{"id":72239,"date":"2012-08-29T12:19:00","date_gmt":"2012-08-29T16:19:00","guid":{"rendered":"http:\/\/dominicanewsonline.com\/news\/?p=72239"},"modified":"2012-08-30T09:29:37","modified_gmt":"2012-08-30T13:29:37","slug":"health-talk-erectile-dysfunction-2","status":"publish","type":"post","link":"https:\/\/dominicanewsonline.com\/news\/homepage\/columns\/health-talk\/health-talk-erectile-dysfunction-2\/","title":{"rendered":"HEALTH TALK: Erectile dysfunction"},"content":{"rendered":"
\"\"
Dr. Victor Emanuel MD<\/figcaption><\/figure>\n

I suspect that this is a major problem for many men. So let\u2019s get a head start, so you know how to deal with it if or when it occurs.<\/p>\n

WHAT IS ERECTILE DYSFUNCTION (ED)?<\/strong><\/p>\n

Once you\u2019ve heard phrases like, \u201ccan\u2019t get it up,\u201d \u201ccan\u2019t keep it up,\u201d \u201cfast Freddie,\u201d and so on, you know what I\u2019m talking about. Besides that though, it covers a range of other disorders, like a curvature (pronounced) of the penis during erection called Peyronie\u2019s disease, prolonged painful erection not associated with desire for sex (priapism).\u00a0 This latter one is often found in sicklers.<\/p>\n

WHO GETS IT?<\/strong><\/p>\n

Men of any age can get it, but it is more common in men over 65.\u00a0 Many of you normal virile young men will get an occasional episode, and that is perfectly normal.\u00a0 \u2018Occasional\u2019 is the key word.\u00a0 As you age, you should expect to have a little trouble more often.\u00a0 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.\u00a0 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.<\/p>\n

We used to call it impotence, and it used to be taboo. But attitudes are changing, we\u2019re understanding it better and finding new and better ways to treat it, and more and more men are seeking help.<\/p>\n

SIGNS AND SYMPTOMS<\/strong><\/p>\n

Patterns may include:<\/p>\n

Occasional inability to obtain a full erection.
\nInability to maintain an erection throughout intercourse
\nComplete inability to achieve an erection<\/p>\n

WHAT ARE THE CAUSES?<\/strong><\/p>\n

First, let\u2019s look at how your penis is put together.\u00a0 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).\u00a0 When a man gets sexually aroused, nerves are stimulated and cause blood flow to these cylinders to increase about seven times the normal amount.\u00a0 This sudden influx of blood expands these sponge-like structures and causes an erection by stiffening and straightening \u2013 if you don\u2019t have Peyronie\u2019s \u2013 the penis.\u00a0 Continued arousal and excitation maintain the higher rate of blood flow, keeping the hard going.\u00a0 After ejaculation or when excitation passes, the excess blood drains out of the spongy tissue and returns to its regular size and shape.<\/p>\n

STEPS TO GET AND SUSTAIN AN ERECTION<\/strong><\/p>\n

Arousal. Sexual arousal is the first step.\u00a0 This comes from sight, touch, thoughts, hearing and smelling the opposite, and sometimes the same gender, for that matter.<\/p>\n

Nervous system response. The brain relays the excitation to the body\u2019s nervous system, which then leads to increased blood to the penis.\u00a0 This is why I sometimes tell people sex is as much up here (head) as it is down there (penis, vagina).<\/p>\n

Blood vessel response. Bloods vessels supplying the penis relax, allowing more blood to flow into the shaft to cause that rock to develop.<\/p>\n

If any of these steps or the delicate balance between them are affected ED can occur.<\/p>\n

So now we get to the real causes.\u00a0 NON-PHYSICAL ones include:<\/p>\n

Psychological problems.\u00a0 The most common being stress, anxiety, and fatigue.\u00a0 Depression is another one.<\/p>\n

Negative feelings.\u00a0 Feelings expressed from either partner to the other may affect the man \u2013 resentment, hostility, or lack of interest.<\/p>\n

However, PHYSICAL causes account for the majority of cases, and these include:<\/p>\n

Nerve damage from longstanding diabetes (diabetic neuropathy).\u00a0 Men, how often have I told you to be serious about your diabetes!<\/p>\n

Heart and blood vessel problems affecting blood supply to the pelvic area (below the waist).<\/p>\n

Certain prescription drugs, AND non-prescription ones.<\/p>\n

Operation for prostate problems.<\/p>\n

Fractures that injure the spinal cord.<\/p>\n

Multiple sclerosis.<\/p>\n

Disorders of the hormones.<\/p>\n

Alcoholism and other forms of drug abuse.<\/p>\n

ED may be one of the first signs of an underlying medical problem.<\/p>\n

Physical and non-physical causes of ED sometimes interact.\u00a0 For example, a minor physical problem slows sexual response causing anxiety, which then worsens the problem.\u00a0 Some of you men, I\u2019ve told relax, avoid performance anxiety and spectatorship (watching yourself and putting undue pressure on yourself).\u00a0 It just makes things worse.<\/p>\n

RISK FACTORS<\/strong><\/p>\n

Physical and emotional risk factors contribute to ED, and include:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Physical disease and disorders, such as chronic diseases of the lungs, liver, kidneys, hearts, nerves, arteries, or veins.\u00a0 Diabetes cannot be over-emphasized.\u00a0 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.\u00a0 ED may also be caused by low levels of the male hormone, testosterone.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Surgery or trauma.\u00a0 ED may result from an injury below the waist or the spinal cord.\u00a0 Surgery on the bladder, rectum or prostate also does it.\u00a0 Prolonged bicycle riding can cause a temporary problem.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Medications.\u00a0 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.\u00a0 Sleeping pills may also be a problem.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Substance Abuse.\u00a0 Alcohol, ganja (marijuana), and other drugs, including tobacco, all cause ED.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Stress, anxiety, and depression have already been mentioned.<\/p>\n

Seek medical advice if ED lasts longer that two months or is a recurring problem.<\/p>\n

SCREENING AND DIAGNOSIS<\/strong><\/p>\n

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.<\/p>\n

If a physical cause is suspected blood tests may be done to check your hormones, or for diabetes.\u00a0 Prescription drugs, if you\u2019re taking any, may be eliminated by the doc one by one to see if any may be the cause of the problem.<\/p>\n

Other tests include:<\/p>\n

Ultra Sound Scan. This is really to detect the adequacy of blood flow to your genital organs<\/p>\n

Neurologic assessment: Doctor will assess possible nerve damage by testing for normal touch sensation in your genital area.<\/p>\n

Cavernosometry and Cavernosography. The former measures penile blood pressure.\u00a0 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.<\/p>\n

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.\u00a0 Most men get many erections during sleep, without remembering them.\u00a0 Wrapping a special perforated tape around your penis before going to sleep can tell whether you get hard during the night.\u00a0 If the tape is separated in the morning, you were hard during the night.\u00a0 This will tell us your cause for ED is not physical, but psychological.<\/p>\n

TREATMENT<\/strong><\/p>\n

Many options exist and which one is right for you depends on your preference, cause and severity of your problem.<\/p>\n

Medications<\/p>\n

Viagra. Which man in the world has not heard of this?
\nCialis.
\nLevitra. We see these advertised on TV all the time.<\/p>\n

What these drugs do is to enhance the effects of a certain chemical.\u00a0 This chemical relaxes what are called \u2018smooth\u2019 muscles in the penis, thus allowing an increased amount of blood flow to the penis.\u00a0 They do not automatically cause an erection but allow one to occur after physical and psychological stimulation.\u00a0 Many men get erections using them whatever their cause of ED.<\/p>\n

A lot of men get overzealous about these drugs, naturally, but some have died because they combine them with other drugs they don\u2019t tell their doctor about, and they don\u2019t mention conditions they have which make the drugs dangerous for them.\u00a0 Always check with doctor and be honest with him.<\/p>\n

PROSTAGLANDIN\u00a0 E\u00a0 (Alprostadil).<\/strong><\/p>\n

This is a hormone which also relaxes smooth muscle, as mentioned above.\u00a0 There are two ways to use it.<\/p>\n

Needle injection therapy.\u00a0 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 \u2013 the needle is so small.<\/p>\n

Self-administered intra- urethral therapy.\u00a0 An applicator is used to insert a tiny suppository, half the size of a rice grain, into the tip of the penis.\u00a0 Placed about two inches down , the substance gets absorbed into the tissues that cause erection, again by increased blood flow.<\/p>\n

Hormone Replacement Therapy.\u00a0 It\u2019s not just women but men too who sometimes need this.\u00a0 If testosterone is deficient, it is simply replaced.<\/p>\n

Penile implants.\u00a0 A devise is surgically placed into the two sides of the penis, allowing erection to occur as often and for as long as desired.\u00a0 The device is either an inflatable device or a semi-rigid rod made from silicone or polyurethane.\u00a0 This is expensive and has risks, so it is used for severe cases.<\/p>\n

Vascular surgery.\u00a0 Surgery to correct blood vessel problems can also be done, usually to relieve blockage.<\/p>\n

Psychological counseling. If there is stress, anxiety, depression or other emotional problems causing ED, one may need to see the shrink.<\/p>\n

Vacuum devices.\u00a0 I will leave this for another time, it is a bit much, and may even seem a little kinky.\u00a0 Let\u2019s defer it.<\/p>\n

CAN YOU PREVENT ED?<\/strong><\/p>\n

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.<\/p>\n

And remember this is a \u201ccouple\u201d thing, or should be, so partners should not feel ashamed to seek assistance in finding ways to cope.\u00a0 Questions? Just ask.<\/p>\n

See you next week.<\/p>\n

People of the north, Dr. Victor Emanuel will be in Portsmouth on Fridays from 8 am to\u00a0 3 pm at Bayside Medical Center across from the police station.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"I suspect that this is a major problem for many men. So let\u2019s get a head start, so you know how to deal with it if or when it occurs. WHAT IS ERECTILE DYSFUNCTION (ED)? 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