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Erectile dysfunction (ED) is a fairly common issue for men. Though it can be caused by various reasons like health conditions, medications, alcohol or smoking, many cases of ED can be resolved through natural remedies and lifestyle modifications.
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Organic Impotence
Erectile dysfunction (ED) is an increasingly common sexual issue among men. Approximately 10% to 20% of middle-aged and elderly men experience it, though the incidence rate increases with age.
Though ED has long been thought of as a psychological issue, new diagnostic tools and treatments have revealed that organic causes are far more common than previously believed. These can include various insults to neurological, hormonal or vascular structures.
Organic impotence is often due to vascular disease. Alterations in vascular hemodynamics (like arterial insufficiency or corporovenocclusive dysfunction) account for more than 50% of all cases.
Diabetes mellitus can also lead to organic impotence. Individuals with insulin-dependent juvenile diabetes commonly experience peripheral neuropathic impotence, while those without the hormone during adult onset diabetes experience vasculogenic symptoms.
Many patients with such disorders as depression, anxiety or performance anxiety often also have coexisting psychiatric disorders that can exacerbate their condition. Fortunately, there is a wide range of psychotherapy options available to address the underlying mental health issues.
Yohimbine, an alpha-adrenoceptor blocker, has been proven to improve erectile function in some organic impotent patients.
It is essential to remember that yohimbine should only be used in combination with other therapies and not on its own. Multiple trials have demonstrated its efficacy in treating erectile dysfunction.
Other treatments exist, including noninvasive procedures like penile implants. Unfortunately, these methods tend to be costly and don’t suit everyone; additionally, they may cause side effects like priapism. Injections may also cause pain and scarring of the genital area but these effects tend to be mild and manageable; thus it is essential that all options be considered prior to undergoing surgery.
Psychogenic Impotence
Psychogenic impotence is typically caused by psychiatric issues like depression, anxiety and post-traumatic stress disorder. Men suffering from this issue may experience an overwhelming fear of failure in the bedroom, preventing them from achieving an erection and becoming frustrated. This anxiety may even prevent men from having sexual relationships altogether – impacting both their mental health and relationships with others.
Psychogenic impotence can often be successfully treated with medication alone or combined with sex therapy. Not only do these treatments improve erectile function, but they may also alleviate anticipatory sexual anxiety and distracting behavior.
Psychogenic ED can be diagnosed through the patient’s history and physical examination. A nocturnal penile tumescence (NPT) test can be helpful in distinguishing psychogenic from organic ED, though it’s not 100% reliable; insomnia symptoms associated with some psychiatric diseases may cause false negatives on this test.
Another common psychogenic cause of erectile dysfunction is sexual performance anxiety. This can create a cycle of worrying about not achieving an erection and distancing oneself from one’s partner.
These patients require a physiologic work-up to rule out physical diseases and are usually candidates for revascularization or penile prostheses. This should include performing a nocturnal penile tumescence test, monitoring blood pressure levels, and consulting with an urologist.
Men, particularly in conservative societies, may suffer from an erectile dysfunction that is linked to sexual performance anxiety. With medical diagnosis and treatment, these men can overcome their fears and gain newfound confidence in obtaining an erection. This helps them improve relationships with their partners while decreasing fear of failure.
Noninvasive Treatments
Millions of men suffer from erectile dysfunction (ED). Unfortunately, many are unaware of the problem and fail to seek treatment.
The causes of erectile dysfunction (ED) are complex and can be attributed to a variety of factors. In some cases, impotence is due to an underlying medical condition like diabetes or high cholesterol levels; on the other hand, it could also be due to psychological issues like depression.
Therefore, physicians must be able to pinpoint what’s causing the issue and offer treatments. A comprehensive workup should include testing for vascular, neurologic, psychogenic, and endocrine disorders.
First-line therapy typically involves administering either a vasodilator injection or medications (alprostadil, papaverine, phentolamine) into the penis to improve blood flow and enhance erectile function.
A vacuum erection device is another noninvasive solution to improve ED. These devices work by drawing blood into the penis and creating a tight constrictive ring at its base to facilitate an erection during sexual activity.
This type of device is safe and effective, though caution should be exercised not to overinflate or leave it on for prolonged periods. Their efficiency largely stems from their ability to improve blood flow and reduce microplaque formation on the shaft of the penis.
Finding a treatment that works is important to take into account several aspects of a patient’s lifestyle and medical history. For instance, many people are predisposed to kidney stones which could affect how efficiently the body absorbs medication. Furthermore, smoking has long been known to contribute to erectile dysfunction in men.
Surgical Treatments
Organic impotence, which affects 10-20% of middle-aged and older men, is typically due to physical issues that impact either the blood supply or how the penis works. Treatments for this condition can range from counseling to surgery.
Organic impotence should be addressed by a urologist to diagnose the source of their issue and suggest appropriate treatments.
In many cases, atherosclerosis of the cavernous arteries in the penis is the primary vascular cause of impotence. This condition reduces artery dilation to increase blood flow – essential for a strong erection – as well as reduce nitric oxide levels which help the artery lining dilate properly.
Another vascular cause of impotence is endothelial dysfunction, which inhibits the small arterioles from vasodilating when needed to increase blood flow to the penis. This can occur due to smoking or diabetes and often comes along with low testosterone levels.
Evaluation of erectile function can be conducted using a Doppler probe and chest cuff, using blood flowing to the penis as measured. This results in an index known as the Penile-Brachial Index (PBI), with values below 0.7 suggesting vascular impotence.
Inflatable penile prostheses, which can be implanted in the erection chambers of the penis during outpatient surgery, offer patients the convenience of having an erection whenever they desire. These devices maintain penile sensation and are generally considered safe for most men.
Medication
Organic impotence is a widespread issue among men. About 10% of middle-aged and 20% of elderly men suffer from it. It often goes hand in hand with other health issues like diabetes, hypertension or high cholesterol levels.
Organic impotence can be difficult to pinpoint the cause, but history, physical examination and laboratory data can provide clues. Potential causes include mechanical problems with the penis that interfere with erection, hormonal disorders and medical conditions like Peyronie’s or Parkinson’s disease.
Additionally, vascular diseases may lead to erectile dysfunction. Diabetics with severe vascular disease are especially at risk for this issue, while revascularization procedures like myocardial infarction or coronary artery bypass surgery have been known to cause it as well.
Organic impotence can be treated with medications. One popular medication is sildenafil (Viagra). This oral drug inhibits type 5 cGMP phosphodiesterase and improves erections by increasing nitric oxide production in the corpus cavernosum.
Yohimbine, an alpha-adrenoceptor blocker, has been studied in a small number of organically impotent patients and found to be effective in some instances.
Medications can be useful in some cases of ED, but they won’t cure it. Some medications may even make symptoms worse such as those that increase urination or reduce testosterone production in the body. Therefore, these drugs should only be taken with medical supervision and with caution since they may cause flushing, headache, dizziness, rashes, and dyspepsia; additionally, you should monitor how much alcohol you drink while taking these medicines.
