Why Willy Won't Work - The Basics of Erectile Dysfunction

[DrK]

Hi all.

 

I thought I'd take five and pen some notes about ED.

 

PLEASE NOTE: I do not recommend self-diagnosis or treatment. What's presented is for information only. Sometimes a little knowlege can be deadly. Don't rely on the internet. See a real-life doctor.

 

Overview

 

Erection is a dance between the nervous, endocrine and vascular system. The easiest way to remember the nervous involvement is "Point (parasympathetic) and Shoot (sympathetic)".

 

Erectile dysfunction (ED) is the inability to obtain or maintain an erection during sex.

 

You can break it down into two categories: Organic (75% of cases) or Psychogenic (25% of cases).

 

Guys with organic problems do not get or have abnormal nocturnal or early morning erections. The do not have a rigid erection under any circumstances.

 

On the other hand, those with psychogenic etiology have normal nocturnal and early morning erection. Their erection difficulty is confined to sex.

 

Testing

 

The way to verify the diagnosis is with a little blood pressure cuff around your penis and measuring what's called the Penile/Brachial index. It's a measurement comparing the two BP. If your ratio is less than 0.6 you most likely have an organic problem. This is covered under many insurances as part of ED workup.

 

I'm going to focus on organic causes because they're in the majority and most of the articles on ED seem to focus on the psychogenic causes.

 

Organic Causes

 

There are four major causes of Organic ED:

 

(1) Hypogonadism (hormonal based problem). There are many different causes, but in the aging male the most common is low testosterone. Normal testosterone levels are 300-1200 so you can see there's quite a range. If you have ED accompanied by gynecomastia (male breast enlargement). Hormonal causes (like hyperprolactinemia) can also manifest as decreased libido and infertility.

 

All of these are diagnosed by blood tests. In addition to testosterone other tests (depending on history, age, etc) may include; prolactin, FSH/LH (*follicular stimulating hormone, leutenizing hormone) and thyroid.

 

(2) Vascular. This includes atherosclerosis (fat in the arteries), smoking, hypertension and diabetes. If you have any of these underlying conditions contributing to ED; this is one reason to treat them.

 

(3) Neurogenic. Number one cause is diabetes although anything that has a widespread effect on the nervous system can affect erections. The other one for our group is vitamin deficiency due to alcoholism! Malnutrition, malabsorption can lead to autonomic nervous dysfunction affecting a lot of things (balance, fine motor) and erections.

 

(4) Drugs. There are a lot of common drugs that can cause ED. I can't tell you how many times someone has been on one of these common medications and presents with ED. There are alternatives to these medications so talk to your doc about a change (if you don't satisfy any of the above causes).

 

Beta Blockers - widely prescribed for high blood pressure (hypertension) and heart disease. These include (but not all) Atenolol, metoprolol and propranolol.

Anti-Depressants - Many can cause dysfunction on a continuum of sexual delay (sometimes beneficial in premature ejaculation) to impotence. Buproprion (in the 'atypical depressant' class) has the least reported sexual dysfunction side effects (although I've seen cause mania on a few occasions, personally I don't like antidepressants in general).

 

Anabolic steroids - much has been written about this.

 

Alcohol can cause temporary impotence but more importantly chronic alcohol use can lead to a relative increase in estrogen. Tobacco is worth a mention again.

 

Opiod class medication (vicodin, oxycodone, etc).

 

Treatment

 

Remember, ED should be correctly diagnosed before treating!

 

Treating the underlying cause! Once again, many causes of organic ED have an underlying cause that should be treated in conjunction with any short term (Viagra-type) therapy.

 

Testosterone patch or intramuscular injection for deficiency.

 

Phosphodiesterase-5 inhibitors: These drugs include viagra (Slidenafil), Levitra (Vardenfil) and Cialis (Tadalafil). They decrease breakdown of PD-5 which contributes to arterial dilation.

 

Fallen out of use:

 

Yohimbine: Don't see this used with the advent of drugs like viagra but it does work. Its mechanism of action is also results in vasodilation (direct alpha-2 receptor agonist).

Transurethral alprostadil: Was the only game before viagra.

Intracavernous therapy : The less said about injecting something into your penis the better.

Vacuum constriction device: Traps blood flow. Works but with obvious downsides. "An erection obtained by the vacuum constriction device is not the same as an erection achieved naturally. The penis tends to be purplish in color and can be cold or numb." Just the thing to present to your superstitious thai one-nighter.

Penile prosthesis: Like a built in strap on. Loads of fun. I've seen one. It clicks into place like Dr. Strangeglove.

NOTE: Any erection longer than 4 hours runs the risk of permanent damage (priapism)! Can't think of much worse than having your dick drained in the wee hours but this is not something worth delaying.

 

Other: I can't stress enough how quitting smoking, exercising, controlling your blood pressure and controlling other causes can help ED. Drugs like Viagra can band-aid the problem but there's so many health benefits besides being able to get hard it's worth looking at.

 

Psychologic:

 

Psychologic causes including premature ejaculation respond well to behavioral therapy. Depression can lead to ED and if you loss of sexual Desire is the primary symptoms you might look at this.

 

 

Well, that covers some basics. Hope it helps.

Edited December 29, 2010 by DrK

[Chris50]

Cheers thank you very much i got a hard on reading it first one for a long time

cheers chris

[pseasnain]

Ooh you're horny ...but I like you!

[diceman]

Under overview, what's the diagnosis if no nocturnal erections but no probs getting an erection during sex?

[yoko]

i am 37 but sometimes i cant perfom, i am just bored, never had so much sex in my life so i could not perfom two times once, i am afraid i will be impotent in few years...

 

i am vegan also so my health is pretty good

[brownlegs]

I am sorry but 'Vegan' is not a healthy life style. If it were boxers and athletes would be vegans and vegetarians. Vegetarianism and veganism are just a socially sanctioned eating disorders.

[airport5]

i am 37 but sometimes i cant perfom, i am just bored, never had so much sex in my life so i could not perfom two times once, i am afraid i will be impotent in few years...

 

i am vegan also so my health is pretty good

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Keep in mind you might not get enough protein. Consider buying some all natural protein powder.

[sanj]

I found that most girls drink a lot with the intention of getting you pissed so you can't perform anyway. Luckily i can drink more than the average man but even i know when to stop.

In Insomnia, the girl i took back kept the drinks flowing and when she realised i wasn't getting pissed as quickly she kept pouring her drink into her own mouth then started kissing me and making me drink it...... Still had my fun though... ;-)

[hemi265]

I am sorry but 'Vegan' is not a healthy life style. If it were boxers and athletes would be vegans and vegetarians. Vegetarianism and veganism are just a socially sanctioned eating disorders.

 

A bit off topic but there are some well known vegetarian and vegan fighters. Jon Fitch from the ufc is a vegan. Timothy Bradley who beat Manny Pacquiao goes on a vegetarian diet during for his last 6 or 8 weeks before a fight.

[hemi265]

For erection problems would cialis be avaliable there?