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Pathophysiology of erectile dysfunction
Marc S. Rendell, MD; Jacob Rajfer, MD; Pierre A. Wicker, MD; Michael D. Smith, PhD; for the Sildenafil Diabetes Study Group
What kinds of Erectile Dysfunction Treatment exist?
Erectile Dysfunction: Lifestyle Changes to Improve ED
Are you experiencing a lot of stress?
The classic test to find out whether the problem is psychological or physical is to measure "nocturnal tumescence." This involves wrapping a strip of paper or tape around the flaccid penis at night. If the strip is broken in the morning, an erection likely occurred during sleep and impotence is most likely a psychological one.
Herbal and other alternative treatments
Urinalysis: Analysis of urine can provide a wealth of information, including information on protein, sugar, and testosterone levels. Abnormal measurements of these substances can indicate diabetes, kidney disease, or a testosterone deficiency, all of which can cause ED.
Tens of millions of men worldwide have benefited from oral ED medications such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). However, these medications which belong to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors have limitations. They can cause systemic side effects that can be serious. These side effects include headache, facial flushing, nasal congestion, upset stomach, abnormal vision as well as isolated reports of hearing and vision loss. Men who've recently suffered a heart attack or stroke or have severe heart disease should use these drugs with caution or not at all. In addition, "an estimated 30 to 50 percent of men with ED do not respond to oral use of PDE5 inhibitors," says senior author Kelvin P. Davies, Ph.D., associate professor of urology at Einstein.
Yohimbine (Yocon) Safe
Kushida suggested that there may be a role for restless legs drugs in erectile dysfunction treatment, and said the question warrants further research.
"What I see as a problem is the public has been educated to believe that good sex requires an erect penis that stays hard through the entire sexual encounter," Shaw tells WebMD. "This definition of good sex changes the basic nature of an encounter from intimacy and pleasure to achievement and performance."
How common is erectile dysfunction?
Background A 46-year-old man presented with erectile dysfunction following a blunt perineal injury sustained 1 year previously. Oral phosphodiesterase type 5 inhibitors failed to improve his erections. The remainder of the patient's history, physical examination and laboratory tests were unremarkable except for a moderate tenderness in the left perineum and some 'fullness' in the corpora cavernosa during physical examination.
Hypertension (high blood pressure): Patients with essential hypertension or arteriosclerosis have an increased risk of developing erectile dysfunction. Essential hypertension is the most common form of hypertension; it is called essential hypertension because it is not caused by another disease, (for example, by kidney disease). It is not clearly known how essential hypertension causes erectile dysfunction; however, patients with essential hypertension have been found to have low production of nitric oxide by the arteries of the body, including the arteries in the penis. Scientists now suspect that the decreased levels of nitric oxide in patients with essential hypertension may contribute to erectile dysfunction. For more information, please read the High Blood Pressure article.
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DATA SYNTHESIS: ED is a common disorder in males with increased prevalence associated with age and presence of cardiovascular disease, prostatectomy, or diabetes mellitus. Sildenafil, vardenafil, and tadalafil are selective PDE5 inhibitors currently available for treatment of ED. Their pharmacology and pharmacokinetics vary slightly, but with potentially important clinical differences in duration of activity; all have similar clinical efficacy and adverse effect profiles in patients with ED of various causes.
In recent years, concern about the effects of BPA, particularly on fetuses and young children, have been growing. Animal studies have shown that BPA can cause reproductive abnormalities in both males and females by disrupting the endocrine system, according to background information in the study.
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