Addressing in depth the causes, symptoms and forms of treatment of erectile dysfunction
Prostatitis, obesity, hypertension, smoking and alcoholism are usual causes in erectile dysfunction. Learn more about symptoms, pathologies and associated treatments.
Erectile dysfunction (E.D.) and sexual impotence are both caused by physical and psychological impairments. Moreover, there are many risk factors associated with them like the cases of obesity, hypertension, smoking and prostatitis.
The first step of the Urologist / Andrologist Doctor is to identify the probable causes of dysfunction and subsequently, to prescribe the adequate treatment.
After completing a clinical evaluation, there are normally two possible scenarios:
1- The Andrologist concludes the inexistence of documentable organic factors and once homeostasis is reestablished, the patient´s condition is considered healed;
2- If the situation persists in parallel with psychological suffering that can be prior or subsequently originated by the whole situation, the Andrologist will redirect the patient to a mental health specialist.
Sometimes the best results are achieved when the Andrologist and the Psychologist work as a team, searching for the most suitable treatment. We advocate and promote this way of working, whenever necessary.
Clinical situations associated with erectile dysfunction
The most common clinical situations associated with the impairment of ED can manifest threw a diversity of pathologies. We will name and explain them below.
1- Direct reasons for erectile function
For a further understanding of the mechanism that´s directly influencing erectile dysfunction, we will give examples and explanations of the most common situations (in some cases dramatic) that a significant number of men are exposed to because of ED.
Atrophy of the cavernous body of the penis or the tunica albuginea.
The atrophy of the cavernous body of the penis (see glossary) and/or the tunica albuginea (see glossary), is possibly one of the most common causes of erectile dysfunction and sexual impotence. Like so, this pathology is also reflected in the aging process of fundamental structures of the erectile function and linked with numerous endogenous and exogenous causes.
Among the endogenous causes of this pathology we find smoking, various traumatisms and finally infections caused by prostatitis.
By external aggression we mean the “fracture” of the penis (a phenomenon caused by drastically rough movements during sexual intercourse) and traumatisms caused by impact or by radioactive therapy.
By endogenous causes we mean those that result from a “normal” life and its inevitable aging process.
There are three main diseases resulting from endogenous and exogenous causes:
1. Atrophy of the tunica albuginea in the dorsal side;
2. Atrophy of the tunica albuginea at the dorsal, ventral and medium line sides of the cavernous body of the penis;
3. The “ring” atrophy of the tunica albuginea (Peyronie Disease). In the image it is the white structure that´s altered into very dark. The cavernous body of the penis is completely involved by this structure, not only in the identified zone of the image but in all its extension.
Inability to fill the cavernous body of the penis.
An erection requires the existence of blood flow in the penis that is 7 times higher than in normal state. This implies that the blood vessels are dilated enough to receive this extra amount of blood.
Thus, a well succeeded sexual intercourse will result from a permanent intra-cavernous pressure of about 400 mm Hg (mercury) throughout the whole intercourse.
The decrease of elasticity in the arteries (arteriosclerosis) and the cavernous body of the penis is directly linked with the stiffness that hinders the dilatation of the vessels. As so, arteries and muscular fibers of the cavernous body are unable to expand and receive the additional blood volume that allows the erection to happen and endure.
Abnormal blood drainage
Erections that are unable to sustain themselves or are rapidly lost before ejaculation can result from abnormal blood drainage (cavern-occlusive dysfunction that is commonly named as venous leak)
There are some few possible reasons that can cause this:
- A weak smooth musculature in the form of a sponge (cavernous body of the penis) can generate insufficient pressure over the drainage veins of the penis (which stops them from closing) and also over the spots where the veins cross the tunica albuginea to return to the external organism. This phenomenon happens because of the lack of expansion of the cavernous body and/or the contraction of the tunica albuginea (the elastic waist that involves the cavernous body). In consequence, erectile compartments are not totally filled and in this specific case we are faced upon a cavern-occlusive dysfunction.
- Failures in erection can result in abnormal connection between the arteries and the veins in the penis. In this case, the venous leak is caused by the abnormal drainage of blood (drainage is done to the outside of the erectile compartments).
- Excessive drainage due to the existence of extra veins, abnormal, inverted or with too much volume, is designated by the name of collateral circulation. This situation can be corrected with a cavern-occlusive dysfunction surgery.
This pathology can be mistaken with cancer. A frequent symptom of Peyronie Disease is a little bump that the patient feels under the skin of his penis. This bump is nothing more than a fibrosis in the interior of the erectile compartments. We believe that it starts to manifest at the tunica albuginea and then spreads to the cavernous body.
While the fibrosis progresses threw the walls of the erectile compartments, the penis becomes incapable of being straight during erection. The scare tissue pulls the penis to the side in which the fibrosis occurred, “bending” it towards the direction of the scare. Some of the times, the penis distortion is so intense that the erection becomes painful or so twisted that penetration or any well-succeeded sexual intercourse is virtually impossible. Even worse, this fibrosis can restrain the blood circulation of the penis to a point of turning the glans zone flaccid. This situation makes penetration very difficult or even impossible.
This disease is not rare in men with ages between 40 to 65 years old, but it can happen at any age.
Its cause is unknown but its pathology can be related with the abuse of alcohol and smoking. Peyronie Disease produces most of its lesions in the first 6 to 12 months, a time from which it can turn inactive and leave its physical scar.
II – Arteriosclerosis
Arterial stiffness is a very common cause of erectile dysfunction.
There are many possible factors originating insufficient circulation in the penis of many elders, but the primordial factors are not a surprise at all:
• High cholesterol
• Inflammation caused by prostatitis
III- Endocrine conditioning of erectile dysfunction
An optimized hormonal balance is extremely favourable for good sexual energy and sexual performance. For that to happen, the balance between testosterone (male sexual hormone), estradiol, growth hormone and thyroid hormone is essential for the rise of these optimal conditions. Even so, erectile dysfunction can still occur.
We should also understand that an excessive presence of prolactin is a significant factor to the decrease of sexual desire and performance.
Erectile dysfunction caused by diabetes
10 years after the diagnosis of diabetes, approximately 65% of men with this condition will identify signs that reveal erectile function impairments.
The opposite is also true, since it is not unusual that the first diagnosis of diabetes comes just after the appointment with a specialist in Urology/Andrology, where patients present complaints about their erectile function.
We have diagnosed diabetes in unsuspicious individuals that present erectile dysfunction complaints. Fortunately, the treatment and the control of diabetes reverts the process that leads to erectile dysfunction, a possibility that needs to be taken as a priority if we are to restore erectile and sexual normality, as well as endorsing its improvement.
Erectile impairments caused by diabetes
First of all, it is important to understand the way in which diabetes can limit a normal sexual performance. The physical process is quite simple. It starts with stiffness in the arteries (arteriosclerosis) and in the cavernous body at a high pace, a process that will restrict the blood flow to the penis. The cavernous body loses its flexibility.
Consequently, nervous lesions (neuropathies) prevent the normal transmission of nerve impulses to the blood vessels and to the cavernous body of the penis. This impairment is one of the forms assumed by a diabetic neuropathy, one which is also on the basis of loss of sensibility and the presence of leg pain whenever these respective nerves are involved.
A diabetic that suffers from erectile dysfunction can enjoy the other aspects of sexuality in a total normal way. For example, sexual desire can still be as intense as it ever was before the pathology began.
Like many man that suffer from erectile dysfunction, diabetics can be stimulated to the point of ejaculation and orgasm, nevertheless their penis will still remain flaccid.
Contrary to common belief, erectile dysfunction is not a sudden phenomenon. Generally speaking, we are talking about a slow declining of sexual function. In the case of the diabetic, the further the erectile impairment goes the bigger the damage is in the nervous fibres, until the point where complete dysfunction emerges.
It is advised that young men presenting signs of erectile function take the time to carry out a diabetes screening. Fortunately, in most of the times this pathology is reversible threw simple control of diabetes.
IV – Anti-ulcer medication
Cimetidine is a widely used medication in the treatment of gastric ulcer. It can increase the level of prolactin in the blood, causing apathy, lack of sexual desire and sexual impotence. Suspending this medication will correct the situation. Nevertheless, this should always be done with medical guidance. Ranitidine, an equivalent medication, is harmless to Prolactin levels and works fine as a substitute for Cimetidine.
Again, its use needs to be done in accordance with your assistant doctor.
V – Priapism
Priapism is a permanent and painful erection that occurs without sexual stimulation and can last for 6 hours. The self-injection programs of papaverine used to treat impotence turned what once was a rare situation into a current one.
It used to be a problem restricted to men that suffered from rare blood diseases, like the case of sickle cell anaemia.
An erection that last´s for 4 straight hours has to be considered a medical emergency! These are cases that demand an immediate intervention of an Urologist, in order to avoid massive destruction of tissues caused by the lack of blood flow and oxygen to the penis.
Amphetamine – A potent stimulant of the central nervous system that strengthens the person´s physical and mental abilities.
Barbiturates – It´s a derivative compound of barbiturates acid, with hypnotic and antispasmoic qualities.
Cavernous body of the penis - A muscular structure organized as a sponge with the shape of a finger. There are two of these structures in the penis, one on each side of the urethra. In a state of flaccidity these structures contract and allow the emptiness of blood within the “holes of the sponge”. These holes on the other side are completely full during erection.
Cocaine – Anesthetic alkaloid and narcotic extracted from coca leaves.
Heroin – Narcotic derived from morphine.
Marijuana – narcotic obtained by dry flowers and leaves of hemp.
Tunica albuginea – elastic waist containing and affecting the cavernous bodies of the penis, just like the “skin of a finger”. In some cases it degrades and presents atrophies, but in the worst cases it can become fibrotic and much more difficult to treat, like Peyronie Disease.