Erectile dysfunction (ED) has become an issue only in the late years, because before the 20th century individuals often did not live beyond the reproductive years. It is characterized by the regular or repeated inability to obtain or maintain an erection during sexual intercourse. It is quite common condition among men which is to some extent age related; occurs frequently in men between the ages of 40 - 70. There are many reasons why men can suffer from erectile dysfunction; it is the result of a complex interaction of psychological, neural, vascular and endocrine factors. It can also be due to high consumption of alcohol, smoking, diabetes, high cholesterol, obesity, heart diseases or the cause can have psychological origin such stress, performance anxiety or depression. Also medications may potentially worsen sexual function.
From physiological perspective, a problem might be in arteries or veins. Venous leak, also called venogenic erectile dysfunction and penile venous insufficiency, is a cause of erectile dysfunction in males, often inflicting young men, unlike other organic causes of erectile dysfunction. Venous leak is an inability to maintain an erection in the presence of sufficient arterial blood flow through the cavernosal arteries of the artery. The reason of venogenic erectile dysfunction is not exactly known. It might be due to large venous channels draining corpora cavernosa or diabetes. Erectile dysfunction may occur in the early stages of diabetes and is one of the complaints of diabetic patients.
A spinal cord injury (SCI) can also significantly affect a penile erection. SCI is an injury to the spinal cord resulting in a change, either temporary or permanent, in the cord's normal motor, sensory, or autonomic function. Common causes of damage are trauma (car accident, gunshot, falls, sports injuries, etc.) or disease (transverse myelitis, polio, spina bifida, Friedreich's ataxia, etc.). Sexual function is often affected by an injury and problems that can occur include erectile dysfunction and loss of ability to ejaculate.
Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but can often be helped. It might be rather the secondary reaction to physical impossibility. Psychological causes of erectile dysfunction include stress, traumatic sexual experiences, (performance) anxiety or depression. Stress might be induced by several factors (e.g. job-related problems or relationship concerns). Alcohol or drug abuse could also contribute to erection failure. Anxiety is frequently related to worries and fear of sexual failure; not being able to satisfy partner. Another cause could be depression affecting individual on mental as well as physical level. Depressed people experience feelings of sadness, helplessness, sleeping disturbances as well as fatigue and all these factors could lead to loss of sex drive and erection problems. Low-self-esteem and side effects of various medications could also be significant factors contributing to erectile dysfunction. Notably in psychological impotence, there is a strong response to placebo treatment. Erectile dysfunction can have severe psychological consequences as it can be tied to relationship difficulties and masculine self-image. It is important to realize that it can happen that sometimes the erection might not occur, nevertheless, after few days problem can be resolved. If the problem is persistent and causing a distress and interpersonal difficulty, it is recommended to seek a professional help.
As a result of ED an individual can experience stress, anxiety, depression and self-esteem, shame, and altogether it can significantly affect his relationship with a partner.
As was mentioned above, feelings of stress, depression, guilt, or anxiety in infertile men can cause psychogenic impotence, which heightens the feelings of inadequacy that already accompany infertility. The psychological stress of infertility has been shown to affect sperm parameters in significant and demonstrable ways that may further contribute to difficulties with erectile potency; emotional reactions to the infertility may alter or even undermine a previous consolidation of a sense of self as sexually adequate. Infertility weighs on many males' minds; this creates mental instability, which often results in impotence. Even with an erection problem, a man may still have sexual desire and be able to have an orgasm and to ejaculate. Thus, it is important to keep in mind that it can be helped if the roots of stress are detected. Talking to a partner about worries,changing life-style and/or maintaining work-life balance can decrease the likelihood of erectile dysfunction.
To prevent ED one should maintain: a healthy diet, exercise regularly, review medication which could contribute to ED and find potential substitutions for those and also avoid smoking. Apart from that stress reduction techniques and open communication with partner could also decrease the risk of ED.
The early detection of medical problems which may underlie erectile dysfunction is important. By accepting and controlling these health problems, the damage done to tissues of the body, including the penis, may be reduced. Men which they move into middle age, should have regular health checks and they should stop smoking, limit alcohol, don't use drugs, exercise regularly and reduce stress.
Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection.
Changing life-style (change diet, decrease the alcohol consumption or stop smoking) could help in treatment of ED. Apart from that, for instance, an aphrodisiac could help. An aphrodisiacis a substance that, when consumed, increases sexual desire. Aphrodisiacs are distinct from substances that address fertility issues such as impotence or secondary sexual (dys)function such as erectile dysfunction.
Throughout history, many foods, drinks, and behaviors have had a reputation for making sex more attainable and/or pleasurable. However, from a historical and scientific standpoint, the alleged results may have been mainly due to mere belief by their users that they would be effective (placebo effect). Likewise it is noteworthy that many medicines are reported to affect libido in an inconsistent or idiopathic ways: enhancing or diminishing overall sexual desire depending on the situation of subject.
Cognitive Behavioral Therapy (CBT) or sex therapy could be helpful in treatment of psychological problems which could be contributing to erectile dysfunction. For sex the mind and body cooperation is very crucial and sometimes persistent feelings of stress and anxiety may actually lead to problems with erection. Anxiety, stress or even relationship troubles could be addressed during counselling. Also sex therapy which is focused on improving overall relationship between partners could be useful for some people. Sex therapy is aimed to overcome sex difficulties and is led by trained mental professionals or psychologists.
It is is a drug used to block the degradative action of cGMP-specific phosphodiesterase type 5 (PDE5) on cyclic GMP in the smooth muscle cells lining the blood vessels supplying the corpus cavernosum of the penis. These drugs areused in the treatment of erectile dysfunction and were the first effective oraltreatment available for the condition. Sildenafil was the prototypical memberof the PDE5 inhibitors (now, many other agents, both natural and synthetic areavailable). Sildenafil, sold as Viagra and other trade names, is a medication used to treat erectile dysfunction and pulmonary arterial hypertension. Its effectiveness for treating sexual dysfunction in women has not been demonstrated. Its primary competitors are tadalafil (Cialis) andvardenafil(Levitra).
Common side effects of taking PDE5 inhibitors include headaches and heart burn, as well as flushed skin. Caution is advised in those who have cardiovascular disease. Rare but serious side effects include prolonged erections, which can lead to damage to the penis, and sudden-onset hearing loss. Sildenafil should not be taken by people who take nitrates suchas nitroglycerin, as this may result in a severe and potentially fatal drop inblood pressure.
Yohimbine has been used in the treatment of impotence.It is also alleged to be an aphrodisiac. Nevertheless, Yohimbine exerts astimulating action on the mood and may increase anxiety. Its effect on blood pressure, if any, would be to lower it; however, no adequate studies are at hand to quantitate this effect in terms of Yohimbine dosage.
Apomorphine hydrochloride was a therapy used in the treatment of erectile dysfunction. It is its mode of stimulating dopamine in the brain which is believed to enhance the sexual response. Around 65-70% of doctors felt it was ineffective, with 60% of over 11,000 patients (avg age 61)discontinuing in month 1 and a further 23% in month 2. (UK studies concentratedon males with generalized erectile dysfunction). Apomorphine affects desire and is not meant to produce a systemic effect unlike drugs such as Viagra, which affect circulation. In those males who have problems with desire as opposed to generalized erectile dysfunction, it works as expected.
There is an injectable three-drug prescribed medication called Trimix, which is also used to treat erectile dysfunction. The injection must be compounded by a pharmacy and administered via intracavernosal injection (an injection at the base of the penis). Trimix is typically compounded by a pharmacy in a sterile environment and then frozen. The compound is stable for up to 6 months while stored frozen and for 1 month if stored refrigerated beginning at the time of manufacture.
Inflatable penile prosthesis
In patients with ED, inflatable penile prosthesis (IPP) surgery is regarded as the gold standard treatment in medically refractory cases or where its conservative treatment options are contraindicated. Despite improvements in surgical technique and implanted materials, IPP surgery retains a substantial complication rate.
There are two primary types of penile prosthesis: noninflatable, semirigid devices and inflatable devices. Noninflatable, semirigid devices consist of rodsim planted into the erection chambers of the penis and can be bent into position as needed for sexual penetration. With this type of implant the penis is always semi-rigid and therefore may be difficult to conceal.
Hydraulic,inflatable prosthesis also exist and were first described in 1973 by BrantleyScott et al. These saline-filled devices consist of inflatable cylinders placedin the erection chambers of the penis, a pump placed in the scrotum for patient-activated inflation/deflation, and a reservoir placed in the abdomen which stores the fluid. The device is inflated by squeezing the pump several times to transfer fluid from the reservoir to the chambers in the penis. After successful sexual relations, the pump can be deactivated to return the penis to a flaccid condition. Almost all implanted penile prosthesis devices perform satisfactorily for a decade or more before needing replacement.
The first-line method for sperm retrieval in men with spinal cord injury is penile vibratory stimulation (PVS). The penile vibratory stimulator is a plier-like device that is placed around glans penis to stimulate it by vibration. In case of failure with PVS, spermatozoa are sometimes collected by electroejaculation.
If there is a significant number of sperm and/or there is any other dysfunction, the retrieved sperm is placed inside woman’s uterus. This process is called intrauterine insemination (IUI).
If the number of sperm is not sufficient or the procedure is not successful, surgical methods of the sperm retrieval can be used (TESE, MESA, PESA, micro TESE). These techniques are used to collect the spermatozoa suitable for egg fertilization by intracytoplasmic sperm injection (ICSI).
An abnormal enlargement of the pampiniform venous plexus in the scrotum.
Complete absence of sperm in the ejaculate of a man.
A disease of excess body fat that can have a negative effect on health, leading to reduced life expectancy and other health problems.
In the case of cryptorchidism one or both testes are absent from the scrotum. It is is the most common etiologic factor of azoospermy in the adult.
The pathological inability to ejaculate in males, with (orgasmic) or without (anorgasmic) orgasm.
A class of sexual disorders defined as the subjective lack of normal ejaculation.
The semen, which would normally be ejaculated via the urethra, is redirected to the urinary bladder.
The set of symptoms that result from two or more X chromosome in males.
A genetic condition where the primary symptom is a failure to start puberty or a failure to fully complete puberty.
Complete absence of sperm in the ejaculate due to testicular failure.
The male sex chromosomal disorder characterized by a spectrum of clinical presentations, ranging from ambiguous to normal male genitalia.
Semen with a low concentration of sperm and is a common finding in male infertility.
A medical term which describes a diminished functional activity of the gonads – the testes and ovaries.
An inflammation of the prostate gland.
Male diagnosis connected with male infertility characterised by the complete absence of semen.
A condition in which a man has an unusually low ejaculate (or semen) volume.
A condition in which fertility impairment occurs spontaneously or due to an unknown cause.
The presence of abnormally high levels of prolactin in the blood.
A frequent autosomal dominant developmental disorder primarily characterized by short stature, typical facial features and heart defects.
A medical condition characterized by not enough androgenic activity in the body.
A medical condition in which the testes diminish in size and may be accompanied by loss of function (production of sperm and testosterone).
A region of the forebrain that regulates body temperature, some metabolic processes and governs the autonomic nervous system.
External male sex organ that additionally serves as the urinal duct.
An endocrine gland, about the size of a pea, whose secretions control the other endocrine glands and influence growth, metabolism, and maturation.
A walnut-sized structure that is located below the urinary bladder in front of the rectum.
Male gonads which produce both sperm and androgens, such as testosterone, and are active throughout the reproductive lifespan of the male.
One of the largest endocrine glands in the body, controls rate of use of energy sources, protein synthesis, and body's sensitivity to other hormones.
A male reproductive cell which is able to fertilize the counterpart female gamete - the oocyte.
An undifferentiated male germ cell with self-renewing capacity representing the first stage of spermatogenesis.
FSH is a hormone secreted by the anterior pituitary gland. It regulates the development, growth, pubertal matur and reproductive functions of the body
Steroid hormone produced primarily in the testes of the male; responsible for the development of secondary sex characteristics in the male.
The physiological process by which a penis becomes erect by being engorged with blood.
Age that may lead to the accumulation of de novo mutations, male infertility and increased genetic risks on the offspring.
A pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work.
Conditions affecting the heart or blood vessels usually associated with a build-up of fatty deposits inside the arteries.
Disorder characterized by symptoms of both anxiety and depression that may cause sexual disorders and anovulation.
A condition in which the body either does not produce enough, or does not properly respond to insulin, a hormone produced in the pancreas.
A patterned use of a drug in which the user consumes the substance in amounts or with methods which are harmful to themselves or others.
A mental disorder defined by abnormal eating habits that negatively affect a person's physical or mental health.
A surgery, which is performed in inguinal part of the body.
A condition characterized by a deficiency of prolactin in the blood.
An abnormally low testosterone production which may occur because of testicular or hypothalamic-pituitary dysfunction.
A medical condition of excess body fat that can have a negative effect on health, leading to reduced life expectancy and other health problems.
Eating habits are one of the few factors within our control that impact not only our chances of falling pregnant.
Surgical removal of all or part of the prostate gland.
Difficulty experienced during any stage of a normal sexual activity, including physical pleasure, desire, arousal or orgasm.
Long-lasting inhalation of the smoke of burning tobacco.
A damage of the spinal cord that causes changes in its function, either temporary or permanent.
A type of sexual dysfunction in which a person cannot achieve orgasm despite adequate stimulation.
The emotional state characterized by unpleasant feelings such as uneasiness, worry, apprehension and dread.
The emotional state characterized by persistent feel of low self-esteem, loss of interest, sadness and negative attitude.
The inability to develop or maintain an erection of the penis during sexual activity in humans.
The failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.
A feeling of insignificance or a lack of importance.
The absence of sexual appetite.
A frustration caused by a discrepancy between a person's desired and achieved sexual activity.
Pauses in breathing or periods of shallow breathing during sleep.
A process of discontinuing or lowering of alcohol drinking.
Process by which a woman donates eggs for purposes of assisted reproduction or biomedical research.
The use of plant or plant-based products for treatment of the repeated inability to get or maintain an erection firm enough for sexual intercourse.
A micromanipulative fertilization technique in which a single sperm is injected directly into an egg.
Kegel exercise consists of repeatedly contracting and relaxing the muscles that form part of the pelvic floor.
The way a person lives.
It is a therapeutic approach to treating medical conditions and their associated symptoms via the use of a specifically tailored diet.
Various medications used in the treatment of erectile dysfunction.
Physical exercise is any bodily activity that enhances or maintains physical fitness and overall health and wellness.
Cognitive behavioural therapy or sex therapy is helpful in treatment of psychological problems which could be contributing to erectile dysfunction.
The procedure in which a man (sperm donor) provides his sperm for fertility treatment.
A process in which an egg is fertilised by sperm outside the body: in vitro. Own or donated gametes may be used.
A process of discontinuing tobacco smoking.
In patients with erectile disfunction, inflatable penile prosthesis surgery is regarded as the gold standard treatment.
A vacuum erection device that helps draw blood into the penis by applying negative pressure.