Erectile Dysfunction

Structure of penis

Penis has two columns of tissue running along the sides called corpus cavernosum and another column of sponge-like tissue running along the front of penis called corpus spongiosum. These tissues get filled up with blood during erection.

How do you get an erection?

An erection begins with both sensory and mental stimulation. During sexual arousal, nerve messages begin to stimulate the penis. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the open spaces, thus expanding penis. The veins running through the outer sheath of the penis then compress which stops the blood from leaving the penis and making it erect. It is now known that nitric oxide triggers an erection and maintains it by relaxing muscles that allow blood to fill the penis.

Erection is reversed when muscles in the penis contract, stopping the inflow of blood and opening outflow channels. As blood starts flowing out of penis, it gets flaccid.

What is erectile dysfunction?

When a man is unable to get an erection or keep an erection that allows sexual activity with penetration, he is said to have erectile dysfunction. It is not a disease by itself but  a symptom of other problems including psychological, physical or a combination of both.

Erectile dysfunction is a very common problem and increases with age. An Australian study found that at least one in five men over the age of 40 years has erectile problems and about one in ten men are completely unable to have erections.

What are the causes of erectile dysfunction?

There are many causes of erectile dysfunction and more than one cause may coexist. However, psychological problems including performance anxiety, marital and relationship problems, depression, financial stresses, and other psychiatric problems are common causes of erectile dysfunction. Many medical conditions associated with erectile dysfunction include diabetes, high blood pressure, obesity, cigarette smoking, sleep apnoea, high cholesterols, thyroid diseases, drug and alcohol abuse, spiral cord injuries, multiple sclerosis, certain prescribed medications, testosterone deficiency and others.

What is the treatment for erectile dysfunction?

There may be more than one cause and treatment often involves a multidisciplinary approach. It is very important to see a medical practitioner or other health professionals for advice and treatment.

Sex therapy and counselling may be needed for psychological issues whereas conditions like obesity, drug and alcohol abuse, smoking, and high cholesterols need lifestyle modifications.

Diabetes, high blood pressure and other medical conditions need medical treatment.

Some specific treatments for erectile dysfunction include:

Medications: Commonly used pills are sildenafil (viagra), tadalafil (cialis) and vardenafil (levitra). You need a prescription for these medications from your doctor.

Injections: If pills do not help, the patient may try using an injection called alprostadil (caverject), which can cause an erection within 10 minutes of injection into the penis. The erection can last from 30 minutes to two hours. The doctor or specialist will first show the patient how to administer the injection, then, if the patient is happy, he can try this at home. Besides the sting of a needle, it is not painful.

Vacuum pumps: Vacuum pumps are devices that fit over the penis and draw blood into the penis to make it erect. The patient can have erection for as long as he likes. However, these devices do not suit everybody.

Implants: Implants are used only as a last resort when other treatments have failed or are unsuitable. Semi-rigid rods are inserted into the penis to make it sufficiently hard to enable sexual intercourse. The disadvantage with implants is that the penis will be partly erect all the time.