Erectile Dysfunction and Impotence

Erectile dysfunction or ED occurs when a man can't get or keep a penis erection firm enough for sexual intercourse.  Common causes include medications, chronic illnesses, poor blood flow to the penis, drinking too much alcohol, or being too tired.  Erectile dysfunction is a common problem and it may affect as many as 80 million men worldwide at some point in their life.  The factors associated with penis erection problems include medical conditions (diabetes, hypertension and heart disease) as well as psychological factors such as depression and anxiety.  The ability to achieve penis erections adequate for sexual intercourse requires that all of the nerves arteries and vein to the penis be functioning appropriately and that the overriding psychological state is positive.  The exact mechanisms that cause erectile dysfunction in the depressed or anxious person are not completely understood but these are well known to occur.  Acute onset of erectile dysfunction in a younger healthy male is uncommonly caused by systemic diseases like hypertension or diabetes.  Stress at work or relationship tensions are the most common causes. These are usually self-limiting and resolve without medical intervention.  Performance anxiety can be a self-fulfilling prophecy if you get too worked up about it because erections are closely associated with emotions.  Pain in the rectum included.

There are other self-inflicted causes of ED such as injuries, tobacco and/or alcohol abuse whereas ED effects from medications are relatively insignificant.  New treatments with medication can be effective for many men.  However the cost and side effects of prescription drugs can be bothersome.

Erectile dysfunction can be cured in most cases using medical treatment, alternative medicine (herbal supplements) and penis (vacuum) pumps, to name a few options.

How Penis Gets Erected?

A penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis. The process is most often initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis.

Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both conditions, an intact neural system is required for a successful and complete erection. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system.  As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light.  The most important organic causes are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects.

Psychological Causes of Erectile Dysfunction

Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but can often be helped. Notably in psychological impotence, there is a strong response to placebo treatment. Erectile dysfunction can have severe psychological consequences as it can be tied to relationship difficulties and masculine self-image generally.

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