What is Erectile Dysfunction (ED)?
Erectile dysfunction (ED) is the inability
for a male to get and/or keep an erection sufficient for sexual activity.
ED has also been inappropriately referred
to as impotence. The term "erectile dysfunction" should be used because
is it more accurately describes the problem while remaining less judgmental.
It is not uncommon for men to have an occasional erection problem at some
point in their lives. However, ED tends to be a continuous, ongoing
problem. In the United States, approximately half of all men aged
40 to 70 years experience ED to some degree.
Having ED does not mean that a man is infertile or unable to have an orgasm or ejaculate. Medical research has found that erectile ability is not related to orgasm or ejaculation. Therefore, males with ED should not feel that they are lacking in virility or potency. Nevertheless, ED can obviously have a deleterious impact on one's life. An individual's self-esteem, self-confidence, self-image and self-worth can be affected. Significant others of men with ED may feel somewhat responsible and thus question themselves regarding their own physical attractiveness. Many people incorrectly believe that ED is simply a natural part of aging. This is not the case.
According to the results of two recent
national surveys, interest in sex continues throughout a person's life.
Results of these surveys revealed that
men aged 40 to 49 years reported having sex an average of six times a month
and men aged 50 to 59 years reported having
sex an average of five times a month. Nearly two-thirds of men in
their sixties reported having sex at least once a month. In addition,
nearly three-fourths of men aged 60 years or older who have regular sex
say they are as satisfied or more satisfied than they were in their forties.
The overwhelming majority of the sexually active 60+ year olds stated that
maintaining an active sex life was an important aspect of their relationship
with their significant other. Another study found that almost half
of the men and women who felt their sex lives to be less emotionally satisfying
compared with when they were in their 40s reported that it was because
they or their partner had a medical condition that prevented them from
having sex. In sum, ED is not a normal part of aging. It is
highly treatable medical condition in most men.
What Causes an Erection?
When a man becomes sexually aroused, the
arteries in his penis relax and widen, allowing increased blood to flow
into
the penis. As the arteries in the penis
expand and harden, the veins that normally carry blood away from the penis
become compressed, restricting the blood flow out of the penis. With more
blood flowing in and less flowing out, the penis enlarges, resulting in
an erection. The erection remains as long as the sexual arousal remains
or until orgasm. After the man has an orgasm or loses sexual arousal,
the extra blood flows out of the penis back into the body and the erection
goes down. The "going down" of an erection serves as a protective
factor to the penis. An erection lasting longer than six hours can
result in permanent damage to the penis. A man should call his physician
immediately if he has an erection for more than four hours.
What causes ED?
The chemical reactions responsible for erections do not occur in men with ED. Therefore, the arteries do not expand and the penis does not become engorged with blood. An erection does not result. There are a variety of common medical conditions and health behaviors that can contribute to ED. ED can be associated with any disease that affects the health of the blood vessels (arteries and veins). This includes medical conditions such as atherosclerosis, cardiovascular disease (heart disease), cerebrovascular disease (stroke), diabetes, and hypertension (high blood pressure). In addition, depression, mental disorders, certain medications, prostate surgery, and injuries that interrupt the connection between the central nervous system and the penis can also contribute to ED. Lifestyle factors such as smoking, excessive alcohol consumption, illicit drug use, and stress have also been found to be associated with ED.
Lifestyle Factors
Certain lifestyle factors can contribute
to ED. Changing or eliminating them can improve your overall and sexual
health. Listed are some lifestyle factors
you may be able to change.
Cigarette Smoking
If you smoke, stop. Smoking causes more than 439,000 deaths each year. It is a major contributor to the top four causes of death in the US (heart disease, cancer, stroke, and chronic obstructive pulmonary disease). Smoking adversely affects circulation which can result in ED. One study found that male smokers with high blood pressure and/or other risk factors were more than twice as likely to have complete ED than those who did not smoke.
Excessive Alcohol Consumption
If you drink alcohol, do so in moderation. Drink no more than two drinks a day. Alcohol is a depressant which decreases central nervous system functioning. It can interfere with one's ability to get an erection.
Illicit Drug Use
In addition to numerous other health risks, the use of drugs such as marijuana and cocaine can cause ED.
Stress
Stress and anxiety can adversely affect arousal and intimacy. Find a way to reduce stress. Learn healthy ways to relax. Exercise, meditation, yoga, reading, playing music and walking are just a few popular stress relievers.
Diabetes
The association between diabetes and ED has been well established. In fact, diabetes is one of the more common physical causes of ED. Approximately three out of four men with diabetes have ED to some degree. ED is the first visible sign of diabetes in 12% of men with diabetes. When diabetes is not controlled through diet, exercise or medication, ED can occur temporarily. In some cases in which a man has had diabetes for many years, ED may not be reversible, but may still be treatable. Because men with type 1 (insulin-dependent) diabetes generally have had diabetes for a long period of time, they are more likely to experience ED at an earlier age. Because type 2 (non-insulin-dependent) diabetes does not develop until adulthood, men with this condition are more likely to experience ED later in life. Eventually, ED tends to be just as common in men with type 1 diabetes as it is in men with type 2 diabetes. Forunately, a majority of cases of ED are treatable.
Hypertension (High Blood Pressure)
High blood pressure is often referred
to as the silent disease because it is possible to have no outward symptoms
and still have blood pressure high enough to cause health problems over
time. One of the possible complications of high blood pressure and its
treatment is ED. Since erections are dependent on an adequate amount
of blood flow into the penis, it stands to reason that any condition that
affects the blood vessels may be linked to the development of ED.
High blood pressure is one of the most
common of these conditions. Approximately one in seven men being
treated for high blood pressure has ED. High blood pressure not only
makes your heart work harder, but it also puts unnecessary strain on your
blood vessels, which may become hard or narrow as a result. When
this happens, the arteries are less able to deliver the amount of blood
that the body's organs - like the penis - need. Without sufficient oxygen
and nutrients, the tissues of organs like the penis can become damaged
and less able to function. Additionally, when high blood pressure
is combined with other conditions that undermine the health of a person's
organs (such as heart disease, high cholesterol, and diabetes), ED is more
likely to develop. Certain lifestyle factors such as those listed above
may further increase the risk of ED in a man with high blood pressure.
Some blood pressure medications have also been found to cause ED as a side
effect. When a man develops ED as a result of high blood pressure therapy,
it may be possible for his health care provider to prescribe an equally
effective drug that may be less likely to cause ED.
Depression
In patients with depression, the cause
of ED can be psychological, physical, or a combination of both. For
many men, ED creates additional depression,
loss of self-esteem, poor self-image, anxiety, and tension
between themselves and their partners.
These emotional disturbances can create physical conditions that lead to
increased difficulty in getting an erection. In one study, it was
found that the probability of some degree of ED in men with depression
ranged from 25 to 90 percent, depending on the severity of their depression.
No one is exactly sure why depression has this effect, but the majority
of cases of ED are treatable. Antidepressants may cause ED as a side
effect.
Heart Disease
If you have heart disease and its complications,
your arteries are less able to deliver the amount of blood to the organs
of your body. Without sufficient oxygen and nutrients, these organs can
become damaged and less able to function.
Since erections are dependent on an adequate
amount of blood flow into the penis, it stands to reason that any
disorder that affects the blood vessels
may be linked to the development of ED. Conditions that affect the health
of blood vessels and are considered risk factors for ED include high blood
pressure, coronary artery disease, disorders of the arteries or veins,
pelvic trauma or surgery, and high cholesterol. It is estimated that
ED may occur in as many as 8 of 10 men who have vascular difficulties,
2 of 3 who have had a heart attack, and more than half who have had
coronary bypass surgery. It is estimated
that 25% of men with ED have the condition in relation to a medication
being taken for another concern. One survey revealed that the prevalence
of complete ED was 14% in men taking blood pressure lowering drugs, and
28% in men taking cardiac drugs. Some diuretics and beta blockers have
also been associated with ED. Fortunately, when a man develops ED
as a result of one of these medications, it may be possible for his health
care provider to reverse the situation by prescribing an equally effective
drug that may be less likely to cause ED. The majority of cases of ED are
treatable, whether they are associated with vascular disease, certain medications,
or any of the conditions
previously discussed.
Spinal Injury
A spinal injury can affect virtually every
system of the human body. Because of this, many people who suffer
serious spinal injuries have concerns
about how their injuries may affect their ability to enjoy a sexual relationship.
In male patients, the most common form of impaired sexuality is ED.
Because healthy, intact nerves and blood vessels are necessary for an erection
to occur, ED can be associated with trauma or surgery that affects the
nervous system or interferes with the blood supply to the penis. In patients
with a spinal injury, the degree of erectile dysfunction depends on the
severity of the injury and its location on the spinal cord.
Patients with serious injuries to the lower
part of the spinal cord will generally have a higher incidence of ED
than those patients with less serious
injuries or injuries to the upper part of the spinal cord. And while 3
of 4
patients with a spinal injury can have
erections, the erections are adequate for intercourse in only one of four.
Prostate Surgery
When a man makes the decision to have prostate
surgery, he takes a step toward solving an important medical problem. However,
after the surgery, he may find that his life is disrupted by an upsetting
new problem: ED.
Erectile dysfunction can be caused by
trauma to the body as a result of surgery to treat prostate cancer or benign
prostatic hyperplasia (BPH). Two of the most common procedures used to
treat these conditions are transurethral resection of the prostate (TURP)
and radical prostatectomy. Unfortunately, ED is a common side effect of
both.
Because healthy, intact nerves and blood
vessels are necessary for an erection to occur, ED can be associated with
trauma or surgery that affects the nervous system or interferes with the
blood supply to the penis. Radical prostatectomy and TURP have the potential
to do both. It is estimated that up to 57% of men who have had radical
prostatectomy develop ED. If you notice a significant change in your
ability to get and/or keep an erection after having either radical prostatectomy
or TURP, your situation is far from uncommon.
Common Medications
Many common medications may bring about
ED as an unwanted side effect. These include some drugs in the
following categories:
Diuretics (water tablets)
High blood pressure medications
Antidepressants
Some types of drugs used to treat cancer
If you suspect that your ED is a result of a medication you have been prescribed, DO NOT STOP TAKING THE MEDICATION, speak with your health care provider. It may be possible for your health care provider to prescribe an equally effective drug that may be less likely to cause ED.
Treatments
Most cases of ED are associated with common
medical conditions, some medications used to treat these conditions, and
certain lifestyle factors like smoking or excessive alcohol consumption.
The good news is that erection problems can almost always be treated. One
treatment is VIAGRA® (sildenafil citrate), a pill available by prescription.
Of course, before you can be properly
diagnosed and treated for ED, you need to talk to your health care provider.
But you can learn more about sexual health, ED, and the physical conditions
that cause ED by clicking on the links above.
If you are interested in visiting other sites to obtain more information about erectile dysfunction and/or the medical conditions associated with it, you may wish to check out the following organizations and corporations.
American Cancer Society
American Diabetes Association
American Foundation for Urologic Disease
American Heart Association
American Urologic Association
Impotence World Association
Lipitor.com (atorvastatin calcium)
Men's Health Center at the Mayo Clinic
National Council on Aging
National Institute of Diabetes and Digestive and Kidney
Diseases
Pfizer.com
Zoloft.com (sertraline HCl)
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This article was updated on June 11, 2001.