Erectile Dysfunction
Also known as: Impotence
What is it?
Erectile dysfunction, or impotence, is the inability to
achieve or maintain an erection long enough for the penis
to enter the vagina and engage in sexual intercourse.
Who gets it?
Erectile dysfunction affects approximately 10-20
million American men and it strikes up to half of all men
between the ages of 40 and 70. Midlife and the later years
bring changes in circulation that may affect the sex
organs.
What causes it?
In older men, physical causes play a primary role in
60% or more of all cases of erectile dysfunction. In men
over the age of 60, the leading cause is atherosclerosis,
or narrowing of the arteries, which can restrict the flow
of blood to the penis. Injury or disease of the connective
tissue, such as Peyronie's disease, may also interfere.
Damage to the nerves of the penis from certain types of
surgery or neurological conditions such as Parkinson's
disease or multiple sclerosis may also cause erectile
dysfunction. Men with diabetes are especially at risk for
impotence because of their high risk of both
atherosclerosis and a nerve disease called diabetic
neuropathy. Other causes include the use of certain drugs,
including certain types of blood pressure medications,
antihistamines, tranquilizers (especially before
intercourse), and antidepressants. Smoking, excessive
alcohol consumption, and illicit drug use may also
contribute. In rare cases, low levels of the male hormone
testosterone can cause erectile failure. Finally,
psychological factors, such as stress, guilt, or anxiety,
may also play a role, even when the impotence is primarily
due to organic causes.
What are the symptoms?
The primary symptom of erectile dysfunction is the
inability of the penis to achieve or maintain an erection
long enough to engage in sexual intercourse. Erectile
dysfunction is diagnosed when the symptoms last longer
than two months or are reoccurring.
How is it diagnosed?
To diagnose erectile dysfunction, a doctor may begin by
asking a number of questions to determine the underlying
cause. A look at a patient’s medical history to find out
about past pelvic surgery, diabetes, cardiovascular
disease, kidney disease, and any medications the man may
be taking may also reveal a cause. The physical
examination may include a genital examination, a
measurement of blood flow through the penis, hormone
tests, and a glucose test for diabetes. In some cases,
nocturnal penile tumescence testing is performed to find
out whether the patient has erections while asleep.
What is the treatment?
Various treatments for erectile dysfunction exist
depending on the cause. Vacuum therapy may be used in
which the patient inserts his penis into a clear plastic
cylinder and uses a pump to force air out of the cylinder
to form partial vacuum around the penis, which helps to
draw blood into the corpora cavernosa. Injection therapy
involves injecting a substance into the penis to enhance
blood flow and cause an erection. In a long-awaited
breakthrough, a pill for combating impotence was cleared
for marketing by the FDA in March 1998. Called sildenafil
citrate (brand name Viagra), the drug boosts levels of a
substance called cyclic GMP, which is responsible for
widening the blood vessels of the penis. Viagra has been
shown to be effective in about 70-80% of men who take it,
and it can even work in men with some psychological
component to their impotence. Unlike drugs that are
injected into the penis, Viagra causes an erection only
when the man is sexually aroused. Implantable penile
prostheses are usually considered a last resort for
treating impotence. They are implanted in the corpora
cavernosa to make the penis rigid without the need for
blood flow. A number of herbs have been promoted for
treating erectile dysfunction, including Coryanthe yohimbe
(available by prescription as yohimbine) and gingko
(Gingko biloba), although neither has been conclusively
shown to help the condition in controlled studies.
Self-care tips
While there are no specific treatments to prevent
erectile dysfunction, maintaining general good health by
exercising regularly, controlling weight, controlling
hypertension and high cholesterol levels, and avoiding
smoking and alcohol can help.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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