Erectile Dysfunction
Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.
Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.
Symptoms of Erectile Dysfunction
Erectile dysfunction symptoms might include persistent:
- Trouble getting an erection
- Trouble keeping an erection
- Reduced sexual desire
Causes of Erectile Dysfunction
Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction.
Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.
Physical causes of erectile dysfunction
In many cases, erectile dysfunction is caused by something physical. Common causes include:
- Heart disease
- Clogged blood vessels (atherosclerosis)
- High cholesterol
- High blood pressure
- Diabetes
- Obesity
- Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
- Parkinson’s disease
- Multiple sclerosis
- Certain prescription medications
- Tobacco use
- Peyronie’s disease — development of scar tissue inside the penis
- Alcoholism and other forms of substance abuse
- Sleep disorders
- Treatments for prostate cancer or enlarged prostate
- Surgeries or injuries that affect the pelvic area or spinal cord
- Low testosterone
Psychological causes of erectile dysfunction
The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:
- Depression, anxiety or other mental health conditions
- Stress
- Relationship problems due to stress, poor communication or other concerns
Complications of Erectile Dysfunction
Complications resulting from erectile dysfunction can include:
- An unsatisfactory sex life
- Stress or anxiety
- Embarrassment or low self-esteem
- Relationship problems
- The inability to get your partner pregnant
Treatment of Erectile Dysfunction
Erectile dysfunction can be treated in many ways, including:
- Oral medications.
- Sex therapy.
- Penile injections.
- Vacuum devices.
- Intraurethral medication.
- Surgery (penile implant).
Penile prosthesis surgery
Inflatable penile prostheses are implanted during outpatient surgery. Once they are part of a man’s body, they enable him to have an erection whenever he desires. The use of a prosthesis preserves penile sensation, orgasm and ejaculation for most men.
The most commonly used penile implant consists of a pair of inflatable cylinders that are surgically implanted in the erection chambers of the penis. The cylinders are connected through tubing to a reservoir of fluid under the lower abdominal muscles, and to a pump inside the scrotal sac.
To inflate the penile prosthesis, the man compresses the pump a number of times to transfer fluid from the reservoir to the cylinders. This causes the penis to become erect. When inflated, the prosthesis makes the penis stiff and thick, which is very similar to a natural erection.
A penile prosthesis does not change the sensation on the skin of the penis or a man’s ability to achieve orgasm or ejaculate. Pressing on a deflation valve attached to the pump returns the fluid to the reservoir, which returns the penis to a flaccid state.
The surgical procedure is performed through one or two small incisions that are generally well hidden. Other people will be unable to tell that a man has an inflatable penile prosthesis. Complications following surgery are not common, but primarily include infection and mechanical device failure.
