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Not all men with ED need to be assessed by a doctor or need to use medical treatment for their erectile difficulties. How often does the loss of erection bother you? If the answer is “not at all,” the problem is not even worth mentioning. That specification of frequency is very important. Based on a few epidemiological studies, erectile dysfunction that is defined solely as a persistent inability to maintain an erection, irrespective of any distress caused by the condition, seems inaccurate and overestimates the problem, particularly in young men who may experience occasional difficulty without necessarily having erectile dysfunction.
In one questionnaire-based study of Swiss men, the prevalence of erectile dysfunction among patients aged 18-24 years was only 27%, of whom only 10% complained about the condition. Indeed, it is a common symptom, while a diagnosis is only appropriate when prolonged or recurrent. Regrettably, the numbers of presented data in literature studies are affected by wide variations depending on the definition applied to erectile function. This could be the answer to the different percentages presented in the literature.
Erectile dysfunction (ED), the repeated inability to get or keep an erection firm enough for sexual intercourse, is not a single disorder, but a group of related disorders. Once thought of as primarily a mental health concern, understanding of impotence has moved in recent years into many other areas of biology. It is now clear that erectile function is not something that only occurs in the brain or only in the penis. It is a complex process that involves the brain, an enormous amount of hormonal activity, nerves inside and outside of the spinal cord, smooth muscle, and blood vessels.
The immediate effect of relaxation of the small arteries giving blood to the penis is a sudden inflow of blood into two isolated channels inside spongy tissue. Since the penis is unable to expand sideways or grow longer, the sudden increase in blood flow compresses the veins that normally drain blood from the penis. Blood coming in is converted into pressure in the two closed compartments, which makes the penis bones firmer (and somewhat larger).
The factors causing ED may be physiological and/or psychological. The physiological ones include arterial insufficiency or venous leakage due to vascular disturbances, which cause 90% of the ED cases. Besides trauma and post-surgical changes, common chronic diseases such as diabetes mellitus, hypertension, important stress, and depression, especially in cases of chronic diseases, can lead to sexual dysfunctions.
The main treatments for psychological effects consist of cognitive therapies, relationship techniques, and relaxation exercises, while the most important treatment methods for physiological causes are oral pharmacotherapies, vacuum constriction devices, vascular reconstructive surgery, and integral implants of three components. However, patient resistance to long-term therapies such as oral pharmacotherapies and vascular reconstructive surgery is a concern.
Erectile dysfunction (ED) can be defined as an inability to achieve or maintain an erection for satisfactory sexual performance. The prevalence of this condition is quite high and increases with age, with almost half of the population being affected to some extent. Even mild ED may have an adverse psychological impact, which can be very severe in some cases, as anxiety caused by ED can aggravate ED conditions.
High systolic and diastolic blood pressure are correlated with erectile dysfunction, although there are a few studies conducted on high diastolic hypertension. The pathological mechanisms of this correlation are thought to be due to high systolic pressure leading to microvascular damage, while structural damage in the artery from the high diastolic pressure. High arterial blood pressure affects the endothelial and neurogenic response, as well as neurotransmission and the smooth muscle function.
The overproduction of the peroxynitrite and aldehyde molecules, which are from the nitric oxide, increased oxygen, and nitrogen, and also influenced through the endothelium dysfunction and decreased smooth muscle synthesis. Increased sympathetic activity is also shown at the onset of hypertension. Increased levels of plasma catecholamine and adrenoceptor responsiveness are seen in hypertensive patients compared to healthy controls. Serum smooth muscle and endothelial cell-specific markers, particularly of muscle injury, are also increased in hypertensive men.
Factors such as age, pharmacologic and neurologic treatment, psychological problems, stress, lifestyle habits, and chronic diseases are the prominent causes of erectile dysfunction. Cardiovascular diseases such as hypertension, coronary artery disease, peripheral arterial diseases, heart valve diseases, and heart muscle diseases are correlated with a high ratio of erectile dysfunction.
Hypertension is one of the primary health problems correlated with erectile dysfunction. In addition, it is one of the known risk factors for cardiovascular diseases. Hypertension causes penile detumescence, which results in erectile dysfunction due to autonomic dysfunction. High blood pressure and erectile dysfunction are both global health problems and affect a large proportion of men.
As the biological age increases, atherosclerotic vessels are thinned, the total area of the arterial bed increases due to the growth of arterial stiffness, and the reserve capacity of the heart decreases. In the natural history of the general process of development of cardiovascular diseases, the onset of erectile dysfunction occurs at the end phase.
Meanwhile, vascular pathology is described from the earliest stages. In many cases of patients who took the first episode of the acute myocardial infarction, the destruction of the vascular endothelium was established theregistered long before the onset of impotence. Often, the early changes in the microcirculation are overlooked. And for any such pathology at an organ’s dysfunction, both receptor and autoregulatory and adaptogenic criteria change. Is there a systemic long preclinical stage of development of cardiovascular diseases prior to the onset of manifest endothelial dysfunction (ED)
One of the largest and oldest clinical experiences established the association of erectile dysfunction in the presence of cardiovascular diseases and its risk factors, both in age and non-age-dependent cases.
The most typical example is the organic origin of vasculogenic erectile dysfunction. 30,000 of the male population aged 40-80 with complaints of erectile dysfunction; 20% angina, 15-20% others (myocardial infarction, bypass, angioplasty, hypertension, etc.) with diabetes (37%); Bruce & TherISBN-TSEA-AlCHF-AAU-Athe presence of age-dependent associated pathology; atherosclerosis and hypertension.
Consequently, circulating glucose is regulated by hormones. These hormones are necessary for keeping the blood sugar levels in the normal range. Sometimes, blood sugar control is less effective than it should be. When there is too much glucose present in the bloodstream, the fluctuations in blood glucose levels can promote nerve damage. These diabetic complications are also referred to as neuropathy – the failure to initiate, maintain, and transduce an erection. Hyperglycemia is believed to be a significant causal factor of complications that exacerbate or induce erectile problems. These interactional factors may include blood pressure, cholesterol levels, body weight, degree of glycemic control (e.g., hemoglobin A1c), smoking, alcohol consumption, among others.
Diabetes is a disease that affects the body’s ability to produce or use insulin. The body’s lack of insulin means too much sugar in the bloodstream. Over time, high blood sugar levels can damage the nerves and blood vessels. This can have serious results for both urinary and erectile function. High levels of blood sugar through the blood vessel walls can damage blood vessels and cause plaque to build up. This plaque can restrict the flow of blood, which could result in decreased blood supply and changes in the ability of the blood vessels to expand and contract. Pressure on the walls may also damage the nerves that are responsible for penile-specific reflexes, leading to erectile dysfunction.
Much of what is known about factors that influence sexual behavior and activity comes from research involving laboratory animals. This research has shown that endocrinological activity and neurotransmitters in the brain are the key determinants of sexual activity in males. Little is known about psychological inhibitions that block sexual activity in male laboratory animals. The behavior of males often reflects male dominance. It is the female that is pursued. From the fact that aggressive conquest behavior in the male is facilitated by the activation of serotonergic neurons in the dorsal and medulla regions of the mouse, one can conclude that the pursuit of a female and sexual behavior is mediated by two separate circuits in the male brain.
The previous discussion has been restricted largely to the vascular and neuroendocrine play in erectile function. This section focuses on psychological factors that play a role in determining the readiness for an erection in the male. Just as the rush of the people to the lifeboats offers some interesting insights into a sinking ship, so also male social, psychological, and sexual behavior offer important insights into factors that may either enhance or inhibit penile erection in the male.
Erectile responses are influenced by individual, interpersonal, and intrapersonal interpretations of the stimulus. The presence of negative emotions can inhibit a genital response, while positive emotions can facilitate the process. Negative thoughts considered inappropriate for maintaining an adequate sexual response have already been correlated with erectile problems. Negative emotions reduce the physical condition necessary for maintaining a sexual response, and erectile difficulties tend to occur in situations when the individual lives with morbidity stressors. According to this cognitive model, worrying and intrusive cognitions about sexual performance can lead to reduced sensory awareness of sexual stimuli, attention difficulties, cognitive distractions, and sympathetic stimulation. High levels of worry, potentially associated with poor performance, can lead to arousal disturbances that depend heavily on attentional capacity.
Sexual function in men is an extremely complex process that involves the brain, the emotions, nerves, muscles, blood vessels, and hormones, among other things. To perceive erectile dysfunction as simply organic or as only a problem related to other diseases such as hypertension, diabetes, degenerative diseases, and the use of drugs or alcohol is an incomplete concept of what is happening. Erectile dysfunctions are related to health, psychosocial, and lifestyle variables. Greater psychological awareness and the development of contemporary context research that involves the social and organic components of male sexual behavior are essential for addressing the clinical implications of the problem. Psychosocial variables play a strategic role in explaining the loss and/or maintenance of an erection, with implications for sexual health promotion and clinical intervention in male sexual response. Social and psychological problems such as stress, anxiety, depression, fear of poor sexual performance, or self-esteem, among others, are some of the main factors leading to erectile dysfunction. In the context of sexual disorders, internalizing emotions are related to the chronicity and severity of the problem.
Moderate alcohol consumption is associated with a decreased incidence of cardiovascular diseases when compared with the consumption of either no alcohol or large doses, so it is plausible to suggest that alcohol may affect the penile erection process, as this is a hemodynamic-dependent phenomenon. Indeed, alcohol extracts a biphasic response on male sexual function, with low and high amounts determining a moderate alcohol consumption with reduced anxiety and inhibition by potentiating erectile function, as has been demonstrated by some authors.
By contrast, alcohol over intoxication so predisposes the man to engage in high-risk behaviors, such as unprotected and assaultive sex, single-night sex, and diminished sexual function with an increase in the probability of sexual dysfunction. Additionally, the negative effects of alcohol on the central nervous system, especially in the case of usage of high dosages, might be directly responsible for erectile function change, while ethanol intoxication represents a risk factor for testosterone reduction.
The inverted-U-shaped dose-response curve between alcohol use and erectile problems probably echoes the partial inhibition caused by a moderate dose through block of the most peripheral excitatory pathways, to reduce the incidental flow of inhibition into the central regulation of penile function, whereas the exhausting effects on the cardiovascular and genitourinary systems, along with the vasculogenic histological and functional alterations and the increased probability of oxidative damage, represent the biological alteration underlying excessive alcohol consumption, probably affecting ER in a complex way.
Men who have sexual intercourse three or more times a week have reduced levels of angina and decreased circumference of carotid arteries, factors that have been associated with increased episodes of ED via penile vascular insufficiency. Indeed, an active sex life is now suggested to be related to cardiovascular fitness and is therefore entitled to be a part of the recommendations offered to men involved in ED prevention programs.
Cigarette smoking, both active and passive, may have an effect on penile erection, as it accelerates the penile aging process and can produce atherosclerotic changes within the small-penile arterial walls. Some authors suggest a dose-response relationship. Some reports demonstrate a significantly higher smoking incidence among men with self-reported ED and among those with definitive ED, and smoking acts as an independent predictor of the presence and persistence of severe ED.
If a threshold effect does exist, it has not been definitely assessed. However, in view of the significant cardiovascular risk reduction that can be attained by even small reductions in tobacco intake, no dose response would be adequate for the aims of ED prevention. Why tobacco adversely affects the penile artery at lower doses than the coronary artery is still a matter of debate, but there is evidence suggesting that the penis is a true tip-of-the-candle for assessing the general health of the whole arterial system.
Accumulative data have suggested that there is a negative association between alcohol consumption and erectile dysfunction. Data from prospective cohort studies showed that alcohol consumption seemed to have a J-curve association with erectile dysfunction, as the rate of erectile dysfunction was increased in both non-drinkers and severe drinkers. The same trend was also observed in another 2007 cross-sectional study, in which moderate alcohol consumption decreased the likelihood of having erectile dysfunction. On the other hand, it was suggested that although alcohol may decrease anxiety, it also has a negative direct impact on erectile function. The vasoconstricting effects of alcohol and its metabolites have been identified as one of the underlying mechanisms of alcohol-induced impairments in erectile tissue.
Cigarette smoke contains a variety of vasoconstrictive constituents that can adversely affect blood flow and the structure of the cavernosal tissue. Clinical evidence also supports the role of smoking in the development and progression of erectile dysfunction. A large cross-sectional study has shown that men reporting current smoking problems had significantly lower erection scores and those with a history of smoking in the past had intermediate scores compared with nonsmokers. These results have also been confirmed in several other epidemiological studies. In addition, nicotine metabolites have been found in the erectile tissue and have been associated with endothelial dysfunction. Erectile function, NO excretion, and abluminal nNOS expression were also significantly impaired in rats exposed to long-term cigarette smoke in a study.
How prescription drugs with a psychological basis affect erectile function: There are about 15 drugs related to ED and in this type of explanation we use a particular psychological cause (stress, anxiety, emotional disturbance, depression).
Non-prescription drugs: Many “over the counter” drugs as well as prescription drugs will affect erectile function. A man taking this type of chemical needs to talk to his doctor about changing to a different drug, or need to be monitored, or change dosage of those that are causing erectile side effects.
Prescription drugs: There are numerous prescription drugs that can affect a man’s ability to have an erection. A man taking prescription medication needs to talk about the issue with his doctor to see if the prescription is impacting such important things as his sex life.
Many prescription medications and treatments can affect erectile function. Men need to discuss these with a doctor so they can be aware of any potential impact. The leading medications and treatments that affect erectile function include:
Another group of possibly harmful drugs are the ones used to treat ulcers, the so-called antiulceratives. These drugs operate as anticholinergics, which are known to disturb erection and ejaculation. A heterogeneous group of medications, but widely used in general, are the so-called antihypertensors. Especially older types have been reported to be followed by a range of sexual disorders. It has been suggested that these drugs result in a lasting hypotensive state which is incompatible with an erection. Losartan and other similar drugs associate with a 5-7% risk of erectile disorders.
There has also been controversy over verapamil, which is not followed by similar criticism in the new institution of medicine. Finally, there is a group of drugs that are specifically known for their anticancer application, which is also linked to the fact that they influence penile function. A complete range of the drugs prescribed physiologically in case of other diseases but which most importantly impact on penile function has come out recently. Currently, new health threats are being disclosed as to the infiltration of impotence factors among the medications usually utilized. However, the correlation of the new information with other pharmaceutical specialties cannot be as straightforward as lately acknowledged for the category of medications used to treat hair loss.
Some medications that are currently in use can lead to problems with sexual function. Psychotropic drugs used in treating depression are among the medications that can produce sexual dysfunction. Problems such as delayed ejaculation and retarded or inhibited orgasm appear more frequently in male patients who receive these drugs. The common medications responsible are chlorides and imipramin. Besides withdrawal of these drugs and starting with even smaller dosages, more potent drugs may be given. These may also fail though. An example of this is increasing the patient’s satisfaction and his long-term orgasmic frequency.
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