Erectile Dysfunction

Erectile Dysfunction (ED) is said to occur when there is a persistent inability to get and keep an erection long enough for sex.

Many times, this could occur as a temporary phenomenon, as when a person is tired, stressed or has consumed too much alcohol.

However, when it is persistent or recurring, it is called Erectile Dysfunction. It is reported that about 30 million people in the United States are affected by ED. It can affect at any age, but increases in incidence as age advances. Half of the men aged 40-70 report it, while almost three-fourths of men above 70 report ED.

What is Erectile Dysfunction?

Erectile Dysfunction has three components:

There is a problem in getting an erection, maintaining the erection and a reduced sexual desire.

To understand a dysfunction, we need to understand how it occurs normally. When a person is sexually aroused, impulses from the brain travel to the penis. Here, the nerve ends release chemical nerve signals called neurotransmitters, which in turn will act on the blood vessels in the penis. The blood vessels widen, and there is a sudden surge of blood in the penis, causing engorgement and, in turn, erection of the penis. Secondly, the veins which drain the penis also get pressed and the blood flowing out of the penis is restricted. This also contributes to the engorgement and enhances erection.

Once sex is stopped, the reverse happens, and the penis gradually returns to its normal state.

What Causes Erectile Dysfunction?

ED is, therefore, a result of problems related to blood flow or nerve dysfunction and absence of sexual arousal.

Erectile Dysfunction may be due to physical and psychological causes.

Physical Causes

It is said that 80% of ED is due to physical causes. They include:

Diseases and injury of nerves: such as spinal cord problems, multiple sclerosis, stroke, Parkinson’s disease, head injury, and spinal cord injury.
Diseases which reduce blood flow to the penis: Arteries that take blood to the penis may be affected by deposits or narrowing, as in high cholesterol, smoking, and uncontrolled high blood pressure.
Diabetes: both the above problems coexist in diabetes. It is by far the most common cause of ED.
Hormonal causes: Testosterone, the male hormone, is produced in the testes and controlled by a pituitary gland in the brain. Disease or injury either to testes or to the brain may cause low testosterone secretion. This is not a common cause. It is usually accompanied by low sexual drive.
Excessive alcohol intake and drugs.
A side effect of medication: observed with beta blockers such as propranolol, some anti-depressants, diuretics, and cimetidine.
Prolonged cycling: probably because nerves are compressed for a long time.
Venous leaks and varicose veins affecting the scrotum and penis.

Psychological Causes

The brain plays a key role in matters of interest, feelings, and sexual excitement, and any changes in the mood and perception of a person could cause ED. Some common causes are - stress, anxiety, depression and poor relation with a partner.

While psychological problems could cause ED, ED itself may worsen it by causing:

Poor self-esteem.
Stress and anxiety.
Problems in relationships.
Unsatisfactory sex life.
Inability to get your partner pregnant.

Risk factors to look out for with Erectile Dysfunction:

Smoking and tobacco use.
Untreated and uncontrolled diabetes and blood pressure.
Over-weight
Alcohol and substance abuse.
Prolonged cycling.
Injuries
Surgeries in the pelvic region.
Cancer treatment and radiation.

Erectile Dysfunction Medications

ED treatment in New Jersey is done systematically. ED is treatable in most cases. Once the underlying problem is treated, ED is resolved. Even when ED is primary and no secondary cause leading to dysfunction is detected, a wide variety of treatment options are now available. Consult your PCP first, who in turn will refer you to the concerned specialist after initial tests.

Treatment options are available for ED treatment in NJ:

First, change the risk factors - change the medicines that may have caused, treat diabetes and blood pressure for meticulous control, change exercise patterns and lifestyle, and avoid indulgence in alcohol and drugs.

Second, treat underlying disorders.

Third, undergo specific treatment for erection. These include:

Oral Drugs

Common drugs used are PDE5 - an acronym for phosphodiesterase-5 inhibitors. These medicines act on the chemical mediators that cause widening of blood vessels and thereby engorgement of the penis. Common drugs are Sildenafil, Tadalafil, Vardenafil and Avanafil (common market names such as Viagra, Cialis, Levitra, and Spera).

They work very well, giving about 80% positive results. They have their limitations:

They will not work if one is not sexually aroused.
They should not be used in combination with some medications used to treat angina and high blood pressure.

Topical Treatment

Alprostadil is an ointment that needs to be applied using a plunger to the penis and surrounding skin 15-30 minutes before sex.

Counseling

As stress and depression could be cause and effect in ED, ED treatment in NJ includes psychological evaluation and treatment.

Less Commonly Used Treatment Options:

Urethral medication - Medicine in the form of a small pellet is to be introduced into the urethra. The medicine used is similar to that in the injection. Works within 15 minutes. Not used nowadays due to the skill requirement for the procedure and side effects if improperly done.

Injections - Medicine needs to be injected at the base of the penis. One needs to learn the procedure. Erection occurs in 15 minutes. Rarely used now; it was used before the availability of tablets. This causes an erection even when not aroused.

Devices A plastic container vacuum device is used to create a vacuum and negative pressure, which pulls blood into the penis. Once an erection is achieved, a rubber band needs to be placed at the base of the penis to maintain the engorgement. It should not be kept for more than 30 minutes.

Prosthesis - A penile prosthesis consisting of an inflatable pump to cause an erection can be implanted surgically. This procedure is expensive and requires the skill of use too.