Friday, 1 January 2016

ERECTILE DYSFUNCTION; causes and treatment

Erection is the ability to establish and maintain hard penis during a sexual encounter. This is enabled by adequate blood and nerve supply to the penile shaft.

ED is failure to establish or maintain an erection. 


Structurally, penis has got to chambers called corpus cavernosus which occupy dorsal aspect of the penile shaft. Then there is corpus spongiosum which surrounds the urethra and is at the ventral aspect of the penile shaft. During sexual arousal, blood enters these chambers causing the penis to stiffen and it elongates. This is called an erection.
An erection can be attained by:-
  1. By touching the penile shaft
  2. The mind (erogenous zone)

Sexual stimulation is associated with release of nitric oxide which relaxes muscles of corpora cavernosa creating room for the blood to flow into cavernosa chambers. This causes the penis to enlarge in size and stiffen. Continued release of nitric oxide is essential for maintaining an erection during the entire process of sexual contact.

To establish and maintain an erection, there is are several factors that are involved to include:-
  • Adequate blood volume 
  • Intact nerve supply to the penis
  • Psychological health
  • Structurally health penis
Erectile dysfunction is common and almost all men will experience at some point in their life as they advance in age. It may also be associated will poor blood supply, hormonal imbalances, alcoholism, smoking, prostate surgery, some drugs, chronic diseases, psychological instability and problem with the nerves.

SYMPTOMS OF ED 
The symptoms of ED include:-
  • Failure to establish an erection e.g a penis that is too soft to cause adequate penetration.
  • Failure to sustain an erection during the entire period of sexual contact.

Causes of ED

DIABETES MELLITUS- Elevated blood sugar levels especially in type 2 Diabetes mellitus precedes a spontaneous increase in insulin secretion. This results into insulin levels being high in the blood and has been attributed to vasodilation. The body has its own intrinsic control mechanism in which it releases vessel constrictor mediators in response to the insulin-induced vasodilation resulting into blood vessel constricting. Diabetes is also associated with deposition of fat plaque at the inner layer of blood vessel (atherosclerosis) resulting into narrowing of blood vessel and causes damage to the nerves (neuropathy). These factors have been linked to play role in development of erectile dysfunction.

PEYRONIE'S DISEASE- In peyronie's disease there is structural abnormality of the penile shaft which is characterized by a fibrous scar tissue in the corpora cavernosa. Scar tissue is not flexible and it limits the relaxation power of the cavernosus muscle limiting the amount of blood entering the penile shaft.

ALCOHOLISM-  has become a lifestyle for both genders. Chronic alcoholics experience hormonal imbalances characterized by elevated levels of estrogen and lowered level of testosterone. In men testosterone, a sex hormone, is responsible for development of secondary sexual characteristics. It increases libido, growth of body hair, increases erection rates like nocturnal penile tumescence, aids in formation of sperms, enlargement of sex organs e.t.c.

LOW SELF-ESTEEM- Negative self image is lethal to ones self esteem. One could be preoccupied with a thought of not being able to perform in bed to the expected standards and how the other partner is going to take that. This negative image tends to replicate itself in bed.

OBESITY- Poor dietary habits is predominant in 20th century. This has escalated obesity cases in almost all age groups. Obesity causes reduced sexual desire which is due to low production of sexual hormone.

HORMONAL IMBALANCE- Testosterone is a sex hormone produced by the testicles in gents. People who have damage to the testicles may be due accident or torture may be unlucky to have inadequate or no testosterone hormone. This may lead to reduced sexual desire, no erection or defective sperms.

SURGERY- Surgeries involving the prostate gland like prostatectomy may lead to damage to the nerve roots supplying nerve impulses to the penile shaft. This has been attributed to increased prevalence of erectile dysfunction. Sporting activity like cycling causes prolonged compression and friction directed yo the genitals and this affects both nerve and blood flow to the genital dampening sexual desire.

DRUGS- Drugs that can lead to erectile dysfunction are like:-
  • Anti-hypertensives- aldomet, verapamil, nifelat, enalapril, metoprolol e.t.c
  • Anti-depressants- amitriptyline, phenelzine, diazepam, imipramin e.t.c
  • NSAIDS- Indomethacin
  • Other drugs like Cimetidine, lasix, prometazine.
Treatment for ED

Surgery- to include blood vessel correction surgery and implants. Implants which are surgically inserted in the penile shaft are inflated during sexual encounter and deflated after ejaculation. These implants are surgically inserted at the corpora cavernosa where inflating them resembles the hydraulic movement of blood into these chambers.

Drugs- like sildenafil. They can be taken some minutes before sexual encounter but should be under doctor recommendation as they can have lethal side effects especially when there is a pre-existing medical condition like high blood pressure and other chronic diseases.

Psychological careImpaired self-image, stress and depression should be addressed with help of a trained counselor.

Exercise-it helps to burn extra fat and calories in the body and helps to overcome obesity and other health challenges that comes along with it. 
Exercise also helps to improve blood flow along the arteries which ensures adequate blood supply to the penis.

Vacuum Pumps- These pumps are meant to create a vacuum which draws blood into the corpora cavernosa chambers and a rubber band is applied at the base of the penile shaft to hold blood and prevent it from flowing out of the chambers.

Common posts:
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SECONDHAND TOBACCO SMOKE (the darkest side to active and passive smokers)


references.
Testosterone- Wikipedia, the free encyclopedia
Viewed on 4/2/2015 at
http://en.wikipedia.org/wiki/Testosterone

Erectile dysfunction- Wikipedia, the free encyclopedia
Viewed on 4/2/2015 at
http://en.wikipedia.org/wiki/Erectile_dysfunction

Erectile dysfuction, diagnosis and treatment, Evidence report: structured abstract. October 2014. Agency for Healthcare Research and Qaulity: Rockville.MD.
http://www.ahrq.gov/research/findings/evidence-based-reports/erecdys.html

The Lancet,
Erectile dysfuction by Dr. Rany Shamloul MD, Prof. HusseinGhanem MD.
Published online on 05/10/2012. Viewed on 4/2/2015.

Mediscape, Pathophysiology of Diabetic Erectile Dysfunction.
By S. Cellek, NE Cameroon, MA Cotter, A Muneer 2013; 25 (1): 1-6


WebMD, Erectile Dysfunction Health Centre. Medications That Can Cause Erectile Dysfunction. http://www.webmd.com/erectile-dysfunction/guide/drugs-linked-erectile-dysfunction