Generality
Erectile dysfunction is the inability to have and / or maintain a satisfactory erection, even in the presence of a good sexual desire.
An accurate diagnosis of erectile dysfunction is always based on an accurate physical examination and a scrupulous medical history.
The treatment of erectile dysfunction includes a causal therapy, that is aimed at treating the cause at the origin of the erection problems, and a symptomatic therapy, whose goal is to help the patient to have an erection.
Short review of what the penis is and an erection
The penis is the male reproductive organ. In fact, through the penis, the man transfers the sperm, the liquid rich in spermatozoa necessary for the reproduction of the species, inside the woman's uterus.
In the penis, different characteristic anatomical elements can be recognized, which are:
- The two corpora cavernosa, within which the so-called cavernous arteries flow;
- The spongy body, in which a good part of the urethra passes. The urethra is used to expel sperm and urine from the bladder;
- The head (or glans ), in which the external opening of the urethra resides, called the urinary meatus;
- The foreskin, that is the layer of skin that serves to cover the glans.
WHAT IS THE PENISATION?
The phenomenon of erection of the penis (or penile erection ) is a spinal reflex, which involves the greater flow of blood to the cavernous arteries (and therefore to the corpora cavernosa) and the consequent increase in turgor and size of the penis.
During a penile erection, if the blood supply to the corpora cavernosa is correct, the penis is also raised; if, on the other hand, the aforementioned blood flow is less than the actual capacity of the corpora cavernosa, elevation, hardening and size increase of the penis are limited.
Penile erection is a complex physiological response, which reflects the state of male sexual arousal and depends on a perfect integration of vascular, endocrine (or hormonal), neurological, muscular and emotional mechanisms.
What is erectile dysfunction?
Erectile dysfunction is the inability to have or maintain an erection of the penis, even when good sexual desire is present.
Among men, the presence of erectile dysfunction is a source of embarrassment and can have a markedly negative impact on the tone of their mood, on their relationship with the partner and on the quality of life in general.
Is erectile dysfunction and impotence the same thing?
According to some currents of thought, the term impotence is synonymous with erectile dysfunction; according to others, however, it includes a wide and varied spectrum of sexual disorders, which concern the ability to have a penile erection, the phenomenon of ejaculation, the orgasmic phase and so on.
Epidemiology
Erectile dysfunction is a very common condition, especially among older men.
The most reliable statistical surveys report that:
- About half of men aged 40 to 70 suffer from some degree of erectile dysfunction;
- About 10% of men aged 40 to 70 suffer from severe erectile dysfunction;
- Only 5-10% of men under 40 are victims of erectile dysfunction;
- In Italy, men suffering from erection problems are 3 million, or about 10-15% of the entire male population.
Causes
The causes of erectile dysfunction are numerous; in fact, a more or less marked incapacity of penile erection may depend on certain medical conditions (physical causes), the use of certain medicines, specific psychic conditions (psychological causes) and other additional circumstances (other causes).
Physical causes of erectile dysfunction
Doctors distinguish five types of physical causes:
- The traumatic physical causes . They include all the circumstances in which to cause an inability to erect is a trauma to the penis .
- Erectile dysfunction resulting from trauma to the penis is also called post-traumatic erectile dysfunction .
- Vascular physical causes . They include all medical conditions that compromise the flow of blood to the penis.
- Erectile dysfunction due to these conditions is called vasculogenic erectile dysfunction .
- The neurological physical causes . They enclose all medical conditions that compromise the health of the nervous system and its control action on the penis.
- Erectile dysfunction resulting from these conditions is called neurogenic erectile dysfunction .
- Physical hormonal causes . All medical conditions that alter the production of hormones involved in the penile erection phenomenon belong to this type of cause.
- Erectile dysfunction due to these conditions is also called hormonal erectile dysfunction .
- The anatomical physical causes . They include all medical conditions that involve anatomical alteration of the penis.
- Erectile dysfunction dependent on these conditions is better known as anatomical erectile dysfunction .
TRAUMATIC PHYSICAL CAUSES
According to some statistical surveys, 15-25% of men suffering from severe trauma to the head of the penis would develop erectile dysfunction.
Doctors also consider erectile dysfunction resulting from damage to the penis post-traumatic, which can occur inadvertently during genital surgeries.
VASCULAR PHYSICAL CAUSES
Examples of vascular conditions that can cause erectile dysfunction are: cardiovascular diseases (eg atherosclerosis, heart diseases, etc.), hypertension and diabetes with its complications.
NEUROLOGICAL PHYSICAL CAUSES
The neurological causes of erectile dysfunction include: multiple sclerosis, Parkinson's disease, spinal cord injuries and stroke with its complications.
HORMONAL PHYSICAL CAUSES
Typical examples of hormonal conditions that can cause erectile dysfunction are: hypogonadism, hyperthyroidism, hypothyroidism and Cushing's syndrome .
ANATOMICAL PHYSICAL CAUSES
The most well-known anatomical anomaly capable of determining erectile dysfunction is the so-called Peyronie's disease .
Medicines that can cause erectile dysfunction
The drugs that can cause erectile dysfunction include:
- Diuretics . They serve to increase urine production; they are indicated in the treatment of conditions, such as hypertension, heart failure and kidney diseases;
- Antihypertensives (eg: beta-blockers). They are used for the treatment of hypertension;
- Fibrates . Belonging to the category of lipid-lowering drugs (drugs that lower the level of lipids in the blood), they are used in the treatment of hypertriglyceridemia (ie the presence of triglycerides in the blood);
- Antipsychotics . They are used to treat some mental illnesses, primarily schizophrenia;
- Antidepressants . They are indicated, mainly, in the treatment of depression and, secondarily, in the treatment of certain types of pain;
- Corticosteroids . Based on cortisol, corticosteroids are used mainly as anti-inflammatories and suppressants of the immune system;
- Anti-H2 or histamine H2 receptor antagonists . Through a particular biocellular mechanism, they reduce the production of acidic digestive juices from the stomach. Doctors prescribe H2 blockers to treat conditions such as gastritis (eg, chronic gastritis), peptic ulcer, gastroesophageal reflux, etc.
- The anticonvulsants . They are used to treat epilepsy;
- Antihistamines . They are used in the treatment of symptoms induced by allergic reactions (eg seasonal allergies, etc.);
- Anti-androgens . They are drugs with the function of preventing or inhibiting the biological effects of androgens, male sex hormones. Anti-androgens are used in the treatment of benign prostatic hyperplasia, hirsutism, male androgenetic baldness, etc .;
- Cytotoxics . They are a category of chemotherapy drugs. Chemotherapy drugs, or simply chemotherapeutic drugs, are medicines used to treat cancer.
Psychological causes of erectile dysfunction
As stated in the initial introduction, mechanisms of an emotional nature also act on erection capacity. Thus, the possibility of having or not having a good erection also depends, to some extent, on the psyche.
Specified this, doctors consider psychological causes of erectile dysfunction:
- Depression . Prolonged periods of low mood, sadness, etc. they can affect the ability to erect even in a profound way;
- Anxiety . Situations of distress, worry, fear, etc are potential causes of anxiety;
- Emotional problems or traumas, which may arise from:
- Relationship problems;
- History of one or more sexual abuse;
- Sexual inexperience;
- History of sexual disorders or dysfunctions;
- Start of a new relationship.
Curiosity
Until a few years ago, experts believed that around 90% of erection problems were purely psychological, but recent neurophysiological, haemodynamic and pharmacological studies have shown that erectile dysfunction is, in at least 50% of cases, linked to an organic cause (ex: one of the above mentioned physical causes).
Other causes
Other possible causes of erectile dysfunction are: alcohol abuse, excessive tiredness and the use of drugs, such as cannabis, heroin or cocaine.
Is cycling a cause of erectile dysfunction?
According to some scientific studies, men who practice cycling for more than 3 hours a week tend to suffer from erectile dysfunction more easily than men who do not use bikes specifically.
The cause of the problems of erection in cyclists would be to be sought in the long stay on the bicycle saddle.
Risk factors
Among the risk factors of erectile dysfunction, they deserve a report:
- Aging;
- Diabetes and cardiovascular diseases; to learn more, read: Diabetes and erectile dysfunction »
- Cigarette smoking and smoking in general;
- Overweight and obesity;
- Some medical treatments, including prostatic surgery and radiotherapy;
- Traumatic injuries to the penis;
- The use of those drugs, reported in a previous sub-chapter, capable of causing erectile dysfunction;
- The presence of depression, anxiety and other psycho-emotional problems;
- Alcohol abuse;
- The use of drugs.
Symptoms and complications
To learn more: Erectile dysfunction - Causes and Symptoms »
The typical symptomatic picture of erectile dysfunction includes: difficulty in getting an erection, difficulty in maintaining an erection, decrease in sexual desire and lack of the so-called night penile tumescence phenomenon.
Sometimes, depending on the triggering causes, to these symptoms are added: problems of ejaculation and difficulty to orgasm.
What is night penile tumescence?
The penile nocturnal tumescence is the spontaneous penile erection, which takes place during sleep (especially during the REM phase) or upon awakening from it.
In a man without erectile dysfunction, the duration and frequency of nocturnal penile tumescence episodes vary with age: in a 15-year-old adolescent, there are on average 4 episodes per night and the duration of these is about 30 minutes; in a 70-year-old man, on the other hand, only 2 episodes per night are recorded and their duration is definitely less than half an hour.
Complications
If incurable or not treated properly, erectile dysfunction can have an extremely negative impact on the lives of the men concerned; in fact, it can be a reason for:
- Unsatisfying sex life;
- Stress, anxiety and / or panic;
- Strong embarrassment and / or low self-esteem;
- Relationship problems;
- Inability to impregnate the partner, to have a child.
When should I go to the doctor?
Erectile dysfunction deserves special medical attention if:
- It is associated with episodes of premature or delayed ejaculation;
- It appears in the presence of medical conditions such as diabetes or heart disease;
- It is associated with a particular symptom picture, which suggests the presence of some disease.
Continue: Erectile Dysfunction - Diagnosis and Care »
