About ED

Erectile dysfunction (ED) is the inability to achieve and maintain an erection for satisfactory sexual activity. ED affects most men at some point in their lives by the age of 40. Some men however experience chronic, complete erectile dysfunction (also known as impotence), which is more common in men over the age of 65, but it can occur at any age. It is estimated that 20-30 million men in the U.S. experience impotence.

As men age, it's also normal to experience changes in erectile function. Erections may take longer to develop, may not be as rigid or may require more direct stimulation to be achieved. Men may also notice that orgasms are less intense, the volume of ejaculate is reduced and recovery time increases between erections.

When erectile dysfunction proves to be a pattern or a persistent problem, it can interfere with a man's self-image as well as his and his partner's sexual life. Erectile dysfunction may also be a sign of a physical or emotional problem that requires treatment.
Erectile dysfunction was once a taboo subject, but more men are seeking help. Doctors are gaining a better understanding of what causes erectile dysfunction and are finding new and better treatments.

Anatomy of the Penis
The penis contains two cylindrical, sponge-like structures that run along its length, parallel to the tube that carries semen and urine (urethra). When a man becomes sexually aroused, nerve impulses cause the blood flow to the cylinders to increase about seven times the normal amount. This sudden influx of blood expands the sponge-like structures and produces an erection by straightening and stiffening the penis. Continued sexual arousal or excitation maintains the higher rate of blood flow, keeping the erection firm. After ejaculation, or when the sexual excitation passes, the excess blood drains out of the spongy tissue, and the penis returns to its non-erect size and shape.

Elements of an Erection
There are three basic elements involved to produce and sustain an erection:

• The Brain
  The mental aspect is often overlooked, but is a vital process to a healthy erection. Neurotransmitters in the brain (epinephrine, nitric oxide, acetylcholine) communicate the sexual excitation to the body's nervous system, which activates increased blood flow to the penis.
  
  
• The Body
  As the body responds to the arousal a relaxing action occurs in the blood vessels (function of nitric oxide) that supply the penis, allowing more blood to flow into the sponge-like shafts that produce the erection.
  
  
• The Libido
  This is the core to a man's sexual prowess; sexual desire. The crucial step in initiating sexual arousal, which men obtain from the senses of sight, touch, hearing and smell…and of course through imagination.

Causes of ED
There are many underlying causes of erectile dysfunction. This goes back to the three basic elements of an erection. If something affects any of these factors or the delicate balance among them, ED can result.

The most common psychological causes; depression, guilt, worry, stress, and anxiety, which all contribute to ED and consequently could affect the libido as well. Experiences in loss of erection could then create anxiety in performance, thus compounding the problem and possibly leading to impotence. Another possibility could involve your partner, such as feelings of resentment, hostility or lack of interest. Psychological factors in impotence are often secondary to physical causes, but more times than not is a direct result of a physical issue.

Physical causes account for many cases of erectile dysfunction and may include:

• Chronic diseases
  Diseases of the lungs, liver, kidneys, heart, nerves, arteries or veins can lead to impotence. So can endocrine system disorders, particularly diabetes. The accumulation of deposits (plaques) in your arteries (atherosclerosis) also can prevent adequate blood from entering the penis.

• Alcohol, smoking and drugs
  Over 200 commonly prescribed drugs are known to cause or contribute to impotence, including drugs for high blood pressure, heart medications, antidepressants, tranquilizers, and sedatives. A number of over-the-counter medications also can lead to impotence. Long-term use of alcohol, smoking and illicit drugs may affect the vascular and nervous systems and are associated with erectile dysfunction.
  
  
• Surgery, Trauma or Chemotherapy
  Damage through trauma to the pelvic region or spinal cord can damage the vascular or nervous system necessary for an erection. Any surgery of the colon, rectum, prostate, or bladder may damage the nerves and blood vessels involved in an erection. Radiation therapy of the bladder or prostate can cause irreversible nerve damage.

As a man reaches 40 (in some cases as early as 30) his level of testosterone begins to decrease. As the testosterone lowers so does his libido. This is a symptom known as andropause. As testosterone decreases a substance known as Sex Hormone Binding Globulin (SHBG) starts to increase. SHBG effectively makes testosterone unavailable for the body to use, effectively lowering "useable" levels even further. Although this is a physiological attribute it needs to be considered by it's residual effect; the lowering of the libido.

When to seek medical advice
It's normal to experience erectile dysfunction on occasion. But if erectile dysfunction lasts longer than two months or is a recurring problem, see your doctor for a physical exam or for a referral to a doctor who specializes in erectile problems. Your own doctor or a specialist can help you determine the underlying cause or causes of erectile dysfunction and then help you find the right type of treatment.

Although you might view erectile dysfunction as a personal or embarrassing problem, it's important to seek treatment. In many cases, erectile dysfunction can be successfully treated. Also, see your doctor if the therapy or medication prescribed to treat erectile dysfunction isn't working for you. Don't try to combine medications or therapies on your own or deviate from prescribed doses.

Screening and diagnosis
Your doctor will want to ask questions about how and when your condition developed, the medications you take and any other physical conditions you may have. Your doctor will also want to discuss recent physical or emotional changes.

If your doctor suspects that physical causes are involved, he or she will likely want to take blood tests to check your level of male hormones and for other potential medical problems, such as diabetes. Your doctor may also want to try eliminating or replacing certain prescription drugs you're taking one at a time to see whether any are responsible for erectile dysfunction.

Prevention
Although most men experience episodes of erectile dysfunction from time to time, you can take these steps to decrease the likelihood of occurrences:

• Limit or avoid alcohol and drugs.
  
• Stop smoking.
  
• Exercise regularly.
  
• Eat a balanced diet
  
• Reduce stress.
  
• Get enough sleep.
  
• Deal with anxiety or depression.

See your doctor for regular checkups and medical screening tests.

References: www.mayoclinic.com www.urologychannel.com