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"Brewer's droop" redirects here. For the band, see Brewers Droop. Erectile dysfunction Classification and external resources ICD-10 F52.2, N48.4 ICD-9 302.72, 607.84 DiseasesDB 21555 MeSH D007172 Erectile dysfunction (ED) or impotence is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance.[1] A penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis. The process is often initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis. The most important organic causes are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects.

Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but often can be helped. Notably in psychological impotence, there is a strong response to placebo treatment. Erectile dysfunction can have severe psychological consequences as it can be tied to relationship difficulties and masculine self-image generally.

Besides treating the underlying causes such as potassium deficiency or arsenic contamination of drinking water, the first line treatment of erectile dysfunction consists of a trial of PDE5 inhibitor drugs (the first of which was sildenafil or Viagra). In some cases, treatment can involve prostaglandin tablets in the urethra, injections into the penis, a penile prosthesis, a penis pump or vascular reconstructive surgery.[2]

The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina; it is now mostly replaced by more precise terms, such as erectile dysfunction (ED). The study of erectile dysfunction within medicine is covered by andrology, a sub-field within urology. Research indicates that erectile dysfunction is common, and it is suggested that approximately 40% of males suffer from erectile dysfunction or impotence, at least occasionally.[3]

Contents [hide] 1 Signs and symptoms 2 Causes 3 Pathophysiology 4 Diagnosis 5 Treatment 5.1 Oral medication 5.2 Topical medication 5.3 Injected medication 5.4 Pumps 5.5 Surgery 5.6 Alternative medicine 6 History 7 Research 8 References 9 External links Signs and symptoms Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection. It is analyzed in several ways:

Obtaining full erections at some times, such as nocturnal penile tumescence when asleep (when the mind and psychological issues, if any, are less present), tends to suggest that the physical structures are functionally working.[4][5] Other factors leading to erectile dysfunction are diabetes mellitus (causing neuropathy). Causes Drugs (anti-depressants (SSRIs[6]) and nicotine are most common) Neurogenic disorders[7] Cavernosal disorders (Peyronie's disease[8]) Psychological causes: performance anxiety, stress, mental disorders,[9] psychological problems, negative feelings.[10][not in citation given] Surgery[11] Aging. It is four times higher in men in their 60s than in men in their 40s.[12] Kidney failure Diseases such as diabetes and multiple sclerosis (MS). While these two causes have not been proven they're likely suspects as they cause issues with both the blood flow and nervous systems. At least one paper has suggested that arsenic poisoning from contaminated well water may be a cause in some regions, perhaps by alteration of voltage gated potassium channels.[13] Lifestyle: smoking is a key cause of erectile dysfunction.[14][15] Smoking causes impotence because it promotes arterial narrowing.[16] See also Tobacco and health. Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Erectile dysfunction is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation, although the prostate gland itself is not necessary to achieve erection.

ED can also be associated with bicycling due to both neurological and vascular problems due to compression.[17] The increase risk appears to be about 1.7-fold.[18]

A recent study suggests an epidemiological association between chronic periodontitis (periodontal inflammation) and erectile dysfunction,[19] similarly to the association between periodontitis and coronary heart diseases,[20] and cerebrovascular diseases.[21] In all the three conditions (erectile dysfunction, coronary heart disease and cerebrovascular diseases), despite the epidemiological association with periodontitis, no causative connection has yet been proven.

February 2011: Men who use non-steroidal anti-inflammatory drugs (NSAIDs) 3 times a day for more than 3 months are at a 22 percent increased risk of erectile dysfunction. A link between NSAID use and erectile dysfunction still existed for different age, race, ethnicity, smoker, diabetes, hypertension, high cholesterol, coronary diasease and other health problems. But due to benefit of NSAID, it's too early for men to avoid NSAIDs based solely on the research stated at Journal of Urology.[22]

Pathophysiology Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both conditions, an intact neural system is required for a successful and complete erection. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems.[23] Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light.

Diagnosis

This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (May 2010) There are no formal tests to diagnose erectile dysfunction. Some blood tests are generally done to exclude underlying disease, such as hypogonadism and prolactinoma. Diabetes is considered a disorder, but is also a risk. Impotence is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease such as coronary artery disease and peripheral vascular disease.

A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection. If never, the problem is likely to be physiological; if sometimes (however rarely), it could be physiological or psychological. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence.

Duplex ultrasound Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue. Injecting prostaglandin, a hormone-like stimulator produced in the body, induces erection. Ultrasound is then used to see vascular dilation and measure penile blood pressure. Penile nerves function Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus. Nocturnal penile tumescence (NPT) It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections. Penile biothesiometry This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis. Dynamic infusion cavernosometry (DICC) technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection. Corpus cavernosometry Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualised by infusing a mixture of saline and x ray contrast medium and performing a cavernosogram.;[24] Digital Subtraction Angiography: In DSA, the images are acquired digitally. Magnetic resonance angiography (MRA) This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a "contrast agent" into the patient's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies. Treatment

This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (November 2013) Treatment depends on the cause.

Exercise, particularly aerobic exercise during midlife is an effective for preventing ED; exercise as a treatment is under investigation.[25]:6, 18–19

Oral pharmacotherapy and vacuum erection devices are first-line treatments,[25]:20,24 followed by injections of drugs into the penis, and penile implants.[25]:25–26

Oral medication Phosphodiesterase type 5 inhibitors The cyclic nucleotide phosphodiesterases constitute a group of enzymes that destroy the cyclic nucleotides cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). Phosphodiesterases exist in different molecular forms and are unevenly distributed throughout the body. One of the forms of phosphodiesterase is termed PDE5, and inhibiting PDE5 increases the amount of cGMP available in the blood supply to the penis, thus increasing blood flow. The PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally.[25]:20–21

Topical medication Alprostadil A topical cream combining Alprostadil with the permeation enhancer DDAIP has been approved in Canada under the brand name Vitaros as a first line treatment for erectile dysfunction.[26]

Injected medication Another treatment regimen is injection therapy. One of the following drugs is injected into the penis: papaverine, phentolamine, and prostaglandin E1.[25]:25

Pumps Main article: penis pump The device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available with a doctor's prescription. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants may be fitted surgically.

Surgery Main article: Penile prosthesis Often, as a last resort if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.[25]:26

Alternative medicine The FDA does not recommend alternative therapies (i.e. those that have not received FDA approval) to treat sexual dysfunction.[27] Many products are advertised as "herbal viagra" or "natural" sexual enhancement products, but no clinical trials or scientific studies support the effectiveness of these products for the treatment of erectile dysfunction, and synthetic chemical compounds similar to sildenafil have been found as adulterants in many of these products.[28][29][30][31][32] The United States Food and Drug Administration has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant.[33]

History

This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (May 2010)


An unhappy wife is complaining to the Qadi about her husband's impotence. Ottoman miniature. During the late 16th and 17th centuries in France, male impotence was considered a crime, as well as legal grounds for a divorce. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677.[34]

Dr. John R. Brinkley initiated a boom in male impotence cures in the U.S. in the 1920s and 1930s. His radio programs recommended expensive goat gland implants and "mercurochrome" injections as the path to restored male virility, including operations by surgeon Serge Voronoff.

Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley, PhD dropped his trousers and demonstrated to a shocked Urodynamics Society audience his papaverine-induced erection.[35] The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. The effect that Brindley discovered established the fundamentals for the later development of specific, safe, orally effective drug therapies.[36][better source needed][37][better source needed]

Research Gene therapy Gene therapy is being developed that would allow for weeks or months long effect, supporting erections. This gene therapy involves injection of a transfer gene, calcium-sensitive potassium channel (hMaxi-K), into the penis.[38][39][40]

Tx2-6 A study done at the Medical College of Georgia has found that venom from the Brazilian wandering spider contains a toxin, called Tx2-6, that causes erections. Scientists believe that combining this toxin with existing medication such as Viagra may lead to an effective treatment for erectile dysfunction.[41]

References Jump up ^ Erectile dysfunction glossary - MUSC Health Jump up ^ Montague DK, Jarow JP, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, Milbank AJ, Nehra A, Sharlip ID (July 2005). "Chapter 1: The management of erectile dysfunction: an AUA update". J. Urol. 174 (1): 230–9. doi:10.1097/01.ju.0000164463.19239.19. PMID 15947645. Jump up ^ Schouten BW, Bohnen AM, Groeneveld FP, Dohle GR, Thomas S, Bosch JL (July 2010). "Erectile dysfunction in the community: trends over time in incidence, prevalence, GP consultation and medication use—the Krimpen study: trends in ED". J Sex Med 7 (7): 2547–53. doi:10.1111/j.1743-6109.2010.01849.x. PMID 20497307. Jump up ^ Levine LA, Lenting EL (1995). "Use of nocturnal penile tumescence and rigidity in the evaluation of male erectile dysfunction". Urol. Clin. North Am. 22 (4): 775–88. PMID 7483128. Jump up ^ "Tests for Erection Problems". WebMD, Inc. Retrieved 2007-03-03. Jump up ^ Delgado PL, Brannan SK, Mallinckrodt CH, Tran PV, McNamara RK, Wang F, Watkin JG, Detke MJ (2005). "Sexual functioning assessed in 4 double-blind placebo- and paroxetine-controlled trials of duloxetine for major depressive disorder". The Journal of clinical psychiatry 66 (6): 686–692. doi:10.4088/JCP.v66n0603. PMID 15960560. Jump up ^ "Neurogenic Sexual Dysfunction in Men and Women". Neurologic Bladder, Bowel and Sexual Dysfunction. Retrieved 2014-03-03. Jump up ^ "Male Sexual Dysfunction Epidemiology". Erectile dysfunction. Armenian Health Network, Health.am. 2006. Retrieved 2007-10-07. Jump up ^ Tom F. Lue, MD (2006). "Causes of Erectile Dysfunction". Erectile dysfunction. Armenian Health Network, Health.am. Retrieved 2007-10-07. Jump up ^ "Erectile dysfunction". Erectile dysfunction. Mayo Clinic. 2006. Retrieved 2007-10-07. Jump up ^ "Erectile Dysfunction Causes". Erectile Dysfunction. Healthcommunities.com. 1998. Retrieved 2007-10-07. Jump up ^ "Erectile Dysfunction". Retrieved 2010-07-01. Jump up ^ Hsieh FI, Hwang TS, Hsieh YC, Lo HC, Su CT, Hsu HS, Chiou HY, Chen CJ (April 2008). "Risk of erectile dysfunction induced by arsenic exposure through well water consumption in Taiwan". Environ Health Perspect. (School of Public Health, Topnotch Stroke Research Center, Taipei Medical University, Taipei 110, Taiwan) 116 (4): 532–6. doi:10.1289/ehp.10930. PMID 18414639. Jump up ^ Peate I (2005). "The effects of smoking on the reproductive health of men". Br J Nurs 14 (7): 362–6. PMID 15924009. Jump up ^ Korenman SG (2004). "Epidemiology of erectile dysfunction". Endocrine 23 (2–3): 87–91. doi:10.1385/ENDO:23:2-3:087. PMID 15146084. Jump up ^ Kendirci M, Nowfar S, Hellstrom WJ (2005). "The impact of vascular risk factors on erectile function". Drugs Today (Barc) 41 (1): 65–74. doi:10.1358/dot.2005.41.1.875779. PMID 15753970. Jump up ^ Sommer F, Goldstein I, Korda JB (July 2010). "Bicycle riding and erectile dysfunction: a review.". The journal of sexual medicine 7 (7): 2346–58. doi:10.1111/j.1743-6109.2009.01664.x. PMID 20102446. Jump up ^ Huang V, Munarriz R, Goldstein I (September 2005). "Bicycle riding and erectile dysfunction: an increase in interest (and concern).". The journal of sexual medicine 2 (5): 596–604. doi:10.1111/j.1743-6109.2005.00099.x. PMID 16422816. Jump up ^ Zadik Y, Bechor R, Galor S, Justo D, Heruti RJ (April 2009). "Erectile dysfunction might be associated with chronic periodontal disease: two ends of the cardiovascular spectrum". J Sex Med 6 (4): 1111–6. doi:10.1111/j.1743-6109.2008.01141.x. PMID 19170861. Jump up ^ Friedewald VE, Kornman KS, Beck JD, Genco R, Goldfine A, Libby P, Offenbacher S, Ridker PM, Van Dyke TE, Roberts WC (July 2009). "The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: periodontitis and atherosclerotic cardiovascular disease". Am J Cardiol 104 (1): 59–68. doi:10.1016/j.amjcard.2009.05.002. PMID 19576322. Jump up ^ Khader YS, Albashaireh ZS, Alomari MA (August 2004). "Periodontal diseases and the risk of coronary heart and cerebrovascular diseases: a meta-analysis". J Periodontol 75 (8): 1046–53. doi:10.1902/jop.2004.75.8.1046. PMID 15455730. Jump up ^ "Most Popular E-mail Newsletter". USA Today. 2011-03-01. Jump up ^ Rany Shamloul; Anthony J Bella (2014-03-01). Erectile Dysfunction. Biota Publishing. pp. 6–. ISBN 978-1-61504-653-9. Jump up ^ Dawson C, Whitfield H (April 1996). "ABC of urology. Subfertility and male sexual dysfunction". BMJ 312 (7035): 902–5. doi:10.1136/bmj.312.7035.902. PMC 2350600. PMID 8611887. ^ Jump up to: a b c d e f Wespes E (chair), et al. Guidelines on Male Sexual Dysfunction: Erectile dysfunction and premature ejaculation. European Association of Urology 2013 Jump up ^ Bujdos, Brian. "New Topical Erectile Dysfunction Drug Vitaros Approved in Canada; Approved Topical Drug Testim Proves Helpful for Erectile Dysfunction". Retrieved 15 April 2011. Jump up ^ "Dangers of Sexual Enhancement Supplements". Jump up ^ Gryniewicz CM, Reepmeyer JC, Kauffman JF, Buhse LF (2009). "Detection of undeclared erectile dysfunction drugs and analogues in dietary supplements by ion mobility spectrometry". Journal of pharmaceutical and biomedical analysis 49 (3): 601–6. doi:10.1016/j.jpba.2008.12.002. PMID 19150190. Jump up ^ Choi DM, Park S, Yoon TH, Jeong HK, Pyo JS, Park J, Kim D, Kwon SW (2008). "Determination of analogs of sildenafil and vardenafil in foods by column liquid chromatography with a photodiode array detector, mass spectrometry, and nuclear magnetic resonance spectrometry". Journal of AOAC International 91 (3): 580–588. PMID 18567304. Jump up ^ Reepmeyer JC, Woodruff JT (2007). "Use of liquid chromatography-mass spectrometry and a chemical cleavage reaction for the structure elucidation of a new sildenafil analogue detected as an adulterant in an herbal dietary supplement". Journal of Pharmaceutical and Biomedical Analysis 44 (4): 887–893. doi:10.1016/j.jpba.2007.04.011. PMID 17532168. Jump up ^ Reepmeyer JC, Woodruff JT, d'Avignon DA (2007). "Structure elucidation of a novel analogue of sildenafil detected as an adulterant in an herbal dietary supplement". Journal of Pharmaceutical and Biomedical Analysis 43 (5): 1615–1621. doi:10.1016/j.jpba.2006.11.037. PMID 17207601. Jump up ^ Enforcement Report for June 30, 2010, United States Food and Drug Administration Jump up ^ Hidden Risks of Erectile Dysfunction "Treatments" Sold Online, United States Food and Drug Administration, February 21, 2009 Jump up ^ Roach, Mary (2009). Bonk: The Curious Coupling of Science and Sex. New York: W.W. Norton & Co. pp. 149–152. ISBN 9780393334791. Jump up ^ Klotz L (Nov 2005). "How (not) to communicate new scientific information: a memoir of the famous Brindley lecture". BJU Int 96 (7): 956–7. doi:10.1111/j.1464-410X.2005.05797.x. PMID 16225508. Jump up ^ Brindley GS (October 1983). "Cavernosal alpha-blockade: a new technique for investigating and treating erectile impotence". Br J Psychiatry 143 (4): 332–7. doi:10.1192/bjp.143.4.332. PMID 6626852. Jump up ^ Helgason AR, Adolfsson J, Dickman P, Arver S, Fredrikson M, Göthberg M, Steineck G (1996). "Sexual desire, erection, orgasm and ejaculatory functions and their importance to elderly Swedish men: a population-based study". Age Ageing 25 (4): 285–291. doi:10.1093/ageing/25.4.285. PMID 8831873. Jump up ^ Emma Hitt (May 29, 2009). "Gene Therapy May Offer Long-Term Impotence Remedy". Reuters Health. Jump up ^ "Erectile Dysfunction :: Gene therapy for erectile dysfunction shows promise in clinical trial". SpiritIndia. December 1, 2006. Jump up ^ George J. Christ, Karl-Erik Andersson, Koudy Williams, Weixin Zhao, Ralph D'Agostino Jr., Jay Kaplan, Tamer Aboushwareb, James Yoo, Giulia Calenda, Kelvin P. Davies, Rani S. Sellers, Arnold Melman (December 2009). "Smooth-Muscle–Specific Gene Transfer with the Human Maxi-K Channel Improves Erectile Function and Enhances Sexual Behavior in Atherosclerotic Cynomolgus Monkeys". European Urology 56 (6): 891–1104. Jump up ^ Hernandez, Vladimir (4 May 2007). "Spider venom could boost sex life". BBC News. External links Erectile dysfunction at DMOZ [show] v t e Mental and behavioral disorders (F 290–319) [show] v t e Male diseases of the pelvis and genitals (N40–N51, 600–608) [show] v t e Outline of human sexuality Categories: Behavioural syndromes associated with physiological disturbances and physical factorsNon-sexualityPenis disordersSexual disordersPsychiatric diagnosisPenile erection Navigation menu Create accountLog inArticleTalkReadView sourceView history

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