PENILE ERECTION:
Penile erection is managed by two different mechanisms:
- The first one is the reflex erection, which is achieved by directly touching the penile shaft.
- The second is the psychogenic erection, which is achieved by erotic stimuli.
The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both conditions an intact neural system is required for a successful and complete erection. Stimulation of penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy male erectile system.
IMPOTENCE & ERECTILE DYSFUNCTION:
Erectile dysfunction (ED), previously termed as impotence, is the inability to achieve/ maintain an erection that is sufficient to ensure satisfactory sexual intercourse for both partners. ED may range from mild to severe dysfunction, ranging from partial to total inability to have erections.
As can be understood from the mechanisms of a normal erection, Impotence and/ED may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems.
Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also include causation by prolonged exposure to bright light or chronic exposure to high noise levels.
A few causes of impotence may be iatrogenic (medically caused). Various antihypertensives (medications intended to control high blood pressure) and some drugs that modify central nervous system response may inhibit erection by denying blood supply or by altering nerve activity.
- Antidepressants, especially SSRIs, can cause impotence as a side effect.
- Surgical intervention for a number of different conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Some studies have shown that male circumcision may result in an increased risk of impotence, while others have found no such effect, and another found the opposite.
- Excessive alcohol use has long been recognized as one cause of impotence, leading to the euphemism "brewer's droop"; Shakespeare made light of this phenomenon in Macbeth.
- A study in 2002 found that ED can also be associated with bicycling. The number of hours on a bike and/or the pressure on the penis from the saddle of an upright bicycle is directly related to erectile dysfunction.
Because ED is a great cause of embarrassment to most men, those suffering from it tend to live in denial. They make up various excuses to justify their problem:
- I’m too tired
- I’m young, so I can’t be having any problem
- It doesn’t happen every time
- I’m just not up to it tonight
- I’m too stressed to pay attention
- Maybe I’m not happy with this relationship
- I’ve been drinking too much
ED is a serious problem, which often points to other diseases such as diabetes, arteriosclerosis, etc. and hence must not be ignored. Consult your physician today! Determine the cause of the problem, so that suitable corrective measures may be undertaken immediately.
The Erection Mechanism
The physiologic mechanism of erection of the penis involves release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation. NO then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood.
Basically, erection process involves following from interest to arousal and finally resulting into penile erection:
- Sexual stimulation and excitement
- Relaxation of their smooth muscles in the genital area
- Dilation of arterioles in the genital area
- Blood fills up spaces of the Corpora Cavernosa in the penis
- Expansion of the Corpora Cavernosa
- Strong pressure exerted on the veins that normally drain blood from the penis
- Exerted pressure allows trapping the blood in the penis
- Thickening, rigidity, and elongation of the penis
- Erector muscle of penis draws the penis forward
- Penis ready for vaginal penetration
Causes of Erectile Dysfunction
Research has shown that a high majority of cases of ED arise from physical causes. The remaining cases, significant nonetheless and constituting about 20% of the total have psychological origins.
Physical Factors
- Vascular Diseases
- Metabolic disorders
- Nerve Disease
- Cancer treatment
- Hormonal Problems
- Side Effects of Medications
- Alcohol: Long-term
- Smoking
- Sedentary Lifestyle
Psychological Factors
- Anxiety
- Stress
- Depression
- Relationship Problems
Psychosocial causes can occur alone or in combination with one or more of the physical causes of ED.
Erectile Dysfunction Diagnosis
However, there is no specific test conducted to determine ED.But to be clear with the fact and also to rule out possible causes, a preliminary investigation is conducted to determine the origin of erectile dysfunction. It consist of some prime questions to be answered before going for any treatment, regarding medical history, lifestyle and even emotional well being. Then certain tests are conducted to confirm the same.
Blood tests: Male hormone levels are measured and tests are conducted to eliminate diseases such as diabetes from the list of potential causes.
Penile nerve function: Physical tests are performed to determine sufficient nerve sensation in the penis.
Ultrasonography: Duplex ultrasound is used to assess the adequacy of arterial circulation in the genital area.
Nocturnal Penile Tumescence (NPT): Various methods are used to measure changes in penile rigidity and girth during nocturnal erections.
Cavernosometry: This test measures vascular pressure in the penis.
Treatment and care
Your doctor or other healthcare professional will suggest several treatment options for your problem, depending on its severity.
Oral Medication (prescription):
The prescription PDE5 inhibitors sildenafil (Viagra®), vardenafil (Levitra®) and tadalafil (Cialis®) are prescription drugs which are taken orally. They work by blocking the action of PDE5, which causes cGMP to degrade. cGMP causes the smooth muscle of the arteries in the penis to relax, allowing the corpus cavernosum to fill with blood.
Oral Medication (herbal remedies):
These are supplements that might be taken before sexual activity to improve erectile function. Usually, herbal supplements like ProCalisX are a combination of herbs, vitamins and minerals that are risk-free and do not involve any side effects.
Vacuum pump:
An external vacuum pump will produce an engorged penis with success approaching 90%; a penis ring will maintain this state, although it should be removed after not more than 30 minutes. The erection is not as rigid or hard as a natural erection; drugs or injections, when they work, may be preferable. Various studies show the degree of satisfaction of users and their partners to be vary variable, even when drugs and injections do not work; in one study, about 20% of men who tried a (high-priced) pump decided to proceed to purchase one. Other studies show higher percentages of satisfied users.
In some cases frequent use of a vacuum pump can eventually improve the degree of erection attainable without use of the pump. Claims of cheap "penis pumps" to permanently increase maximum penis size should be viewed with caution,
Sex Counseling:
Consulting a trained counselor, psychologist or psychiatrist may help you identify, understand and deal with your sexual distress.
Penile Injection Therapy:
Shortly before sexual activity, the patient injects a medication that increases blood flow to the penis.
Intraurethral Therapy:
Pellets of a medication that increases blood flow are inserted into the urethra (through which urine flows out).
Vacuum Therapy:
A vacuum device is used to cause blood to flow into the penis and a constriction ring is placed at its base to maintain the erection.
Penile Implant Surgery:
This is a device that is surgically inserted into the penis and used when there is a desire for sexual intercourse.
Controversial and unapproved treatments
Bremelanotide The experimental drug Bremelanotide (formerly PT-141) does not act on the vascular system like the former compounds but allegedly increases sexual desire and drive in males as well as females. It is applied as a nasal spray. Bremelanotide allegedly works by activating melanocortin receptors in the brain. It is currently in Phase IIb trials.
hMaxi-K
hMaxi-K is a form of gene therapy using a plasmid vector that expresses the hSlo gene that encodes the alpha-subunit of the Maxi-K channel. It has undergone phase I safety trials.
Ginseng
A double-blind study appears to show evidence that ginseng is better than placebo
Herbal and other alternative treatments
These are generally ineffective when tested blind, but may be useful for their psychological (placebo) effect: if a good result is expected, any highly-praised, and often expensive, treatment can be effective. Reputable drugs can also benefit from the same effect.
Precaution is ALWAYS BETTER than cure
Before starting any medication for ED, it may be advisable to make some simple changes to your daily routine. Your doctor or healthcare professional may recommend and help you follow a few of these:
- Exercise
- Healthy Diet
- Stress management
- Quit smoking
- Reduce alcohol intake
