseling. If there is stress, anxiety, depression or other emotional problems causing ED, one may need to see the shrink.

Vacuum devices.  I will leave this for another time, it is a bit much, and may even seem a little kinky.  Let’s defer it.

CAN YOU PREVENT ED?

You can decrease the likelihood by adopting the following: Limit or avoid alcohol and similar drugs; stop smoking; exercise regularly; reduce stress; get enough sleep; deal with anxiety or depression; see doctor regularly for check-ups and screening tests.

And remember this is a “couple” thing, or should be, so partners should not feel ashamed to seek assistance in finding ways to cope.  Questions? Just ask.

See you next week.

People of the north, Dr. Victor Emanuel will be in Portsmouth on Fridays from 8 am to  3 pm at Bayside Medical Center across from the police station.