Impotency and the male erection - Econdoms guide

Info and Overview

A male erection appears so easy and natural. However, a male erection is a rather intricate process that works in coordination with psychological, neurological and cardiovascular systems. The penis becomes erect only after a series of events. First, arousal, the nerves are stimulated. This can happen in a variety of ways either visual, mental or physical. When arousal occurs, the brain coordinates the following series of events:

Nerve impulses transverse the length of the spinal cord to the pudendal nerve and on to the penis. Smooth muscle within the walls of the penile arteries respond by relaxing. Subsequently, the penile arteries dilate allowing up to eight times more blood to flow into the corpora cavernosum, (two parallel cylinders that transverse the length of the penis). The cavernosum become engorged with blood expanding and lengthening the penis. This is when a male erection is achieved. The expanding tissue then exerts a positive pressure compressing the veins that normally empty the blood from the penis, maintaining the blood in the penile tissue. This maintains the male erection. When ejaculation occurs or when arousal is discontinued the penis returns to its non-erect state and the erection is lost.
Erectile Dysfunction (ED) is the persistent or repeated inability for at least 3 months to attain, and/or maintain an erection sufficient for satisfactory sexual performance. A 5 item Erectile Function Scale called the "EF Index" was developed to assist clinicians and patients in the communication process.
In 1992, the National Institutes of Health defined erectile dysfunction as the inability to attain or sustain an erection adequate for satisfactory sexual intercourse. "Erectile Dysfuntion" is more precise than impotence, a term that some associate with being sterile or lacking strength, vigor, or power. Men who have ED have a frequent or consistent problem in getting or keeping an erection that's firm enough for sexual activity. ED is also defined by the degree to which it bothers the man and his partner. It is different from other male sexual problems, such as premature (rapid) ejaculation, low sexual desire, or an inability to have an orgasm (climax). However, these common conditions may also occur in men with ED, just as they can in any man.
Your sex life is a private matter and it's understandable to feel a little uncomfortable talking to your doctor or your partner about an erection problem. But speaking up may be the best thing you can do to improve your health and the quality of your life. This web site was designed to help you work with your doctor and your partner to resume an active sexual life. With so many treatment options available, there is no need for men and their partners to suffer the consequences in silence.
The first step in addressing erectile dysfunction is to understand the definition of the condition and acknowledge its existence. Experts agree that good communication is the foundation for an enduring relationship. However, when couples encounter sexual difficulties, communication in the best of relationships can become strained or break down entirely. Erectile dysfunction may divide and distance couples, often-causing conflict and emotional pain. Couples may intentionally, or unintentionally ignore or deny the condition, thus delaying treatment. Fortunately, many sexual difficulties can be improved or resolved through open communication and a mutual commitment to learn about the condition and treatment options.
Once thought to be a psychological condition, ED in most cases is now known to have a primary physical cause, such as disease, injury, or drug side effects. For example, certain medications are known to interfere with the nerve signals that cause an erection. Heart disease, hardening of the arteries, and high blood pressure can cause damage to the blood vessels, interfering with blood flow to the penis. (In fact, since smoking is a major risk factor for these conditions, it is also a major risk factor for ED.) Diabetes can cause temporary or permanent damage to nerve tissues in the body, which may also interfere with erection. Men who are treated for prostate cancer sometimes develop ED as a result of their treatment. Other possible physical causes include alcoholism, liver failure, high cholesterol, hormonal abnormalities (such as low testosterone), and neurological disorders. In just about all cases of ED even when there is a definite physical cause there is a psychological component as well. Men typically feel anxiety, guilt, or depression, which in turn makes the problem worse.

Treatments

ED: The American Medical Association estimates that 95% of ED cases are treatable through one of the following measures.
· Drug therapy: Sildenafil (Viagra ) was approved by the Food and Drug Administration in 1998 and is the only oral drug proven to treat ED. Taken an hour or so before sexual activity, it increases the concentration of a natural chemical in the penis that causes the blood vessels to dilate, which in turn increases blood flow to the penis. Unlike injection therapy (see below), it doesn't cause an automatic erection; rather, it works in response to sexual stimulation. However, Viagra isn't the right choice for all men. Men who have heart problems or are taking medications that help widen the coronary arteries are not good candidates because the drug combination can make blood pressure dangerously low. Some men with hormonal imbalances may be helped by testosterone shots, pills, or skin patches. Additional medications, both oral and topical, are under investigation in clinical trials.
· Psychotherapy: Whether there is a physical cause or not, men may benefit from working with a therapist to learn techniques that can decrease anxiety associated with intercourse.
· Vacuum constriction device: This involves placing a plastic tube over the penis and pumping the air out of the tube, drawing blood into the penis and making it erect. An elastic band is placed around the base of the penis to maintain the erection.
· Penile injection therapy: Medication is injected directly into the side of the penis, causing the blood vessels to widen and erection to occur.
· Intraurethral therapy: A soft pellet of medication is inserted into the urethra, and then absorbed into the erection chambers of the penis.
· Surgery: Surgery may involve one of three procedures: implanting a device (prosthesis) that can cause the penis to become erect; reconstructing arteries to increase blood flow to the penis; or repairing the veins within the penis that are failing to keep sufficient blood within the organ.
All of these treatments have different complications and side effects, so it's important for men to work with their doctors to determine what's right for them.

Understanding the Male Erection

Male Erection and the Therapeutic Options in the Management of Erectile Dysfunction

To understand the assessment and treatment of sexual dysfunction, it is necessary to first review normal sexual function. Normal male sexual function involves 3 phases: Libido, Erectile Rigidity, and Orgasm.

1. Libido is centered in the medial preoptic area of the hypothalamus and is associated with psychological, social, physical, and endocrine factors. There are testosterone receptors in this area, and decreased testosterone levels result in a decreased libido. Testosterone replacement increases libido in a dose-dependent fashion.

2. Erectile Rigidity requires normal penile anatomy and function. The human penis consists of three corpora (or tube-shaped bodies). There are a pair of corpora on the dorsal surface of the penis known as the corpus cavernosa. These are involved in the development of an erection. The third corpus is on the ventral surface and is known as the corpus spongiosum. It surrounds the urethra and forms the glans penis distally. The corpora are surrounded by blood vessels, a mesh of trabecular smooth muscle, and a thick fibrous sheath known as the tunica albuginea (see Figure 1).

An erection is a vascular event initiated by neuronal action and maintained by a complex interplay between the central nervous system and local factors. It may occur as a result of genital stimulation or psychic input (fantasy, sight, sound, or smell). Stimuli are processed in the hypothalamus, and neural impulses are transmitted to the thoracolumbar and sacral erection centers. The thoracolumbar center provides sympathetic innervation that maintains penile flaccidity. The sacral erection center provides parasympathetic innervation that leads to erection. Parasympathetic input relaxes the trabecular smooth muscle and dilates the helicine arteries of the penis. This leads to expansion of the lacunar spaces and entrapment of blood as increasing blood volume compresses venules against the tunica albuginea. This process is known as the corporal veno-occlusive mechanism.

3. Orgasm is poorly understood at the present time. It appears that orgasm is a result of pudendal nerve stimulation. The pleasure associated with orgasm may be related to either pressure caused by seminal collection in the posterior urethra or from bulbocavernosus and pelvic muscle contractions. Orgasmic dysfunction, although poorly studied, may occur in older hypogonadal men. it is manifested as a less intense orgasm and a smaller volume of ejaculate.

The process of erection and return to flaccidity (detumescence) has been summarized and divided into different phases as listed below:
· Phase 0 - This is the flaccid state.There is dominant sympathetic influence and minimal blood flow.
· Phase I - This is the latent or filling phase. Parasympathetic nervous activity dominates. Increased parasympathetic activity results in an increased production of nitric oxide and vasoactive polypeptide. This results in an increased production of cyclic guanidine monophosphate that reduces intracellular calcium, resulting in smooth muscle relaxation and increased blood flow through the pudendal and cavernous arteries.
· Phase 2 - This is the tumescence phase.The intercavernous pressure increases rapidly and penile engorgement occurs.
· Phase 3 - In this phase, known as the full erection phase, outflow of blood is restricted. As the penis is engorged, subtunical venules are compressed by the increased blood volume against the tunica albuginea.The intercavernous pressure rises to 10-20 mm Hg below systemic blood pressure.
· Phase 4 - This is the skeletal or rigid erection phase. Intercavernous pressure increases well above systemic blood pressure as a result of voluntary or reflexogenic contraction of the ischiocavernosus and bulbocavernosus muscles. This results in a rigid erection.There is no blood flow through the cavernous artery at this stage.
· Phase 5 - In this transitional phase, there is increased sympathetic nervous system activity. This results in increased vascular tone and low level resumption of arterial blood flow. Blood outflow is still restricted.
· Phase 6 - This is the initial detumescence phase. Intercavernous pressure declines and the outflow restriction decreases.
· Phase 7 - This is known as the fast detumescence phase. Intercavernous pressures decline rapidly The outflow restriction is inactivated, and arterial blood flow returns to normal levels. The penis returns to the flaccid state.
Of the three phases of normal male sexual function, erectile rigidity plays the biggest role in male erectile dysfunction.

Many patients feel that erectile dysfunction is a normal consequence of aging. This is not true, although there are some age-related changes that may affect sexual function. An example is a decrease in libido related to hypogonadism.

For the most part, sexual dysfunction is the result of the effects of age associated disease and/or their treatment on the ability to develop or maintain an erection.

The etiology of erectile dysfunction may be broadly categorized as organic, psychogenic, or mixed. Organic causes may be vascular, neurogenic, hormonal, or pharmacologic. They may be related to surgery or radiation. Organic disorders account for the majority of all cases of erectile dysfunction.

Because adequate arterial blood supply is critical for erection, any disorder that affects blood flow may be a cause for erectile dysfunction. Other disorders impair the ability to trap blood within the penis, or affect the neuronal pathways involved in achieving and/or maintaining an erection. Hormonal and psychological factors may also play a role.

Most cases of erectile dysfunction are multifactorial in etiology, with organic and psychologic aspects. This requires a multidisciplinary approach to assessment and treatment.

Erectile dysfunction is a widespread and under-reported disorder affecting millions of men. With the aging of our population and the age-related comorbid conditions, this problem is only going to increase in magnitude.

There are a multitude of treatment options for Male Erectile Dysfunction currently available, including:

• Vacuum Devices
• Penile Prostheses
• Penile Sheath
• Hormonal Therapy
• Penile Injection Therapy
• Topical Solutions
• Intraurethral Application
• Vascular Surgery

MONDAY
Oranges, Lemons, Kiwi Fruit, Mango, Papaya, Raspberries and Blackberries, Green Vegetables

TUESDAY
Grapes, Redcurrants, Garlic, Onion, Green Pepper, Bulgur Wheat, Tomatoes, Parsley

WEDNESDAY
Wholemeal Rice, Liver, Milk, Egg Yolks, Cabbage, Beetroot, more Green Vegetables

THURSDAY
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FRIDAY
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WEEKEND
Any of the above plus Chocolate, Bananas and Treacle or Molasses