If a man does not get an erection for an extended period of time, or if penis relaxes during intercourse, he may have an erectile dysfunction. There can be various causes for this. Often mental factors like stress play a role. But also physical illnesses can lead to erection problems.
If the penis does not become stiff, lack of sexual arousal is not always the reason. Especially in older men, erectile dysfunction is usually a symptom of certain physical disorders.
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What’s erectile dysfunction?
An erectile dysfunction is when a man does not get an erection persistently for a prolonged period of time (at least six months) despite sexual arousal or is insufficient for sexual intercourse.
Overall, more than 5 out of every 100 men in the population have erectile dysfunction. Especially older men are affected. Every second man over the age of 40 complains about it at least temporarily. In younger men, erectile dysfunction problems are much less common.
Anyone who suffers from it should consult a urologist . The Urologist is not only an expert on all urinary and discharging organs such as kidney and bladder, but also on the sex organs of the man. The urologist is the one who must determine the causes of the problem and inform the patient of the most appropriate treatment options.
An erectile dysfunction manifests itself in that;
- Difficulty to achieve an erection.
- The erection is weaker or less rigid.
- Spontaneous erections in the morning are less frequent.
- Climax is reached in less time or with an incomplete erection.
- Loss of erection with the change of position.
In some cases, those affected also experience premature ejaculation (Ejaculatio praecox) or delayed ejaculation (Ejaculatio retarda).
As most men define their masculinity through the ability to maintain an erection and consummate their sexual relations, erectile dysfunction can have a great impact on the patient’s self–esteem .
If the dysfunction has always been present, we talk about primary erectile dysfunction . This would be when the man has never been able to maintain a complete sexual relationship for lack of erection.
When the problems of erection occur after a period of normal erections or after a systemic or general illness, we speak of secondary erectile dysfunction .
That is to say, the male can suffer some episodes of erectile dysfunction, but this has not always been the case and he can regain his erection in the future.
Erectile dysfunction is one of the most frequent sexual problems in men. It is estimated that in the western world there are between 25 and 30 new cases per thousand population per year.
It affects 50% of men over 40 years at least temporarily or sporadically by some circumstances such as alcohol abuse, fatigue, stress, emotional problems …
The odds of having erectile dysfunction increase with age. Thus, it is estimated that at age 60, 17% of men are unable to have or maintain an erection. At age 70, half of men have erectile dysfunction. Although this pathology is associated with aging, men under 40 can also be affected by it.
In general, erectile dysfunction is a poorly diagnosed problem, since men do not usually consult the doctor, since they perceive it as an inevitable disorder associated with age. For this reason, it is difficult to know the actual incidence figures. Thus, it is estimated that more than half of men with erectile dysfunction have never consulted a specialist about it. This is especially striking among males of 60-70 years.
How does it occur ?
In the penis there are two chambers called corpora cavernosa. These corpora cavernosa are made up of muscles, fibers, veins and arteries, which is called spongy tissue.
When the man feels excited, either mentally or physically, the brain sends signals to those corpora cavernosa so that the muscles relax. It is then when the bloodstream is mobilized, filling all spaces and making the penis grow, thanks to the pressure it causes. This produces an erection.
If the muscles of the corpora cavernosa do not relax, they do not let the veins and arteries fill with blood, so that erection is impossible and we would be facing an erectile dysfunction.
The erection problems can significantly limit the quality of life and wellbeing of patients as well as their sexual partner. However, we must know that they are treatable problems whatever the cause and at any age.
Erectile dysfunction is closely related to other health problems, especially with cardiovascular disorders. Thus, cardiovascular diseases and diabetes are risk factors . Also other health problems such as metabolic syndrome or urinary tract infections could cause erectile dysfunction.
The causes of erectile dysfunction are many and various, often occur in combination . In younger men, psychological problems often play a role, such as stress or pressure to perform . Also, depression and other mental illnesses can reduce sexual interest and lead to erectile problems.
Overall, erectile dysfunction is based on physical causes in most cases . These are mostly:
- Physical causes
- Circulatory disorders
- Nerve damage or diseases
- Hormonal disorders
Among the possible physical causes of are the following:
- Chronic renal failure
- Chronic liver diseases
- Vascular surgery in the abdomen
- Bladder and bowel operations
The possible psychic causes of erectile dysfunction are many such as:
- The stress to the sex
- The fear of sexual failure
- The stress (for example, business partner, in other personal areas).
- Unresolved conflicts
- Lack of sexual interest
The following points may indicate that erectile dysfunction occurs due to psychic causes :
- Erectile dysfunction starts suddenly.
- There do not seem to be physical causes.
- There are stressful situations in the life of the patient when erectile dysfunction begins.
- Erection problems come and go.
- Erection problems occur only in certain situations (for example, in the presence of the couple) but do not affect self-satisfaction.
- At night or in the morning spontaneous erections occur.
- Patients do not suffer physical risk factors (such as, for example, diabetes mellitus , drugs that inhibit erection, alcohol or drug abuse).
- The patient is less than 50 years old.
In elderly patients , circulatory disorders are the most common cause of erectile dysfunction. If the cavernosum in the penis can not fill enough with blood, the penis remains soft. There are two main reasons for this:
- It does not flow enough blood through the arteries into the blood vessels of the erectile tissue (arterial circulatory disorder).
- The blood leaves the erectile tissue too fast (venous circulatory disorder).
An arterial circulatory disorder is common is a consequence of certain metabolic disorders such as:
- Diabetes mellitus.
In people with atherosclerosis , the blood vessels throughout the body – including in the penis – narrowed, because in the vessel walls, blood lipids and lime have deposited. Diabetes mellitus and hypertension also lead to a so-called microangiopathy , a damage of the smaller blood vessels (arterioles and capillaries ), which connect the arteries and veins with each other. This too can hinder the influx of blood into the erectile tissue.
Also, the venous circulation of the penis may be disturbed. Normally, the veins in the penis act like valves : during an erection, they remain closed so that the blood in the penis stays stiff. The smooth muscles in the penis indirectly ensure this , As it relaxes, the arteries dilate. The cavernous bodies fill with blood, expand and compress the veins. So you close your valves.
However, in some men with erectile dysfunction, this mechanism does not work because the muscles in the penis can not properly relax . The veins allow the inflowing blood to flow out of the erectile tissue too quickly .
There may be different causes for this, some of which have not been fully explored. Among other studies suggest that morbidly elevated blood sugar that can cause harm to the penis smooth muscle cells .
An erection starts in the brain, it sends signals to the penis via the nerves. There are nerve fibers that release certain messengers when aroused. These ensure, among other things, that the smooth penile muscles relax and dilate the blood vessels in the erectile tissue.
If this signal path from the brain to the penis disturbed, the penis can not stiffen despite arousal. This is the case with about one in ten patients with erectile dysfunction. Which are common in people with diabetes mellitus and alcohol addiction.
Peripheral nerves affected, which permeate the entire body.
Strokes, multiple sclerosis, Parkinson’s disease, Alzheimer’s and traumatic brain injury damage the central nervous system .
The male sex hormone testosterone plays an important role in the erection. Men who lack testosterone usually experience less sexual arousal and therefore less often have an erection.
In addition, an excess of prolactin can cause erectile dysfunction. This hormone promotes milk production in mothers, but is also formed in the male body (for reasons that are not yet fully understood). Certain diseases and drugs appear to increase prolactin production, which can also cause potential problems.
Did you know that in 1 of every 4 cases of erectile dysfunction, is due taking of a pharmacological treatment?
There are many medications that can affect male sexuality , especially in chronic patients who must receive medication for long periods of time.
In many cases men are unaware of this direct relationship between the drug and its sexual function, and it usually takes a long time before they decide to consult their doctor; while others – when aware of this reality – tend to abandon the medications to prevent their sexuality from being affected.
List of medication categories that can cause an erectile dysfunction, for example:
- Gastrointestinal agents (eg cimetidine ,Ranitidine )
- Heart medications (eg digitalis , propafenone ,Verapamil )
- anti-inflammatory drugs (eg cortisone )
- Drugs for drainage (eg thiazides , spironolactone )
- antihypertensive drugs (eg clonidine , dihydralazine )
- Hair restorer ( finasteride )
- Medicines for depression ( antidepressants )
- anxiolytic drugs, so-called tranquilizers (eg phenothiazines , butyrophenones, thioxanthenes)
- Beta blocker ( propranolol ,Atenolol )
- Antiandrogens (agents that inhibit the action of male sex hormones)
What men has to do if they take these medications and suspect that they may be affecting them ?
The solution is to seek a multidisciplinary approach to the problem, which allows the patient to continue with their medication to treat the chronic disease they suffer and not put their health at risk, while enjoying a sex life as pleasant as possible; in this sense, there are options that can range from a change in medication to the reduction of doses, so men should check with their doctor if they think that the dysfunction may be related to the consumption of certain drugs. Together, men and the doctor, can find the best alternative to solve the situation.
Examination & Diagnosis
First, the doctor talks to the patient and asks some questions, for example:
- Since when are the erection problems?
- How exactly do the erectile dysfunction manifest?
- Do you have nocturnal and / or morning spontaneous actions?
- Do you take certain medications ?
- Do you regularly consume alcohol and tobacco?
- Do you have pre-existing conditions, such as cardiovascular diseases , diabetes mellitus or neurological diseases ?
The question of nocturnal and morning spontaneous erection ( morning wood ) is important because it indicates a physical cause.
How is the physical examination going?
If the doctor suspects that the erection problems are physical, he may perform various examinations. He can already recognize circulatory problems by checking the blood pressure and the pulses on the arms and legs.
In addition , the doctor scans the outer genitalia and the prostate of the patient in order to examine these for possible pathological changes and deformations. He can also test the reflexes in the area of the external genitals and the anus.
Among other things, a blood test provides information about hormone status (eg suspected testosterone deficiency), blood sugar levels (in the case of suspected diabetes mellitus) and blood lipid levels (eg to rule out a lipid metabolism disorder).
The level of testosterone needed to maintain an erection is unknown, since it is related to other factors such as LH levels. It is reasonable to request morning testosterone levels in patients with secondary sexual characteristics or in a male over 50 years of age. If testosterone is diminished, it will be thought in late onset hypogonadism and the need to request the determination of prolactin will be assessed.
There is a series of complementary tests that are not part of the basic evaluation, which will be requested to complete the study in selected cases such as night registration of tumescence of the penis , intracavernous injection of alprostadil, Doppler ultrasound and caversonography. the last indicated in young men with a history of trauma, looking for a segmental occlusion.
Sometimes, the doctor may need further investigation to determine the causes of the erectile dysfunction. These include:
- The Doppler ultrasound sonography.
- The Intracavernous injection test (SKIT).
- Neurological examination procedures.
Intracavernous injection test
In the intracavernous injection test , the doctor injects the patient with a male sex hormone from the group of prostaglandins in the erectile tissue of the penis . In this way the erection usually occurs in a short time. If a small amount is sufficient for a sustained erection, the causes of erectile dysfunction are probably due to non-vascular conditions.
With Doppler ultrasound , a type of ultrasound , the doctor can evaluate the blood flow of the penis and thus determine if erectile dysfunction occurs due to vascular causes.
To determine if blood flow has problems passing through the penile vein and, therefore, erection is not possible (for example, due to a venous leak), a cavernosogram is performed .
In this, an erection occurs in patients through drugs. Then the doctor supplies a contrast medium in the erectile tissue and with an x-ray done at regular intervals (every few seconds) can observe the blood flow in the erectile tissue.
Using the neurological examination, the doctor wants to clarify whether the nerves in the penis are still able to transmit signals . If not, it may indicate a nervous condition or a disease that damages the peripheral nerves, such as diabetes mellitus.
If the doctor finds no physical causes , he can refer his patient to a psychotherapist . This can fathom in conversation with the patient possible mental causes of the erectile dysfunction.
Erectile dysfunction is one of most disease that men are confused about its treatment options. Most of men looking for a treatment that reverse it permanently but such therapy isn’t available yet. The current treatment options include;
- Oral Pills
- Cavernous Auto Injection Therapy
- Transurethral Therapy
- Vacuum Penile Pump Devices
- Penile Implants
- Bypass surgery
- Psychiatric-Psychological therapy
- Natural Remedies
Read More about ⇒ Most Popular treatment Options to Get Erection Back
If there are psychological reasons for erectile dysfunction, it often occurs only temporarily and usually disappears automatically when the patient copes with his conflicts and / or reduces stress. If the causes are physical, the help in most cases is a medication. If the erectile dysfunction is a symptom of another disease, the course also depends on its cause.
When the erectile dysfunction is not solved, both the man and his partner can suffer problems of self-esteem and relationship that end up extra problems added to the medical cause.
Since it is a recurring problem, it’s advisable to go to the doctor to determine the cause and seek the best treatment. Whatever the case, the sooner the therapy starts, the better the chances of curing an erectile dysfunction.
Can erectile dysfunction be prevented ?
Erectile dysfunction can have several causes. Therefore, it can only be prevented partially.
Overweight, nicotine and excessive alcohol intake increase the risk of erectile dysfunction. Therefore, to prevent erection problems, men should not smoke, eat a balanced diet and exercise.
Stress in sexual relationships, whether caused by oneself or by one’s sexual partner, must be minimal.In any case, we must try to talk to the couple about what is happening and if it is something sporadic, look for what may have caused it and correct the precipitating cause.
However, in general, maintaining a healthy lifestyle, controlling the stress factors, feeding and fleeing sedentary life influences the state of health in general and, therefore, the possible appearance of an erectile dysfunction problem .
There is no doubt and it is advisable to consult a doctor. On the one hand, the chances of success of a treatment are better the earlier it begins. On the other hand, other illnesses can hide behind erectile dysfunction (eg diabetes mellitus , cardiovascular diseases , neurological diseases ), which must be treated.
However, currently half of men with erectile dysfunction problems do not consult with the doctor for believing that there is no solution or for other reasons such as shame.