Definition of Erectile Dysfunction

Erectile dysfunction is the inability to develop an erection firm enough to enable a man to enjoy sexual intercourse. It’s not necessarily a complete loss of erection, for it can involve partial loss of erection in certain situations. It also implies that under certain conditions and may lose his erections during sexual activity.

What you need to know about erection problems

Loss of erection can occur under many different circumstances, the most common of which would be when a man is attempting to engage in sexual activity and experiences anxiety.  

In most cases erection problems go away fairly quickly. It’s only when a man experiences erectile failure on several consecutive occasions that he may begin to develop such a persistent level of anxiety that he becomes truly impotent.

If an erection problem is ongoing it certainly can damage a man’s sexual self-esteem and sexual self-confidence. And even when there are obvious physical causes, the psychological contribution of a man’s mind is profound. One key indicator of the cause of erectile failure is whether or not a man experiences erections during the night. These involuntary erections are a good indication of whether or not his body is capable of sustaining an erection.

Fortunately it’s not difficult to check whether a man is experiencing firm erections during the night. The so-called nocturnal penile tumescence test involves placing a measuring device around this shaft of the penis and seeing if it expands in erection during the night. 

We need hardly add, I am sure, that ejaculation problems such as premature ejaculation or delayed ejaculation have only a very limited connection with erectile dysfunction. 

Causes of erection problems

Penile erection is a complicated process that requires the interaction of many different parts of the body: the nervous system, the circulatory system and the mind. Any interruption at any part of this rather complicated process can lead to a significant difficulty during sexual activity.

The causes of erection failure are:

• The first and most well-known condition that causes erectile failure is diabetes, but others conditions such as high blood pressure heart disease and neurological disorders can also be implicated. Parkinson’s disease and multiple sclerosis in particular are significant causes of erectile failure.
• Prescription medications: those issued for high BP, in particular  beta-blockers; mood altering drugs such as antidepressants; sleeping pills and some heart medications. 
• Prostate surgery, and surgery for pelvic injuries which required deep surgery, nerve damage during such surgery is often followed by erectile failure.
• Smoking, drinking alcohol, and the use of illegal drugs such as cocaine.
• Emotinal issues: poor communication within a relationship, lack of desire for your partner, emotional resentment, anger, depression, anxiety and a host of other stressful emotions and situations can cause erectile failure. 
• Bad feelings repeatedly expressed within a relationship.
• Spinal cord injury is a major cause of erectile failure.
• iEmotions that cause erectile failure are anxiety, stress, anger and depression. 
• Men who have sexual performance standards, or whose view of sex is governed by the view that the man must “perform”, give the woman orgasm, satisfy the woman at all times, and only then take pleasure, anxiety about being a good enough lover can often produce erection difficulties.

It is true that erection problems become more common as a man gets older. However, as we have observed direction problems can strike a man at any age: the physically-based problems are more common in older men, and the emotional/psychologically-based problems or more common in younger men.

It’s worth mentioning at this point that good communication between the partners in an committed relationship is absolutely essential. This avoids problems of anorgasmia (delayed ejaculation) or erectile failure. 

Video – erection problems

What to Expect If You Visit The Doctor With Concerns About Your Erection

In general the doctor will perform several examinations and should also run tests for hormone levels and cholesterol levels in your blood to ensure that there is not a circulatory issue affecting your penis. Other likely questions include: How long has the difficulty been present? Do you experience nocturnal erections or emissions? what are your energy levels? Are you anxious around sexual activity because of your erectile failure? Have there been any recent changes in your relationship, sexual activity, life changes, health, energy levels, stress levels? Have you recently had surgery, any treatments for your circulation system, your heart, your kidneys or any other aspect of your well-being? Do you have other symptoms? Do you have problems urinating?

You may find that the doctor orders a series of tests which will include blood tests, hormone profiles, cholesterol profiles, prostate specific antigen (PSA), erection rigidity monitoring, stress tests and so on.

The treatment of erection problems

This all depends on the cause of your erectile dysfunction. If your difficulty is caused by some kind of hormonal imbalance, then whatever underlying endocrine disorder exists must be treated first. If you have an abnormality of the penis such as Peyronie’s disease, then then this may need treating first. It goes without saying that if you’re a heavy smoker, drinker, or eat excessively, then you need to make some lifestyle changes before you start addressing the issue of your ED.

The treatment of erectile dysfunction in recent times has been revolutionized by the advent of new treatment options. Viagra and its associated compounds are highly effective treatments which work for a large percentage of men with erectile failure. (Men with whom these drugs do not work may wish to consider addressing the emotional/psychological aspects of their relationship and the issues that may be causing them difficulty in achieving and sustaining erection. There are of course side-effects with each  sort of treatment.) We’ll just mention these briefly:

Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are drugs prescribed for men who have erectile dysfunction.

They are phosphodiesterase-5 inhibitors, a name which refers to the enzyme on which they act to prevent loss of erection during sexual activity. They are not aphrodisiacs: that is to say, they do not promote sexual desire, they only work well as pre-existing libido to increase rigidity of the penis. They also may have side effects which can be disturbing if you are not aware of them in advance: these include flushing of the face, a blueish tinge to your vision, and muscular pain. These drugs need to be avoided if you are taking certain types of heart medication. For example when taken with nitroglycerin they can lead to a dangerous fall in blood pressure.

The contraindications for PDE5 use include any of the following medical conditions (subject to medical advice):

• stroke
• moderate to severe heart disease including unstable angina, cardiac arrhythmia or a recent heart attack
• heart failure
• hypertension (high blood pressure)
• diabetes
• low blood pressure (hypotension)

One of the best combinations of medication for ED is testosterone replacement therapy and Viagra. This is especially true for men who are experiencing a drop in hormone levels due to the mid-life andropause.

Viagra for Treatment of Erectile Dysfunction

What is Viagra?

Viagra (sildenafil citrate) is a drug made by Pfizer Pharmaceuticals. It was approved for sale in March 1998, so it has been around forever 24 years and its safety record is pretty good.

It was developed by Pfizer as a drug which was designed to help men experiencing chest pain, but its development was aborted in 1992 because it did not show any promising signs of effectiveness as a heart medication. However, ancedotal information about the effects of sildenafil citrate caused Pfizer researchers to consider it as a treatment for erectile dysfunction.

When re-evaluated as a treatment for erectile dysfunction it showed considerable promise: studies on more than 3500 men aged between 19 and 87 years have demonstrated that Viagra works effectively in a number of conditions associated with ED including:

• diabetes
• injury to the spinal cord
• prostate surgery
• unknown cause
• hypertension and coronary artery disease

Viagra was so effective that the FDA approved the drug only six months after submission, because there were no issues of any significance, including adverse side-effects associated with it. (Although it has subsequently merged that Viagra must not be taken with various heart medications with which it can interact adversely.)

When taking Viagra

It is important to emphasize that there are some men who do not respond to it, and it does not increase libido or sexual desire.  This is because it works on the physical response to nerve impulses produced by sexual arousal in mind or body.

General precautions before taking Viagra should be observed as follows:

• anyone taking nitrates, such as nitroglycerin, must not use Viagra. These compounds in combination can lower blood pressure too far.
• Viagra is only suitable for use by adult men.
• the use of Viagra shows be preceded by a complete medical examination.
• any man at risk of priapism or sustained erection (for example men with conditions such as sickle cell anemia, leukemia or multiple myeloma), or a man who has any penile abnormality should not take Viagra.
• you need to be aware that medications can interact with Viagra and therefore should consult your doctor about any existing prescriptions that you are using.
• Viagra Should not be used in combination with any other form of treatment for ED.

What are the side effects of Viagra?

Viagra has been found to have the following side effects in the clinical studies referred to above:

• headache – 16 percent
• flushing – 10 percent
• indigestion – 7 percent
• nasal congestion – 3 percent
• urinary tract infection – 3 percent
• less than three percent:
• mild and temporary visual changes (blue/green color perception changes and/or blurred vision), with possibly increased sensitivity to light
• diarrhea
• dizziness
• rash
• other side-effects included respiratory tract infection, back pain, flu and joint pain

Side effects that occurred less than 2 percent included respiratory tract infection, back pain, flu syndrome, and arthralgia (joint pain).

The mechanism of Viagra

The erectile mechanism of the penis involves nitric oxide (NO) being released. This compound is released in response to sexual stimulation in the corpora cavernosa of the penis.

• Nitric oxide is responsible for activating guanylate cyclase, which results in an increase in the tissue levels of cyclic guanosine monophosphate (cGMP).
• This increase induces smooth-muscle relaxation in the corpora cavernosa and this in turn allows the inflow of blood.
• Viagra (sildenafil citrate ) does not cause a direct relaxation of the human corpora cavernosa.
• Viagra enhances the effect of nitric oxide (NO) by inhibiting phosphodiesterase type 5 (PDE5). Read more here.
• PDE5 is responsible for causing the degradation of cGMP in the corpora cavernosa – this makes the penis become flaccid, or relaxed, as blood flow out of the penis increases. 
• Sexual stimulation induces local release of NO, while Viagra inhibits PDE5, which causes an increase in tissue levels of cGMP in the corpora cavernosa. This allows continuing smooth-muscle relaxation, which permits inflow of blood to the corpora cavernosa, and erection of the penis.
• Viagra does not work when sexual stimulation is absent.