Understanding and treating erectile dysfunction
By Kenneth Orbeck, D.O.
In the past, erectile dysfunction has commonly been dismissed as an unfortunate condition of aging and was treated as little more than a lost luxury. However, after years of study and technological advancements, doctors and researchers have discovered that erectile dysfunction is often an indicator of a deeper health concern. This revelation has led to the development of more and more comfortable and convenient treatment options for men dealing with erectile dysfunction. Understanding what is happening to your body and why, may help you choose the best treatment plan to improve your sexual health and overall quality of life.
Erectile dysfunction, or ED, is the inability to obtain or maintain an adequate erection for sexual activity or penetration. ED is an inevitable part of the aging process although; there are many other contributing causes. More than 30 million men in the United States are affected by ED, however most cases are treatable.
Physiology of an Erection
An erection involves the convergence of multiple pathways involving the autonomic nervous system, vascular system and a cascade of hormones and enzymes. Having a basic comprehension of the internal anatomy of the penis will help you better understand how the various treatment options impact erectile dysfunction and other conditions of your health.
There are two chambers that run the length of the penis called corpora cavernosa. These chambers are spongy-like tissue filled with tiny arterioles that potentiate blood flow allowing an erection to occur. The pathway of an erection begins with mental or sensory stimulus, or a combination of the two that excites the brain. This excitation triggers the peripheral nervous system to release the enzyme, nitric oxide synthase (NOS,) activating the neurotransmitter, nitric oxide (NO,) resulting in the relaxation of the vascular system. This relaxation of smooth muscle tissue initiates the dilation of arterioles and arteries stimulating blood flow into the penis. This causes compression of the tunica albuginea, a thin area of tissue surrounding the corpora cavernosa, inhibiting venous return, trapping blood in the penis to sustain the erection.
Causes of Erectile Dysfunction
Nerve Interference. Nerve interference is amongst the leading causes of ED. Nerve interference is the inability of your brain to send or receive the signals that activate the pathways for an erection to occur. Injuries to your spinal cord, stroke, diabetic neuropathy, multiple sclerosis and adrenal stress are some of the conditions that are linked to nerve impairment and may ultimately cause ED.
Vascular Impairment. ED is often symptomatic of common conditions like uncontrolled hypertension and atherosclerosis. These conditions are an impairment of the vascular system which, as previously discussed, plays a critical role in an erection. I find it is crucial to take an in-depth approach when a patient complains of ED, he may have some dangerous blockage occurring or be at-risk for other vascular diseases. Taking the time to investigate and address these issues may not only remedy the erectile dysfunction, but also save his life.
Hormone Imbalance. With aging and sometimes genetics, comes a reduction in testosterone levels, which may also impact your ability to achieve or sustain an erection. Testosterone is an anabolic hormone that serves several functions in the body, in this case it is responsible for maintaining the structure and function of the nerves and cells that improve blood supply to the penis. This includes regulating NOS and preserving the delicate smooth muscle of the corpora cavernosa.
Treating the Cause. If your ED is linked to an underlying condition, such as diabetes, metabolic syndrome, hypertension or adrenal fatigue, it is best to choose a treatment plan that initially improves these conditions. For example, low levels of testosterone may be remedied with bioidentical hormone therapy or hypertension may be reduced with diet modifications and short-term use of blood pressure medications. Ultimately these treatments should improve the patient’s total health and eradicate ED – if it was merely a symptom of the primary condition.
Medications. In the event that you are still experiencing ED, it is likely that ED was not simply a symptom of an adverse health condition, but an issue related to the overdrive of the sympathetic nervous system. An erection is a parasympathetic mechanism; therefore it may be necessary to minimize the sympathetic response through inhibition of the enzyme, phosphodiesterase-5 (PDE-5.) PDE-5 causes the degradation of another enzyme, cyclic guanosine monophosphate (cGMP,) that initiates the pathway for an erection to occur. In this case, it is necessary to prescribe medications designed to inhibit PDE-5 and prolong the effects of cGMP- relaxation of the smooth muscle tissue and initiation of blood flow. These medications include brand names you may be familiar with like Viagra, Cialis and Levitra.
Alternative Therapy. Occasionally, treating the underlying causes or administering medications does not work, or certain individuals may not be eligible for these options due to conflicting medications or allergies. Exploring alternative therapies such as a vacuum erection device (VED) or injections becomes necessary.
A VED is the logical first choice because it is budget-conscious, 90 percent effective and also serves penile rehabilitation. This device does require patience and a supportive partner, as it requires practice and some adjustments. The side effects are minimal – some painless bruising may occur and the penis may temporarily feel numb.
Injection therapy is associated with a greater expense and, although highly effective, comes with potentially severe side effects. The injection consists of small doses of three drugs that address all three pathways of erectile dysfunction. The patient self-administers the injection into the base of the penis with a small needle and, generally, it immediately becomes engorged with blood. Side effects include scarring of the penis and a persistent, painful erection, known as priapism. Priapism is often the result of administering more of the drug than is recommended and can cause permanent tissue damage. Patients are advised to seek immediate medical attention if the condition persists for more than four hours.
To learn more information about prevention and treatment of erectile dysfunction and associated conditions, visit www.bodylogicmd.com or call my office at 877. 341.7407.