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Erectile dysfunction is the inability of the male to obtain and or maintain penile erection sufficient for vaginal penetration and satisfactory intercourse. It is estimated that 10 to 20 million men suffer erectile dysfunction in the United States, and 30 million men suffer partial or temporary erectile dysfunction.
The incidence of erectile dysfunction increases with age. At age 40, about 1 in 20 suffer this condition; at age 65 and older, the incidence is 15 percent to 25 percent.
The causes of erectile dysfunction can generally be classified as either organic or psychological. Although the majority of men with erectile dysfunction are thought to have an organic factor, psychological aspects of anxiety, depression, self-confidence, and partner relationship are important contributing factors. Consequently, many men have a combination of organic and psychological factors.
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The organic causes and risk factors of erectile dysfunction include vascular disease, diabetes mellitus, hypertension (high blood pressure), certain medications, neurologic disorders such as multiple sclerosis, chronic alcoholism, prolonged heavy smoking, pelvic trauma and spinal cord injury, pelvic surgery (such as non-nerve-sparing radical prostatectomy, cystectomy, or resection of rectum), Peyronie's disease (buildup of scar tissue in the penis), hormonal abnormalities, and other medical and surgical conditions.
Psychological causes include performance anxiety, stress, depression, and marital conflict.
Although erectile dysfunction is often assumed to be a natural consequence of aging because its incidence increases with age, it is not inevitable. However, many conditions associated with aging—vascular disease, diabetes, cancer, and their treatments—may cause erectile dysfunction.
Abnormalities in the vascular, neurological, or endocrine systems can be assessed by physical examination and laboratory tests. Adequacy of blood supply to the penis can be ascertained by blood flow or pressure measurements within the penis. Neurological adequacy is assessed by specialized studies, and endocrine abnormalities are measured in blood tests.
A comprehensive diagnosis of erectile dysfunction often includes nocturnal tumescence monitoring studies that appraise the ability to attain or maintain an erection by measuring episodes of erection that occur normally during sleep. At any age, men should experience spontaneous erections during sleep. The absence of these erections may point to an organic cause for erectile dysfunction.
The urologist usually coordinates efforts to diagnose and treat erectile dysfunction, performing the initial examination and referring the patient for consultations with other health care professionals such as sex therapists, psychologists, psychiatrists, marital counselors, endocrinologists, or neurologists.
Therapy depends upon the specific cause of erectile dysfunction in the individual patient, his mental, physical, marital, and social conditions, age, interests and goals, and toleration of therapy or buy viadalista.
Sex Therapy (Behavioral Therapy). Appropriate for patients without organic cause of erectile dysfunction. This therapy focuses on patient education and reduction of performance anxiety. Involving the partner in the therapy process accelerates the success of behavioral therapy.
Hormones (Such as Testosterone). Indicated only in patients with documented low testosterone levels. Injections with testosterone are generally not very effective and occasionally cause serious side effects, such as prostate enlargement and infertility. Currently, there are no highly effective oral medications.
Penile Self-injections with Vasoactive Drugs. These increase the blood flow into the penis, as well as decrease the blood flow out of the penis. Utilized in the treatment of organic erectile dysfunction, penile injection therapy is a new alternative for diagnosing and treating most organic, but also some psychological, erectile dysfunction.
A full erection lasting for approximately one hour can be achieved by self-injection of a combination of papaverine hydrochloride and phentolamine mesylate, or prostaglandin E-1. The method is successful for approximately 85 percent to 90 percent of affected men, except for those with severe vascular damage. The incidence of complications is low, although some men will experience bruising, pain, and nodule development at the site of the injection. A few men experience priapism, which can be treated with vasoconstrictor medication.
Any injection-induced erection that lasts longer than 4 hours should be immediately reported to the urologist.
The Vacuum Constriction Device. A nonsurgical, external device that induces erection by applying negative pressure to fill the penis with blood and traps the blood with a rubber ring at the base of the penis. This treatment is simple and noninvasive. Disadvantages include pain, numbness in the penis, dangling erection, and nonacceptance by patient or partner. Main contraindications are hematologic disorders and the use of blood thinners such as coumarin (Coumadin).
Implanted Penile Prostheses. Can be used if intracavernosal injections are impractical or vacuum devices are not successful.
Penile prostheses are very simple semi rigid devices that produce a permanent erection; more complex systems with inflatable cylinders can be pumped up or deflated on demand. While semi rigid prostheses are least inexpensive, they produce a constant erection, which at times can be cumbersome or embarrassing.
Inflatable prostheses—pumps that manually transfer fluid from a reservoir into cylindrical balloons implanted within the penis—are sophisticated devices that during the nonfunctional, or flaccid, state are indistinguishable from normal penises. When inflated, this type produces an excellent erection, essentially duplicating a normal erection. However, these devices may have problems resulting from a complicated surgical implantation process as well as from mechanical failures.
The technology of penile prostheses has progressed significantly, and recent models have rectified many earlier mechanical difficulties.
Micro vascular Surgery. Corrects erectile dysfunction by correcting abnormal blood flow to and from the penis. This innovative treatment works best in young, otherwise healthy patients who have suffered erectile dysfunction as a result of trauma.
Because of the myriad possible causes of erectile dysfunction, there are no reliable preventive measures. Avoidance of alcohol and prolonged heavy smoking— which may restrict blood flow to the penis—may help prevent erectile dysfunction in some men.