"Brewer's droop" and "Impotent" redirect here. For the band, see Brewers Droop. For the classification of poverty, see impotent poor.
| Erectile dysfunction |
| Classification and external resources |
| ICD-10 |
F52.2, N48.4 |
| ICD-9 |
302.72, 607.84 |
| DiseasesDB |
21555 |
| eMedicine |
med/3023 |
| MeSH |
D007172 |
Erectile dysfunction (ED) is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance.[1]
A penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis. The process is often initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis. Erectile dysfunction is indicated when an erection is difficult to produce. There are various circulatory causes, including alteration of the voltage-gated potassium channel, as in arsenic poisoning from drinking water.[2] The most important organic causes are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects.
Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but often can be helped. Notably in psychological impotence, there is a strong response to placebo treatment. Erectile dysfunction, tied closely as it is about ideas of physical well being, can have severe psychological consequences.
Besides treating the underlying causes such as potassium deficiency or arsenic contamination of drinking water, the first line treatment of erectile dysfunction consists of a trial of PDE5 inhibitor drugs (the first of which was sildenafil or Viagra). In some cases, treatment can involve prostaglandin tablets in the urethra, injections into the penis, a penile prosthesis, a penis pump or vascular reconstructive surgery.[3]
The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina. It is now mostly replaced by more precise terms.[vague] The study of erectile dysfunction within medicine is covered by andrology, a sub-field within urology.
|
Contents
- 1 Signs and symptoms
- 2 Causes
- 3 Pathophysiology
- 4 Diagnosis
- 5 Treatment
- 5.1 Medication
- 5.2 Surgery
- 5.3 Devices
- 5.4 Alternative medicine
- 6 History
- 7 Research
- 8 References
- 9 External links
|
Signs and symptoms
Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection. There are several ways that erectile dysfunction is analyzed:
- Obtaining full erections at some times, such as when asleep (when the mind and psychological issues, if any, are less present), tends to suggest the physical structures are functionally working.
- Other factors leading to erectile dysfunction are diabetes mellitus (causing neuropathy).
Causes
- Drugs (anti-depressants (SSRIs) and nicotine are most common)
- Neurogenic disorders (spinal cord and brain injuries, nerve disorders such as Parkinson's disease, Alzheimer's disease, multiple sclerosis, and stroke[4])
- Cavernosal disorders (Peyronie's disease[5])
- Psychological causes: performance anxiety, stress, mental disorders (clinical depression, schizophrenia, substance abuse, panic disorder, generalized anxiety disorder, personality disorders or traits[6]), psychological problems, negative feelings.[7][not in citation given]
- Surgery (radiation therapy, surgery of the colon, prostate, bladder, or rectum may damage the nerves and blood vessels involved in erection. Prostate and bladder cancer surgery often require removing tissue and nerves surrounding a tumor, which increases the risk for impotence[8])
- Ageing. It is four times higher in men in their 60s than in men in their 40s.[9]
- Kidney failure
- Diseases such as diabetes and multiple sclerosis (MS). While these two causes have not been proven they’re likely suspects as they cause issues with both the blood flow and nervous systems.
- Lifestyle: smoking is a key cause of erectile dysfunction.[10][11] Smoking causes impotence because it promotes arterial narrowing.[12] See also Tobacco and health.
A few causes of impotence may be iatrogenic (medically caused).
Surgical intervention for a number of different conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Complete removal of the prostate gland or external beam radiotherapy of the gland are common causes of impotence; both are treatments for prostate cancer.
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.[13][better source needed]
A recent study suggests an epidemiological association between chronic periodontitis (periodontal inflammation) and erectile dysfunction,[14] similarly to the association between periodontitis and coronary heart diseases,[15] and cerebrovascular diseases.[16] In all the three conditions (erectile dysfunction, coronary heart disease and cerebrovascular diseases), despite the epidemiological association with periodontitis, no causative connection has proved yet.
February 2011: Men who use non-steroidal anti-inflammatory drugs (NSAIDs) 3 times a day for more than 3 months are at a 22 percent increased risk of erectile dysfunction. A link between NSAID use and erectile dysfunction still existed for different age, race, ethnicity, smoker, diabetes, hypertension, high cholesterol, coronary diasease and others health problems. But due to benefit of NSAID, it's too early for men to avoid NSAIDs based solely on the research stated at Journal of Urology.[17]
Pathophysiology
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This section needs additional citations for verification. (May 2010) |
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 or emotional 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 erectile system. As can be understood from the mechanisms of a normal erection, impotence 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 be caused by prolonged exposure to bright light.
Diagnosis
|
This section needs additional citations for verification. (May 2010) |
There are no formal tests to diagnose erectile dysfunction. Some blood tests are generally done to exclude underlying disease, such as hypogonadism and prolactinoma. Diabetes is considered a disorder, but is also a risk. Impotence is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease such as coronary artery disease and peripheral vascular disease.
A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection. If never, the problem is likely to be physiological; if sometimes (however rarely), it could be physiological or psychological. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence.
- Duplex ultrasound
- Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue. Injecting prostaglandin, a hormone-like stimulator produced in the body, induces erection. Ultrasound is then used to see vascular dilation and measure penile blood pressure.
- Penile nerves function
- Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus.
- Nocturnal penile tumescence (NPT)
- It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections.
- Penile biothesiometry
- This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.
- Dynamic infusion cavernosometry (DICC)
- technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.
- Corpus cavernosometry
- Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualised by infusing a mixture of saline and x ray contrast medium and performing a cavernosogram.;[18] Digital Subtraction Angiography: In DSA, the images are acquired digitally.
- Magnetic resonance angiography (MRA)
- This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a "contrast agent" into the patient's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies.
Treatment
Treatment depends on the cause.
Exercise, particularly aerobic exercise is an effective treatment for erectile dysfunction.[19][better source needed]
When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants may be fitted surgically. Medications carry risk of priapism.
All these mechanical methods are based on simple principles of hydraulics and mechanics and are quite reliable, but have their disadvantages.
Medication
- Phosphodiesterase type 5 inhibitors
The cyclic nucleotide phosphodiesterases constitute a group of enzymes that catalyze the hydrolysis of the cyclic nucleotides cyclic AMP and cyclic GMP. They exist in different molecular forms and are unevenly distributed throughout the body.
One of the forms of phosphodiesterase is termed PDE5. The prescription PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally.[20] They work by blocking the action of PDE5, which causes cGMP to degrade.
- Alprostadil
Alprostadil in combination with the permeation enhancer DDAIP has been approved in Canada under the brand name Vitaros as a topical cream first line treatment for erectile dysfunction.[21]
Another treatment regimen is injection therapy. One of the following drugs is injected into the penis: papaverine, phentolamine, and prostaglandin E1.[22]
Surgery
Main article: Penile prosthesis
Often, as a last resort if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.[23][unreliable source?]
Devices
Main article: penis pump
The device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available with a doctor's prescription.
Alternative medicine
The FDA does not recommend alternative therapies to treat sexual function.[24][clarification needed] There are many different products advertised as "herbal viagra" or "natural" sexual enhancement products, but there are no clinical trials or scientific studies that support the effectiveness of these products for the treatment of erectile dysfunction, and synthetic chemical compounds similar to sildenafil have been found as adulterants in many of these products.[25][26][27][28][29] The United States Food and Drug Administration has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant.[30]
History
|
This section needs additional citations for verification. (May 2010) |
Dr. John R. Brinkley initiated a boom in male impotence cures in the US in the 1920s and 1930s. His radio programs recommended expensive goat gland implants and "mercurochrome" injections as the path to restored male virility, including operations by surgeon Serge Voronoff.
Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley, Ph.D. dropped his trousers and demonstrated to a shocked Urodynamics Society audience his papaverine-induced erection.[31] The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. The effect that Brindley discovered established the fundamentals for the later development of specific, safe, orally effective drug therapies.[32][better source needed][33][better source needed]
Research
- Gene therapy
Gene therapy is being developed that would allow for weeks or months long effect, supporting erections. This gene therapy involves injection of a transfer gene, calcium-sensitive potassium channel (hMaxi-K), into the penis.[34][35][36]
- Tx2-6
A study done at the Medical College of Georgia has found that venom from the Brazilian wandering spider contains a toxin, called Tx2-6, that causes erections. Scientists believe that combining this toxin with existing medication such as Viagra may lead to an effective treatment for erectile dysfunction.[37]
References
- ^ www.muschealth.com
- ^ Risk of erectile dysfunction induced by arsenic exposure through well water consumption in Taiwan.Hsieh FI, Hwang TS, Hsieh YC, Lo HC, Su CT, Hsu HS, Chiou HY, Chen CJ.School of Public Health, Topnotch Stroke Research Center, Taipei Medical University, Taipei 110, Taiwan
- ^ Montague DK, Jarow JP, Broderick GA et al. (July 2005). "Chapter 1: The management of erectile dysfunction: an AUA update". J. Urol. 174 (1): 230–9. DOI:10.1097/01.ju.0000164463.19239.19. PMID 15947645.
- ^ "Erectile Dysfunction causes". Erection Problems (Erectile Dysfunction). Healthwise. 2006. http://health.msn.com/centers/mensexualhealth/articlepage.aspx?cp-documentid=100062424. Retrieved 2007-10-07.
- ^ "Male Sexual Dysfunction Epidemiology". Erectile dysfunction. Armenian Health Network, Health.am. 2006. http://www.health.am/sex/more/male_sexual_dysfunction_epid/. Retrieved 2007-10-07.
- ^ Tom F. Lue, MD (2006). "Causes of Erectile Dysfunction". Erectile dysfunction. Armenian Health Network, Health.am. http://www.health.am/sex/more/causes_of_erectile_dysfunction/. Retrieved 2007-10-07.
- ^ "Erectile dysfunction". Erectile dysfunction. Mayo Clinic. 2006. http://www.mayoclinic.com/health/erectile-dysfunction/DS00162/DSECTION=3. Retrieved 2007-10-07.
- ^ "Erectile Dysfunction Causes". Erectile Dysfunction. Healthcommunities.com. 1998. http://www.urologychannel.com/erectiledysfunction/causes.shtml. Retrieved 2007-10-07.
- ^ "Erectile Dysfunction". http://www.medicinenet.com/impotence/symptoms.htm. Retrieved 2010-07-01.
- ^ Peate I (2005). "The effects of smoking on the reproductive health of men". Br J Nurs 14 (7): 362–6. PMID 15924009.
- ^ Korenman SG (2004). "Epidemiology of erectile dysfunction". Endocrine 23 (2–3): 87–91. DOI:10.1385/ENDO:23:2-3:087. PMID 15146084.
- ^ Kendirci M, Nowfar S, Hellstrom WJ. (2005). "The impact of vascular risk factors on erectile function". Drugs Today (Barc) 41 (1): 65–74. DOI:10.1358/dot.2005.41.1.875779. PMID 15753970.
- ^ Schrader S, Breitenstein M, Clark J, Lowe B, Turner T (1 November–December 2002). "Nocturnal penile tumescence and rigidity testing in bicycling patrol officers". J Androl 23 (6): 927–34. PMID 12399541. http://www.andrologyjournal.org/cgi/content/full/23/6/927.
- ^ Zadik Y, Bechor R, Galor S, Justo D, Heruti RJ (April 2009). "Erectile dysfunction might be associated with chronic periodontal disease: two ends of the cardiovascular spectrum". J Sex Med 6 (4): 1111–6. DOI:10.1111/j.1743-6109.2008.01141.x. PMID 19170861.
- ^ Friedewald VE, Kornman KS, Beck JD et al. (July 2009). "The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: periodontitis and atherosclerotic cardiovascular disease". Am J Cardiol 104 (1): 59–68. DOI:10.1016/j.amjcard.2009.05.002. PMID 19576322. http://www.ajconline.org/article/S0002-9149(09)01025-X/abstract.
- ^ Khader YS, Albashaireh ZS, Alomari MA (August 2004). "Periodontal diseases and the risk of coronary heart and cerebrovascular diseases: a meta-analysis". J Periodontol 75 (8): 1046–53. DOI:10.1902/jop.2004.75.8.1046. PMID 15455730.
- ^ "Most Popular E-mail Newsletter". USA Today. http://yourlife.usatoday.com/health/story/2011/03/New-study-links-pain-relievers-to-erectile-dysfunction/44363996/1?csp=34news&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+usatoday-NewsTopStories+%28News+-+Top+Stories%29.
- ^ Dawson C, Whitfield H (April 1996). "ABC of urology. Subfertility and male sexual dysfunction". BMJ 312 (7035): 902–5. PMC 2350600. PMID 8611887. http://www.bmj.com/cgi/content/full/312/7035/902.
- ^ Sexual Function in Men Older Than 50 Years of Age, annals.org, August 5, 2003
- ^ John P. Mulhall, M.D., Saving Your Sex Life: A Guide for Men with Prostate Cancer, Chicago, Hilton Publishing Company, 2008
- ^ Bujdos, Brian. "New Topical Erectile Dysfunction Drug Vitaros Approved in Canada; Approved Topical Drug Testim Proves Helpful for Erectile Dysfunction". http://www.accessrx.com/blog/current-health-news/vitaros-testim-topical-drugs-treat-erectile-dysfunction-a1115. Retrieved 15 April 2011.
- ^ American vein and aesthetic institute, "Intra-Corporeal Injections For Erectile Dysfunction" http://www.medrehab.com/ICI_Impotence.php
- ^ Penile prostheses (implants) Chris Steidle, MD, SeekWellness.com
- ^ "Dangers of Sexual Enhancement Supplements". http://www.medscape.com/viewarticle/562177.
- ^ Gryniewicz, CM; Reepmeyer, JC; Kauffman, JF; Buhse, LF (2009). "Detection of undeclared erectile dysfunction drugs and analogues in dietary supplements by ion mobility spectrometry". Journal of pharmaceutical and biomedical analysis 49 (3): 601–6. DOI:10.1016/j.jpba.2008.12.002. PMID 19150190.
- ^ Choi, Dong Mi; Park, Sangaeh; Yoon, Tae Hyung; Jeong, Hye Kyoung; Pyo, Jae Sung; Park, Janghyun; Kim, Deukjoon; Kwon, Sung Won (2008). "Determination of analogs of sildenafil and vardenafil in foods by column liquid chromatography with a photodiode array detector, mass spectrometry, and nuclear magnetic resonance spectrometry". Journal of AOAC International 91 (3): 580–588. PMID 18567304.
- ^ Reepmeyer, John C.; Woodruff, Jeffrey T. (2007). "Use of liquid chromatography-mass spectrometry and a chemical cleavage reaction for the structure elucidation of a new sildenafil analogue detected as an adulterant in an herbal dietary supplement". Journal of Pharmaceutical and Biomedical Analysis 44 (4): 887–893. DOI:10.1016/j.jpba.2007.04.011. PMID 17532168.
- ^ Reepmeyer, John C.; Woodruff, Jeffrey T.; 'Avignon, D. Andre. (2007). "Structure elucidation of a novel analogue of sildenafil detected as an adulterant in an herbal dietary supplement". Journal of Pharmaceutical and Biomedical Analysis 43 (5): 1615–1621. DOI:10.1016/j.jpba.2006.11.037. PMID 17207601.
- ^ Enforcement Report for June 30, 2010, United States Food and Drug Administration
- ^ Hidden Risks of Erectile Dysfunction "Treatments" Sold Online, United States Food and Drug Administration, February 21, 2009
- ^ Klotz, L. (Nov 2005). "How (not) to communicate new scientific information: a memoir of the famous Brindley lecture". BJU Int 96 (7): 956–7. DOI:10.1111/j.1464-410X.2005.05797.x. PMID 16225508.
- ^ Brindley G (October 1983). "Cavernosal alpha-blockade: a new technique for investigating and treating erectile impotence". Br J Psychiatry 143 (4): 332–7. DOI:10.1192/bjp.143.4.332. PMID 6626852.
- ^ Helgason ÁR, Adolfsson J, Dickman P et al. (1996). "Sexual desire, erection, orgasm and ejaculatory functions and their importance to elderly Swedish men: a population-based study". Age Ageing 25 (4): 285–291. DOI:10.1093/ageing/25.4.285. PMID 8831873.
- ^ Emma Hitt, "Gene Therapy May Offer Long-Term Impotence Remedy ," Reuters Health, May 29, 2009 http://www.erecthard.com/gene_therapy_for_impotence.php
- ^ Erectile Dysfunction :: Gene therapy for erectile dysfunction shows promise in clinical trial published at SpiritIndia on Friday, December 1, 2006 http://www.spiritindia.com/health-care-news-articles-4359.html
- ^ "Smooth-Muscle–Specific Gene Transfer with the Human Maxi-K Channel Improves Erectile Function and Enhances Sexual Behavior in Atherosclerotic Cynomolgus Monkeys" George J. Christ, Karl-Erik Andersson, Koudy Williams, Weixin Zhao, Ralph D’Agostino Jr., Jay Kaplan, Tamer Aboushwareb, James Yoo, Giulia Calenda, Kelvin P. Davies, Rani S. Sellers, Arnold Melman. European Urology, Volume 56, issue 6, pages 891-1104, December 2009; Accepted 11 December 2008, pages 1055 - 1066 http://www.europeanurology.com/article/S0302-2838%2808%2901491-7/abstract
- ^ Hernandez, Vladimir (4 May 2007). "Spider venom could boost sex life". BBC News. http://news.bbc.co.uk/1/hi/world/americas/6625397.stm.
External links
- Erectile dysfunction at the Open Directory Project
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