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ERECTILE DYSFUNCTION
(An overview)
Dr. Musheer Ahmed, MD (Hom)
Dr. G. Mohan, BHMS
In last decade or so sex has come out of
Indian bedrooms and is being discussed in open. With
this change, more and more patients are coming to
doctors to discuss their sexual problems. Erectile
dysfunction is one such problem.
Impotence is the consistent inability to
maintain an erection that is firm enough or inability to
sustain erection long enough for sexual intercourse.
Impotence can be a total inability to achieve erection,
an inconsistent ability to do so, or a tendency to
sustain only brief erections. Usually, incidence rises
with age. However, it is not an inevitable part of
aging.
The term “Erectile Dysfunction” (ED) is
used in the field of medicine to describe this
particular disorder and to differentiate it from other
problems that interfere with sexual intercourse, such as
lack of sexual desire and problems with ejaculation and
orgasm.
How does an erection occur?
Erection begins with sensory and mental
stimulation. The penis contains two chambers, called the
corpora cavernosa, which run the length of the organ.
These chambers are filled with a spongy tissue and
surrounded by a membrane, the tunica albuginea. The
spongy tissue contains smooth muscles, fibrous tissues,
spaces, veins and arteries. The urethra runs along the
underside of the corpora cavernosa.
Impulses from the brain and local nerves
cause the corpora cavernosa to relax, allowing blood to
flow in and fill the open spaces. The blood creates
pressure in the corpora cavernosa, making the penis
expand. The tunica albuginea helps to trap the blood in
the crpora cavernosa, thereby sustaining erection.
Causes of ED
Since an erection requires a sequence of
events that includes nerve impulses in the brain, spinal
column and area of the penis, and response in muscles,
fibrous tissues, blood vessels in and near the corpora
cavernosa, any problem in this sequence can cause ED.
Causes of ED or Impotency can be broadly
divided into following two groups:
1. Psychological causes; and
2. Physical causes.
Psychological Causes of Impotency
Psychological factors include stress,
anxiety, guilt, depression, low self-esteem and fear of
sexual failure. These may be secondary reactions to
underlying physical causes.
Stress, from any source or situation can
lead to impotency. It is vicious circle as stress can
cause impotence, and impotency can adds to stress.
Depresson can cause lack of energy and
reduced sex drive, which may result in an occassional
inability to get erection, which further may lead to
deeper depression and finally impotency. Like stress,
with depression also there is an vicious circle.
Physical Causes of Impotency
Damage to arteries, smooth muscles and
fibrous tissues, often as a result of a disease, is the
most common cause of impotence. The lists of such
diseases include diabetes, kidney disease, chronic
alcoholism, multiple sclerosis, atherosclerosis and
vascular disease.
Injury to the penis, spinal cord,
prostate, bladder, and pelvis can lead to impotence due
to damage to nerves, smooth muscles, arteries, and
fibrous tissues of the corpora cavernosa.
Surgery can also be the cause of injury.
Impotence is can also be due to side
effect of some drugs. These include high blood pressure
drugs, anti-histamines, antidepressants, tranq-uilizers
and appetite suppressants etc.
Addictions to alcohol or smoking are
another factor responsible for ED. Smoking affects
blood flow in veins and arteries. Alcohol disrupts
hormon levels and can also cause nerve damage leading to
impotence.
Hormonal abnormalities, such as
insufficient testosterone are rarely the cause of
impotency.
Clinical examination
A detail medical history can disclose
diseases that lead to impotence.
Enquiries about sexual activity might
distinguish between problems with erection, ejaculation,
orgasm, or sexual desire.
If the penis does not respond as expected
to certain touching, a problem in the nervous system may
be a cause.
Abnormal secondary sex characteristics,
such as hair pattern, can point to hormonal problems,
which would mean the endocrine system is involved.
A circulatory problem might be indicated
by, for example, an aneurysm in the abdomen. Also
examine pulse in penis and surrounding pelvic area.
Rectal examination to check for
prostatitis or other prostate problems.
Sleep monitoring
During the dream portion of sleep, most
men experience 3 to 4 erections. Monitoring erections
that occur during sleep (nocturnal penile tumescence)
can help rule out certain psychological causes of
impotence.
If nocturnal erections do not occur, then
the cause of impotence is likely to be physical rather
than psychological. However, sleep monitoring tests of
nocturnal erections are not completely reliable. |
