Erectile Dysfunction is the inability to get or keep an erection firm enough for sexual intercourse. ED can be a total inability to achieve an erection, an inconsistent ability to do so, or a tendency to sustain only brief erections.
ED is sometimes called impotence, but that word is being used less often so that it will not be confused with other, nonmedical meanings of the term.
Around 20% of men suffer at some point in their life from erectile dysfunction. Incidence increases with age: About 4 percent of men in their 50s and nearly 17 percent of men in their 60s experience a total inability to achieve an erection. The incidence jumps to 47 percent for men older than 75. But ED is not an inevitable part of aging. ED is treatable at any age.
Our specialized centers throughout the world have successfully treated in excess of 20,000 patients with erectile dysfunction. We offer a comprehensive package of clinical investigation, psychological profiling, hormonal, pharmaceutical and surgical therapies guaranteeing a solution.
The vast experience of our medical professionals enables us to provide tailor made therapies, matching exactly the hormonal and physical profile of each patient. This is in contrast with less experienced doctors who limit the treatment of erectile dysfunction to drug prescription often resulting to unsuccessful therapy and patient disappointment.
ED usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED.
Because an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.
Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases-such as diabetes, high blood pressure, nerve disease or nerve damage, multiple sclerosis, atherosclerosis, and heart disease-account for the majority of ED cases. Patients should be thoroughly evaluated for these conditions before they begin any form of treatment for ED.
Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of ED. Smoking, drinking alcohol excessively, being overweight, and not exercising are possible causes of ED.
Surgery-especially radical prostate and bladder surgery for cancer-can also injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and the fibrous tissues of the corpora cavernosa.
In addition, ED can be a side effect of many common medicines such as blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine, an ulcer drug.
Psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure can also cause ED. Even when ED has a physical cause, psychological factors may make the condition worse.
Hormonal abnormalities, such as low levels of testosterone, are a less frequent cause of ED.
A person’s medical and sexual histories help define the degree and nature of ED. The medical history can disclose diseases that lead to ED and a simple recounting of sexual activity may identify problems with sexual desire, erection, ejaculation, or orgasm.
Use of certain prescription or illegal drugs can suggest a chemical cause as drug side effects are a frequent cause of ED.
Making a few healthy lifestyle changes may solve the problem. Quitting smoking, reducing alcohol consumption, losing excess weight, and increasing physical activity may help some men regain sexual function.
Cutting back on or replacing medicines that could be causing ED is considered next. For example, if a patient thinks a particular blood pressure medicine is causing problems with erection, he should tell his doctor and ask whether he can try a different class of blood pressure medicine. Treating ED requires a systemic approach and an experienced doctor will usually consider a combination of the following therapies, tailored specifically to each patient:
In March 1998, the U.S. Food and Drug Administration (FDA) approved sildenafil (Viagra), the first pill to treat ED. Since that time, vardenafil hydrochloride (Levitra) and tadalafil (Cialis) have also been approved.
Additional oral medicines are being tested for safety and effectiveness.
Viagra, Levitra, and Cialis all belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Taken an hour before sexual activity, these drugs work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.
The regimen includes:
- PDE5 Inhibitors
- Intercavernosal Injectable Medications
- to implant a device that can cause the penis to become erect
- to reconstruct arteries to increase blood flow to the penis
- to block off veins that allow blood to leak from the penile tissues
Implanted devices, known as prostheses, can restore erection in many men with ED.
Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.
Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid. Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. The pump causes fluid to flow from a reservoir residing in the lower pelvis to two cylinders residing in the penis. Inflatable implants can expand the length and width of the penis to some degree. They also leave the penis in a more natural state than malleable implants do when not inflated.
Once a man has either a malleable or inflatable implant, he must use the device to have an erection.
Surgery to repair arteries can reduce ED caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with a small blockage of an artery because of an injury to the groin or fracture of the pelvis.