Erectile Dysfunction

February 1, 2017

Erectile dysfunction, or male impotence, is defined as the persistent inability to maintain or to achieve an erection of sufficient rigidity to have satisfying sex. It is one of the most commonly untreated medical disorders in the world. It is not a disease, but a symptom of some other problem, either physical or psychological or a mixture of both.

Erectile dysfunction is very common affecting as many as 30 million American men. Erectile dysfunction affects older men more than younger men. About 1% of men in their 40s, 17% of men in their 60s, and nearly 50% of men 75 or older aren’t able to achieve an erection sufficient for intercourse.

Most men have occasionally experienced some difficulty with their penis becoming hard or staying firm, but this is not normally cause for a diagnosis of erectile dysfunction. This condition is only considered a concern if satisfactory sexual performance has been impossible on a persistent number of occasions for some time.

Getting an erection is a complicated process. There are two tubes of spongy tissue that run along the length of the penis. A tough fibrous, partially elastic outer casing surrounds this spongy material. When stimulated by the nerves, the spongy tissue arranges itself in such a way that more blood can be stored in the penis. The veins running through the outer sheath of the penis then compress which stops the blood from leaving the penis. As the blood is stopped from flowing out, the penis fills with blood and stretches within the outer casing, giving an erection.

In both the spongy tissue and blood vessels, muscle cells react to chemicals in the body; some make an erection happen and some make the penis flaccid (soft). The balance of these chemicals controls whether the penis is hard or soft.


ED can be caused by things like stress or fatigue or bad interpersonal relationship. But a lot of times, ED is not something that you can control. That’s because it’s often due to a physical problem that affects your blood flow.

Usually when a man is sexually aroused –

  • The brain sends an impulse telling the arteries in the penis to widen.
  • As a result, more blood flows to the penis.
  • When this happens, the penis expands and hardens. This causes an erection.

When a man has ED, the nerves or blood vessels in the penis don’t work properly. This prevents blood from flowing to the penis. And that can prevent an erection. ED can happen at any age. It is usually caused by an underlying health problem. A variety of risk factors predict a man’s likelihood of developing ED. Most of these are problems that interfere with blood supply to the penis, or involve nerve function.

Hormonal Imbalance – A finely-tuned balance of hormones is required for normal erections. This balance includes having normal levels of testosterone, low levels of estrogen (yes, men have some estrogen in their system), as well as normal thyroid levels. Small non-cancerous pituitary gland growths can secrete high levels of prolactin, a hormone that causes ED and often breast enlargement. Obesity can play a role in ED as well. The extra fat cells in the abdomen of men convert testosterone to estrogen, interfering with the normal testosterone/estrogen balance.

Nervous system – An intact and functioning nervous system is important for normal erections. The nervous system includes the deep brain as well as the nerves that travel throughout the body, especially to the penis. Injury to these nerves, such as after a stroke, surgery, injury, from a tumor or neurologic disorder such as MS, can interfere with erections. Structures deep within the brain control the body’s nerves and hormones that are necessary for normal sexual drive and function.

Pelvic surgery or radiation, including treatments for prostate, bladder or colo-rectal cancer and the repair of abdominal and pelvic artery problems are also known to cause ED.

Age –

  • Young men – The most common cause of erectile dysfunction for young men is anxiety. This may include concerns about getting someone pregnant, not wanting to appear inexperienced, or worrying about using a condom without embarrassment or losing your erection while putting a condom on.
  • Middle-aged men – Common causes of erectile dysfunction for middle aged men may include stress, guilt, or having sex with a new partner after many years of monogamy. Other causes may include diabetes.
  • Older men – Although 70% of men over the age of 70 are still sexually active, erectile dysfunction does get more likely as you get older. This may be linked to the deterioration to the blood vessels that carry blood to the penis, and also to the deterioration of heart or brain arteries.

There is no doubt that the muscle cells in the ageing penis are less responsive, interfering with getting and keeping good erections. Like the rest of the ageing body, muscle tone in the penis reduces with age, as do many other aspects of sexual function. It can take longer for a man to get fully aroused. It may take much longer before a second erection happens compared to when the man was younger, and usually the erection is not as firm.

Risk Factors

Briefly, the most common risk factors for ED include –

  • Medical conditions like high blood pressure, high cholesterol, diabetes and hardening of the arteries
  • Spinal cord injury, multiple sclerosis, stroke
  • Anxiety, stress and depression
  • Alzheimer’s disease
  • Hyperthyroidism, hypothyroidism, hypogonadism and hyperprolactinemia
  • Pelvic injury, surgery and irradiation of the pelvic region (e.g. for surgery of the prostate or the colon)
  • Medications like diuretics (water pills), high blood pressure medications, anti-depressants, some types of drugs used to treat cancer and epilepsy medications
  • Cigarette smoking, obesity, alcohol abuse and drug use


The main symptom is the inability to achieve or maintain penile erection sufficient enough for satisfactory sexual activity. ED often leads to –

  • Anxiety, depression, loss of self-esteem, and diminished quality of life
  • Diminished willingness to initiate sexual relationships withdrawal from
  • intimate relationships
  • Negative effect on their overall health


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


Pills – Three effective drugs are available—sildenafil, vardenafil, and talafadil. All three work by increasing blood flow to the penis during sexual stimulation.

Direct penis therapies – Medications that can be injected into the penis or inserted into the urethra (the tube that carries urine and semen outside the body) to increase blood flow. These may work when pills do not.

Testosterone replacement therapy – In men with low testosterone levels and hypogonadism, testosterone can be replaced through injections, skin patches, gels, or tablets placed between the cheek and gums. Combination medical therapy. Some men who don’t respond well to any one of the first three therapies alone may have a better response with a combination of a pill plus direct penis therapy and/or, if blood testosterone levels are low, testosterone replacement therapy.

Vacuum device – This is an external plastic cylinder and gentle hand-held vacuum pump that pulls blood into the penis. Then an elastic ring is placed around the base of the penis to prevent blood from flowing from the penis back into the body.

Surgery – Penile implants (rigid or inflatable types) are used for the rare patient who doesn’t respond well to other therapies. Implants are expensive, can lead to infections, and may not work in the long term. Surgery is rarely used to correct a blockage of penile blood flow; the best candidates are young men with limited blockage.

Psychological counseling – If a relationship or an emotional problem is causing ED, a sex therapist may be needed.

Lifestyle Changes

  • Diet – Everyone should eat a diet rich in fresh fruits and vegetables, whole grains, and fiber and low in saturated fats and sodium. Because erectile dysfunction may be related to circulation problems, diets that benefit the heart are especially important.
  • Foods that some people claim to have qualities that enhance sexual drive include chilies, chocolate, scallops, oysters, olives, and anchovies. No evidence exists for these claims.
  • Weight Control – Being overweight can contribute to erectile dysfunction. Try to achieve and maintain a healthy weight.
  • Exercise – Regular exercise is helpful for weight control, stress reduction, and a healthy heart.
  • Alcohol and Smoking – Men who drink alcohol should do so in moderation. Quitting smoking is essential.

Complementary & Alternative Treatment

DHEA is a steroid hormone naturally produced by the body; it only helps when you have a low level of testosterone, which is a rare condition and unlikely to cause ED. Side-effects include acne and a reduced level of good cholesterol. High levels of bad cholesterol can over time lead to ED.

Vitamins – Several supplements and vitamins are sometimes advertised as remedies for erectile dysfunction, too. Studies have shown that Vitamin E may help men who also take Viagra – but conclusions are largely speculative. Vitamin supplements don’t have side effects, as long as dosage directions are followed carefully.

Ginseng is a natural cure for ED which originated in China. Studies have shown that it can have a mild positive effect on impotence. However, ginseng may also lower your blood sugar levels, which makes it highly dangerous for diabetics. Do not take it if you think your ED may have been caused by diabetes.

L-arginine is an amino acid that increases nitric oxide levels in the body. Nitric oxide is a molecule that signals smooth muscle surrounding blood vessels (including those in the penis) to relax, which dilates blood vessels and increases blood flow – a necessity for maintaining erections.

Zinc is a mineral involved in regulating many enzymes and hormones. It is found in a wide variety of foods such as red meat, poultry, oysters, beans, and fortified cereal. Low levels of zinc have been associated with sexual dysfunction.

L-carnitine is a compound involved in energy metabolism in the body. It is produced naturally in the body but it is also found in food, particularly in animal products, and in supplement form. Although there are various forms of carnitine supplements, propionyl L-carnitine has been used for blood flow issues and has been explored for erectile dysfunction.

Niacin may help men with erectile dysfunction. The results indicate that the men in the study, who had moderate or severe erectile dysfunction, reported an improvement in their ability to maintain an erection after taking a niacin supplement for 12 weeks.

Saw palmetto comes from the fruit of a small palm tree. It has been used to treat symptoms in men with an enlarged prostate gland, such as difficulty urinating, and it has been recommended to treat ED caused by an enlarged prostate.

Pycnogenol, which is extracted from French maritime pine bark, contains flavonoids, proanthocyanidins and other phytochemicals with powerful antioxidant activity that protect the artery walls and provide overall support for the cardiovascular system. Like arginine, Pycnogenol also aids in the production of NO, making it an equally effective supplement for erectile dysfunction.

Yohimbe – This comes from the bark of an African tree, Pausinystalia yohimbe, is the basis of several pharmaceutical drugs used to treat impotence. It contains an alkaloid, yohimbine, which previously was the only drug listed in the Physician’s Desk Reference as a sexual booster. This herb, however prized as an aphrodisiac, can have some side effects (agitation, anxiety and insomnia) that make many men prefer not to use it.

Viramax is a commercial product that contains yohimbine, the active chemical ingredient of yohimbe, and three other herbs: catuaba, muira puama, and maca.

Gamma-Butyrolactone (GBL) – GBL is found in products marketed for improving sexual function (such as Verve and Jolt). This substance can convert to a chemical that can cause toxic and life-threatening effects, including seizures and even coma.

Gingko Biloba – Although the risks for gingko biloba appear to be low, there is an increased risk for bleeding at high doses and interaction with vitamin E, anti-clotting medications, and aspirin and other NSAIDs.

Acupuncture – Acupuncture has been used for centuries to treat ED and impotence in China.


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