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have impotence .com - impotence - erectile dysfunction - viagra - ED
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ihaveImpotence.com
help
for men with ED
Greetings
and hello!
This website exists to help men with erectile dysfunction (ED). Erectile
dysfunction (ED) is the repeated inability to get or keep an erection
firm enough for sexual intercourse.
FAQ -
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Millions of men are effected, and there are great new treatments! |
What
is erectile dysfunction?
If you have trouble in the bedroom, you may have have ED. Erectile dysfunction,
sometimes called "impotence," is the repeated inability to get or keep an erection
firm enough for sexual intercourse. The word "impotence" may also be used to
describe other problems that interfere with sexual intercourse and reproduction,
such as lack of sexual desire and problems with ejaculation or orgasm. Using
the term erectile dysfunction makes it clear that those other problems are not
involved.
Erectile dysfunction, or ED, can be a total inability to achieve erection, an
inconsistent ability to do so, or a tendency to sustain only brief erections.
These variations make defining ED and estimating its incidence difficult. Estimates
range from 15 million to 30 million, depending on the definition used. According
to the National Ambulatory Medical Care Survey (NAMCS), for every 1,000 men
in the United States, 7.7 physician office visits were made for ED in 1985.
By 1999, that rate had nearly tripled to 22.3. The increase happened gradually,
presumably as treatments such as vacuum devices and injectable drugs became
more widely available and discussing erectile function became accepted. Perhaps
the most publicized advance was the introduction of the oral drug sildenafil
citrate (Viagra) in March 1998. NAMCS data on new drugs show an estimated 2.6
million mentions of Viagra at physician office visits in 1999, and one-third
of those mentions occurred during visits for a diagnosis other than ED.
In older men, ED usually has a physical cause, such as disease, injury, or side
effects of drugs. Any disorder that causes injury to the nerves or impairs blood
flow in the penis has the potential to cause ED. Incidence increases with age:
About 5 percent of 40-year-old men and between 15 and 25 percent of 65-year-old
men experience ED. But it is not an inevitable part of aging.
ED is treatable at any age, and awareness of this fact has been growing. More
men have been seeking help and returning to normal sexual activity because of
improved, successful treatments for ED. Urologists, who specialize in problems
of the urinary tract, have traditionally treated ED; however, urologists accounted
for only 25 percent of Viagra mentions in 1999.
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How
does an erection occur?
The penis contains two chambers called the corpora cavernosa, which run the
length of the organ (see figure 1). A spongy tissue fills the chambers. The
corpora cavernosa are surrounded by a membrane, called the tunica albuginea.
The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and
arteries. The urethra, which is the channel for urine and ejaculate, runs along
the underside of the corpora cavernosa.
Erection begins with sensory or mental stimulation, or both. Impulses from the
brain and local nerves cause the muscles of the corpora cavernosa to relax,
allowing blood to flow in and fill the spaces. The blood creates pressure in
the corpora cavernosa, making the penis expand. The tunica albuginea helps trap
the blood in the corpora cavernosa, thereby sustaining erection. When muscles
in the penis contract to stop the inflow of blood and open outflow channels,
erection is reversed.
Figure 1. Arteries (top) and veins (bottom) penetrate the long, filled
cavities running the length of the penis--the corpora cavernosa and the corpous
sponglosum. Erection occurs when relaxed muscles allow the corpora cavernosa
to fill with excess blood fed by the arteries, while drainage of blood through
the veins is blocked.
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What
causes ED?
Since an erection requires a precise sequence of events, ED can occur when any
of the events is disrupted. The sequence includes nerve impulses in the brain,
spinal column, and area around the penis, and response in muscles, fibrous tissues,
veins, and arteries in and near the corpora cavernosa.
Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a
result of disease, is the most common cause of ED. Diseases--such as diabetes,
kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular
disease, and neurologic disease--account for about 70 percent of ED cases. Between
35 and 50 percent of men with diabetes experience ED.
Also, surgery (especially radical prostate surgery for cancer) can injure nerves
and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate,
bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries,
and fibrous tissues of the corpora cavernosa.
In addition, many common medicines--blood pressure drugs, antihistamines, antidepressants,
tranquilizers, appetite suppressants, and cimetidine (an ulcer drug)--can produce
ED as a side effect.
Experts believe that psychological factors such as stress, anxiety, guilt, depression,
low self-esteem, and fear of sexual failure cause 10 to 20 percent of ED cases.
Men with a physical cause for ED frequently experience the same sort of psychological
reactions (stress, anxiety, guilt, depression).
Other possible causes are smoking, which affects blood flow in veins and arteries,
and hormonal abnormalities, such as not enough testosterone.
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How
is ED diagnosed?
Patient History
Medical and sexual histories help define the degree and nature of ED. A medical
history can disclose diseases that lead to ED, while a simple recounting of
sexual activity might distinguish between problems with sexual desire, erection,
ejaculation, or orgasm.
Using certain prescription or illegal drugs can suggest a chemical cause, since
drug effects account for 25 percent of ED cases. Cutting back on or substituting
certain medications can often alleviate the problem.
Physical Examination
A physical examination can give clues to systemic problems. For example, if
the penis is not sensitive to touching, a problem in the nervous system may
be the cause. Abnormal secondary sex characteristics, such as hair pattern,
can point to hormonal problems, which would mean that the endocrine system is
involved. The examiner might discover a circulatory problem by observing decreased
pulses in the wrist or ankles. And unusual characteristics of the penis itself
could suggest the source of the problem--for example, a penis that bends or
curves when erect could be the result of Peyronie's disease.
Laboratory Tests
Several laboratory tests can help diagnose ED. Tests for systemic diseases include
blood counts, urinalysis, lipid profile, and measurements of creatinine and
liver enzymes. Measuring the amount of testosterone in the blood can yield information
about problems with the endocrine system and is indicated especially in patients
with decreased sexual desire.
Other Tests
Monitoring erections that occur during sleep (nocturnal penile tumescence) can
help rule out certain psychological causes of ED. Healthy men have involuntary
erections during sleep. If nocturnal erections do not occur, then ED is likely
to have a physical rather than psychological cause. Tests of nocturnal erections
are not completely reliable, however. Scientists have not standardized such
tests and have not determined when they should be applied for best results.
Psychosocial Examination
A psychosocial examination, using an interview and a questionnaire, reveals
psychological factors. A man's sexual partner may also be interviewed to determine
expectations and perceptions during sexual intercourse.
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How
is ED treated?
Most physicians suggest that treatments proceed from least to most invasive.
Cutting back on any drugs with harmful side effects is considered first. For
example, drugs for high blood pressure work in different ways. If you think
a particular drug is causing problems with erection, tell your doctor and ask
whether you can try a different class of blood pressure medicine.
Psychotherapy and behavior modifications in selected patients are considered
next if indicated, followed by oral or locally injected drugs, vacuum devices,
and surgically implanted devices. In rare cases, surgery involving veins or
arteries may be considered.
Psychotherapy
Experts often treat psychologically based ED using techniques that decrease
the anxiety associated with intercourse. The patient's partner can help with
the techniques, which include gradual development of intimacy and stimulation.
Such techniques also can help relieve anxiety when ED from physical causes is
being treated.
Drug Therapy
Drugs for treating ED can be taken orally, injected directly into the penis,
or inserted into the urethra at the tip of the penis. In March 1998, the Food
and Drug Administration approved Viagra, the first pill to treat ED. Taken an
hour before sexual activity, Viagra works by enhancing the effects of nitric
oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation
and allows increased blood flow.
While Viagra improves the response to sexual stimulation, it does not trigger
an automatic erection as injections do. The recommended dose is 50 mg, and the
physician may adjust this dose to 100 mg or 25 mg, depending on the patient.
The drug should not be used more than once a day. Men who take nitrate-based
drugs such as nitroglycerin for heart problems should not use Viagra because
the combination can cause a sudden drop in blood pressure.
Additional oral medicines may soon be available to treat ED. Vardenafil and
Cialis are being tested for safety and effectiveness. Both of these drugs work
like Viagra by increasing blood flow to the penis. A third drug being tested,
Uprima, works on the brain and nervous system to trigger an erection.
Oral testosterone can reduce ED in some men with low levels of natural testosterone,
but it is often ineffective and may cause liver damage. Patients also have claimed
that other oral drugs--including yohimbine hydrochloride, dopamine and serotonin
agonists, and trazodone--are effective, but the results of scientific studies
to substantiate these claims have been inconsistent. Improvements observed following
use of these drugs may be examples of the placebo effect, that is, a change
that results simply from the patient's believing that an improvement will occur.
Many men achieve stronger erections by injecting drugs into the penis, causing
it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine,
and alprostadil (marketed as Caverject) widen blood vessels. These drugs may
create unwanted side effects, however, including persistent erection (known
as priapism) and scarring. Nitroglycerin, a muscle relaxant, can sometimes enhance
erection when rubbed on the penis.
A system for inserting a pellet of alprostadil into the urethra is marketed
as Muse. The system uses a prefilled applicator to deliver the pellet about
an inch deep into the urethra. An erection will begin within 8 to 10 minutes
and may last 30 to 60 minutes. The most common side effects are aching in the
penis, testicles, and area between the penis and rectum; warmth or burning sensation
in the urethra; redness from increased blood flow to the penis; and minor urethral
bleeding or spotting.
Research on drugs for treating ED is expanding rapidly. Patients should ask
their doctor about the latest advances.
Vacuum Devices
Mechanical vacuum devices cause erection by creating a partial vacuum, which
draws blood into the penis, engorging and expanding it. The devices have three
components: a plastic cylinder, into which the penis is placed; a pump, which
draws air out of the cylinder; and an elastic band, which is placed around the
base of the penis to maintain the erection after the cylinder is removed and
during intercourse by preventing blood from flowing back into the body (see
figure 2).
Figure 2. A vacuum-constrictor device causes an erection by
creating a partial vacuum around the penis, which draws blood into the corpora
cavernosa. Pictured here are the necessary components: (a) a plastic cylinder,
which covers the penis; (b) a pump, which draws air out of the cylinder; and
(c) an elastic ring, which, when fitted over the base of the penis, traps the
blood and sustains the erection after the cylinder is removed.
One variation of the vacuum device involves a semirigid rubber sheath that is
placed on the penis and remains there after erection is attained and during
intercourse.
Surgery
Surgery usually has one of three goals:
- to implant a
device that can cause the penis to become erect
- to reconstruct
arteries to increase flow of blood to the penis
- to block off
veins that allow blood to leak from the penile tissues
Implanted devices, known as prostheses, can restore erection in many men with
ED. Possible problems with implants include mechanical breakdown and infection,
although mechanical problems have diminished in recent years because of technological
advances.
Malleable implants usually consist of paired rods, which are inserted surgically
into the corpora cavernosa. The user manually adjusts the position of the penis
and, therefore, the rods. Adjustment does not affect the width or length of
the penis.
Inflatable implants consist of paired cylinders, which are surgically inserted
inside the penis and can be expanded using pressurized fluid (see figure 3).
Tubes connect the cylinders to a fluid reservoir and a pump, which are also
surgically implanted. The patient inflates the cylinders by pressing on the
small pump, located under the skin in the scrotum. Inflatable implants can expand
the length and width of the penis somewhat. They also leave the penis in a more
natural state when not inflated.
Figure 3. With an inflatable implant, erection is produced by squeezing
a small pump (a) implanted in a scrotum. The pump causes fluid to flow from
a reservoir (b) residing in the lower pelvis to two cylinders (c) residing in
the penis. The cylinders expand to create the erection.
Surgery to repair arteries can reduce ED caused by obstructions that block the
flow of blood. The best candidates for such surgery are young men with discrete
blockage of an artery because of an injury to the crotch or fracture of the
pelvis. The procedure is less successful in older men with widespread blockage.
Surgery to veins that allow blood to leave the penis usually involves an opposite
procedure--intentional blockage. Blocking off veins (ligation) can reduce the
leakage of blood that diminishes the rigidity of the penis during erection.
However, experts have raised questions about the long-term effectiveness of
this procedure, and it is rarely done.
Hope
Through Research
Advances in suppositories, injectable medications, implants, and vacuum devices
have expanded the options for men seeking treatment for ED. These advances have
also helped increase the number of men seeking treatment. Gene therapy for ED
is now being tested in several centers and may offer a long-lasting therapeutic
approach for ED.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
sponsors programs aimed at understanding the causes of erectile dysfunction
and finding treatments to reverse its effects. NIDDK's Division of Kidney, Urologic,
and Hematologic Diseases supported the researchers who developed Viagra and
continue to support basic research into the mechanisms of erection and the diseases
that impair normal function at the cellular and molecular levels, including
diabetes and high blood pressure.
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Points
to Remember
- Erectile dysfunction
(ED) is the repeated inability to get or keep an erection firm enough for
sexual intercourse.
- ED affects
15 to 30 million American men.
- ED usually
has a physical cause.
- ED is treatable
at all ages.
- Treatments
include psychotherapy, drug therapy, vacuum devices, and surgery.
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For
More Information
Sexual Function Health Council
American Foundation for Urologic Disease
1128 North Charles Street
Baltimore, MD 21201
Phone: 1-800-433-4215 or (410) 468-1800
Email: impotence@afud.org
Internet: http://www.impotence.org
Finding a Health Care Provider or Counselor
American Urological Association
1120 North Charles Street
Baltimore, MD 21201
Phone: (410) 727-1100
Email: aua@auanet.org
Internet: http://www.auanet.org
(AUA can refer you to a urologist in your area.)
American Diabetes Association (ADA)
National Office
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1-800-DIABETES
Internet: http://www.diabetes.org
(ADA can help you find a doctor who specializes in diabetes care in your area.)
American Association of Sex Educators, Counselors, and Therapists (AASECT)
P.O. Box 238
Mount Vernon, IA 52314
Internet: http://www.aasect.org
(Check the AASECT website to find a certified sexuality educator, counselor,
or therapist in your area.)
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3580
Email: nkudic@info.niddk.nih.gov
The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
is a service of the National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under
the U.S. Department of Health and Human Services. Established in 1987, the clearinghouse
provides information about diseases of the kidneys and urologic system to people
with kidney and urologic disorders and to their families, health care professionals,
and the public. NKUDIC answers inquiries, develops and distributes publications,
and works closely with professional and patient organizations and Government
agencies to coordinate resources about kidney and urologic diseases.
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