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Erectile Dysfunction

Erectile dysfunction, sometimes called impotence, is the repeated inability to achieve or maintain an erection firm enough to have sex. The word impotence may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm. The use of words erectile dysfunction makes it clear that those other problems are not involved.

Erectile dysfunction, or ED, can be a total inability to achieve erection, an inconsistent ability to do so or a tendency to sustain only brief erections. These variations make defining ED and estimating its incidence. Estimates vary from 15 to 30 million, depending on the definition used. According to the survey by National Ambulatory Medical Care (NAMCS, an acronym in English), for every 1,000 men in the United States, there were 7.7 medical visits for ED in 1985. In 1999 the rate had nearly tripled to 22.3. The increase happened gradually, presumably as they were more widely available treatments such as vacuum devices and injectable drugs became accepted discussion of erectile dysfunction. Perhaps the most publicized advance was the introduction of the oral drug sildenafil citrate (Viagra) in March 1998. NAMCS data on new drugs show an estimated 2.6 million mentions of Viagra at physician office visits in 1999 and one third of those mentions occurred during visits for a diagnosis unrelated to DE.

In older men, ED usually has a physical cause such as illness, injury, or side effects of medications. Any disorder that causes injury to the nerves or impairs blood flow to the penis can cause ED. The incidence increases with age: about 5 percent of men 40 years of age and between 15 and 25 percent of men 65 years old experience ED. But it is an inevitable part of aging.

ED is treatable at any age, and knowledge of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for ED. Traditionally, urologists who specialize in disorders of the urinary tract, have tried the SD, however, urologists are only responsible for 25 percent of Viagra mentions in 1999.

How does an erection?

The penis contains two chambers called the corpora cavernosa, which run the length of the organ (see Figure 1). A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa.

Erection begins with mental stimulation and the senses, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection is reversed.

What causes ED?

Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spine, and the area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

The most common cause of ED is damage to nerves, arteries, smooth muscles and fibrous tissues, often as a result of an illness. Diseases such as diabetes, kidney enermedades, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease and neurologic disease - account for about 70 percent of ED cases. Between 35 and 50 percent of men with diabetes suffer from ED.

Also, surgery (especially radical prostate surgery due to cancer) can injure nerves and arteries near the penis, causing ED. An injury to the penis, spinal cord, prostate, bladder and pelvis can lead to ED by harming nerves, smooth muscles, arteries and fibrous tissues of the corpora cavernosa.

In addition, many common medicines - blood pressure medications, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug) - can cause ED as a side effect.

Experts believe that psychological factors like stress, anxiety, guilt, depression, low self-esteem and fear of failure cause sex 10 to 20 percent of ED cases. Men with a physical cause for ED frequently experience the same sort of psychological reactions (stress, anxiety, guilt, depression).

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