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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
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Erectile Dysfunction
What is erectile dysfunction?
Erectile dysfunction is when a man can't get an erection or
can't keep an erection long enough to finish having sex.
Another term for this problem is impotence.
It is normal for most men to have trouble having an erection
sometimes when they are tired or nervous. When erectile
dysfunction becomes a pattern or a long-lasting problem,
however, it can deeply affect the emotional lives of men and
their sex partners.
Erectile dysfunction affects older men more than younger
men. Midlife and the later years bring changes in
circulation that may affect the sex organs. Couples need to
be more open and understanding with each other about sexual
problems such as erectile dysfunction.
Fortunately, erectile dysfunction can sometimes be cured.
How does it occur?
An erection is caused when there is increased blood flow
into the penis. Penile veins then clamp down to trap blood
there, causing stiffness. Nerves in the penis provide
feelings of pleasure and help maintain the erection until
ejaculation.
There are many possible physical and nonphysical causes of
erectile dysfunction, including:
- disturbance of blood flow to the penis
- eating or drinking too much, which diverts blood to the
organs involved in digestion
- being very tired or having jet lag
- fear of failure at intercourse
- loss of interest in sex
- depression, stress, or anxiety
- diabetes
- diseases or injuries of the nervous system, such as
paralysis of the lower body or multiple sclerosis
- alcohol and drug abuse
- low levels of male hormone (testosterone)
- side effects of medicines for heart disease, high blood
pressure, epilepsy, and mental or emotional disorders
- problems after radical surgery for prostate cancer.
How is it diagnosed?
If erectile dysfunction lasts longer than 2 months or is a
recurring problem, you will want your doctor to do a
physical exam or refer you to a doctor who specializes in
erectile problems.
The exam will include urine and blood sugar tests so that
the doctor can rule out diabetes. In addition, the doctor
may want to measure the level of testosterone, a male
hormone in your blood.
The doctor may want to test penile blood flow and pressure.
He or she may also want to measure the nighttime stiffness
of the penis by the snap gauge test or stamp test.
In the snap gauge test, a band is placed around the penis
before you go to sleep. If there is an erection, the snap
gauge will break.
For the stamp test, you take a strip of stamps (such as
Easter Seals) and make a ring around the nonerect shaft of
the penis. Moisten and seal the stamp overlap before going
to sleep. Do not use postage stamps because the glue is
too strong. If you have an erection during sleep, the stamp
ring will break. This will wake you up and allow you to feel
the degree of erection. Awakening the next morning with the
ring intact means you did not have an erection while you
were asleep. Repeat the test the next two nights. If the
stamp ring is intact three times, you probably have impaired
blood flow in your penis.
If the doctor has ruled out physical problems as a cause of
erectile dysfunction, he or she may refer you and your
partner to a psychotherapist or family counselor.
Psychological problems causing erectile dysfunction are
varied, but most can be helped. Therapy often leads to
improved function in other areas of life as well as in
sexual function. Psychotherapists often like to work with
both partners. Therapy, like other treatments, can be
uncomfortable but worthwhile. If you have concerns about
your referral, discuss them with your primary doctor.
How is it treated?
If you have low blood pressure to your penis or have a
problem with blood flow to it, you may have several options.
Drug Treatment
If a man's level of testosterone is low, he can take monthly
injections of this male hormone in the arm.
Drugs may also be used to get more blood to enter the penis
through the arteries, producing or enhancing an erection.
Drugs can be injected directly into the penis to produce an
erection. Viagra (sildenafil) can be taken as
a pill rather than injected into the penis.
Viagra can help men have and keep an erection. It should be
taken about an hour before sexual activity. Viagra should
not be used by men who are taking nitrates because the
mixture could make the blood pressure dangerously low.
Erythromycin and some antifungal medicines can interact with
Viagra, too, so a lower dose of Viagra is prescribed for men
taking these medicines. Viagra can cause some mild side
effects, including flushing, headache, and less commonly,
indigestion.
Differing combinations and dosages of other drugs can be
self-injected into the penis when an erection is desired.
An occasional problem with injections has been priapism
(painful and prolonged erections), requiring emergency
treatment. Therefore, the injections must be done only with
a doctor's prescription. A man will usually become erect in
3 minutes or less. Men with hormonal or nerve problems will
usually respond in 5 minutes. Erections occurring from
injections usually last as long as an hour.
External Mechanical Devices
There are mechanical devices that trap blood in the penis to
cause an erection. They come with a vacuum chamber, a pump,
connecting tubing, and elastic bands. The system requires
time and dedication on the part of the couple to become
comfortable with it. There are a number of such devices on
the market. They may be covered by Medicare when the
problem is related to blood flow and the device is
prescribed by a doctor.
You insert the soft penis into the vacuum chamber tube
connected to a pump by a piece of tubing. You then apply
suction by using the small hand pump. Suction pulls blood
into the penis, producing an erection. The blood is held in
the penis by placing a tight band, similar to a rubber band,
around the base of the erect penis. You should not keep the
band in place longer than 30 minutes or fall asleep with it
on.
Advantages of these devices include:
- Positive results increase the desire to remain sexually
active.
- They may help to reestablish penile blood flow by
creating stiffness.
Surgery
Men who have defects of penile arteries or veins may choose
surgery to correct the defects.
Invasive Mechanical Devices or Implants
These are mechanical devices actually placed inside the
body.
Invasive devices are used only when:
- There is nerve and blood vessel damage.
- There has been no improvement with mechanical devices
used outside the body, hormonal replacement therapy, or
medical treatment of the cause.
Treatment involves inserting a mechanical device or
prosthesis into the area where the blood normally collects
to stiffen the penis.
Although the overall success rate of the penile prosthesis
is greater than 95%, many doctors urge couples to consider
simpler, less expensive choices before surgery.
The doctor will discuss the pros and cons of each type of
device and help couples select the proper one for them. The
implant has rods or cylinders that can be inflated or
deflated at will. Most prostheses can be inserted during a
one-day surgery and require no overnight hospital stay.
Semi-rigid or rigid implants:
Advantages of a semi-rigid or rigid implant are:
- It is less expensive than an inflatable implant.
- It is simple to insert.
- It can be inserted under local anesthesia.
- It is always ready for use once it is in place.
Disadvantages of a semi-rigid or rigid implant are:
- It is always at its full size.
- It may be hard to conceal. A semi-rigid implant can be
bent so it can be hidden and then brought into position
when desired.
Inflatable Implants:
Advantages of an inflatable implant are:
- It can be easily hidden. It uses a pump tucked in the
scrotum above the left testicle and a fluid reservoir
behind the pubic bone. The hollow cylinders that replace
the erectile tissues are connected to the reservoir and
can be inflated or deflated at will. The penis returns
to a resting state when the fluid is returned to the
reservoir from the cylinders by reversing the flow with
the pump.
Disadvantages of an inflatable implant are:
- It is more expensive.
- Inserting it requires a hospital stay of 24 to 48 hours.
- Since it is more complex, there are more ways in which
the device could stop working.
For More Information
You can contact:
American Foundation for Urologic Disease
1128 North Charles Street
Baltimore, MD 21201
Phone: 800-242-2383
Web sites: http://www.afud.org or
http://www.impotence.org
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