sexual function and dysfunction in men
men s health issues
Erectile Dysfunction (ED)
To achieve an erection, the penis needs an adequate amount of blood flowing in, a slowing of blood flowing out, proper function of nerves leading to and from the penis, adequate amounts of the male sex hormonetestosterone, and sufficient sex drive (libido), so a disorder of any of these systems may lead to erectile dysfunction (ED). Most cases of ED are caused by abnormalities of the blood vessels or nerves of the penis. Other possible causes include hormonal disorders, structural disorders of the penis, use of certain drugs, and psychologic problems (see table Common Causes and Features of Erectile Dysfunction ). The most common specific causes are Hardening of the arteries (atherosclerosis) that affects the arteries to the penis Diabetes Mellitus (DM) None Complications of Surgery None Certain drugs such as those used to treat high blood pressure or an Drugs and those that act on the central nervous system, such as drugs used to treat depression Occasional inability to achieve an erection is normal and does not mean that a man has erectile dysfunction. Almost half of men older than 65 and some men older than 80 can usually have erections adequate for penetration. Low levels oftestosteronetend to decrease sex drive rather than cause erectile dysfunction. Combinations of drugs injected into the penis and devices that constrict or apply suction to the penis are highly effective and lack some of the side effects of oral drugs. Sexual counseling can help even when erectile dysfunction has a physical cause. Often several factors contribute to ED. For example, a man with a slight decrease in erectile function caused by diabetes or peripheral vascular disease can develop severe ED after starting a new drug or if stress increases. Atherosclerosis may partially block blood flow to the legs (peripheral vascular disease). Usually, arteries to the penis are also blocked, decreasing the amount of blood flow to the penis and causing ED. Diabetes, high cholesterol levels, high blood pressure, and smoking contribute to atherosclerosis and therefore to ED. Sometimes blood leaks out of the veins in the penis too fast, decreasing blood pressure in the penis and thus interfering with achieving or maintaining an erection (called veno-occlusive dysfunction). If the nerves sending messages to the penis are damaged, ED can occur. In addition to causing atherosclerosis, Diabetes Mellitus (DM) can also affect the nerves that supply the penis. Because nerves to the penis run along the prostate gland, prostate surgery (such as for cancer or an enlarged prostate) often causes ED. Less common nerve disorders that cause ED include spinal cord injury, multiple sclerosis, and stroke. Also, prolonged pressure on the nerves in the buttocks and genital area (the so-called saddle area), as may occur during long-distance bicycle riding, can cause temporary ED. Hormonal disturbances(such as abnormally low levels oftestosterone) tend to decrease sex drive but can also result in ED. Peyronie Disease , In Peyronie disease, inflammation inside the penis causes scar tissue to form. Because the scar tissue does not enlarge during an erection, the erect penis is curved, making penetration during sexual intercourse difficult or impossible. The scar tissue may extend into the erectile tissue (corpora cavernosa), causing erectile dysfunction. Drugs,including alcohol and illicit drugs such ascocaineand amphetamines, can also cause or contribute to ED. Sometimespsychologic problems(such as performance anxiety or depression) or factors that decrease a man's energy level (such as illness, fatigue, or stress) cause or contribute to ED. Erectile dysfunction may be situational, involving a particular place, time, or partner. Prolonged, painful erection ( Persistent Erection ) may damage the erectile tissue of the penis, leading to ED. 