ERECTILE DYSFUNCTION

ERECTILE DYSFUNCTION
Source: NEJM 12.01.07

Inability to keep an erection strong enough to permit satisfactory sex is called Erectile Dysfunction. Five percent of men in their 40’s and 15% of men in there 70’s complain of this problem.

Years ago it was thought that is was in the mind. Now we recognize its causes and can treat this problem and maintain intimate relationships.
See www.drneedles.com for more information on intimate marital problems.

Erections occur because of increased artery and vein flow through the smooth muscle and sinusoids of the penis. Nitric oxide is made triggering the smooth muscle cells to relax. The veins are then blocked by compression resulting in an erection.

EDS may be the only symptom of serious medical problems. Biologic and psychological often cause this problem. Coronary disease accounts for two thirds of the cases and medications for 25% of the cases.

The other 9% are caused by: metabolic syndrome, enlarged prostate, heart disease, and neuralgic diseases as Parkinsonism, smoking, diabetes, and endocrine problems. Symptoms may disappear by losing weight, exercising, stop smoking and relieving stress.

Use of Viagra and other medications that relax the smooth muscles work in 51% of patients. Failure occurs because of vasodilatation reactions in other parts of the body resulting in myocardial infarctions and coronary ischemia. Vision and headaches and nausea also can occur in use of these medications.

Marked physical activity during sex increases the sympathetic activity that raises the heart rate and the blood pressure. If coronary ischemia is present or nitroglycerine is used, the blood pressure may dangerously drop.

PENILE INJECTIONS
Prostaglandin E can be injected into the penile smooth muscle. This decreases the calcium in the cells and increases AMP. Full rigidity occurs in 50% of the patients. By adding papaverine, TRIMIX, the success rate is much higher.

PENILE SUPPOSITORIES
These suppositories are put in the urethra. Success rate is about 43% in men who do not respond to Viagra. There is a small risk of erections longer than 4 hours. This is called priaprism.

TESTOSTERONE
This can be given transdermally and is 80% successful. Giving it in the muscle results in a 50% success rate. There are some drawbacks to this treatment. Breasts may enlarge, sleep apnea may occur, prostate may enlarge, cholesterol may rise, and liver enzymes may be affected. A trial of 3 months is recommended. If complications occur, treatment is stopped.

PENILE DEVICES
If nothing works one can consider a penile device.
Vacuum erections trap blood in the penis by use of an elastic band at the base of the penis. One third of men are satisfied.

Surgical implants into the penis with inflatable implant or a malleable implant. Most men are very satisfied.

PSYCHOTHERAPY
Non-genital massage, behavioral interventions and sex instructions may help.

STOPPPING MEDICATIONS
Known drugs causing EDS are diuretics, beta-blockers, cardiac drugs
cholesterol lowering drugs as statins, antidepressants and tranquilizers, anticonvulsant, cocaine, and alcohol.

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