Category: Erectile Dysfunction

To truly understand ED, it’s helpful to know a little about the mechanics of an erection, which usually begins in the brain with feelings of sexual desire. These feelings trigger the release of nitric oxide, a neurotransmitter that sets in motion a relaxation of muscles and allows increased blood flow to the penis.

Breaking these steps down a bit further, we find that the nitric oxide released by the brain in response to feelings of sexual desire sets in motion a chain of chemical reactions that eventually results in an erection. When the nitric oxide reaches the bundle of nerves and blood vessels surrounding the prostate gland, it prompts the guanylate cyclase enzyme to produce cyclic guanosine monophosphate (cGMP), which controls the expansion and contraction of blood vessels that supply the penis. This release of cGMP temporarily expands the arteries that supply the penis and contracts the blood vessels that carry blood away from the penis. This results in an erection.

Also present in the body is the phosphodiesterase-5 enzyme, which under normal conditions breaks down cGMP after an erection. However, sometimes its presence prematurely interferes with the erection process. PDE5 inhibitors temporarily block the effect of the enzyme, which facilitates erection.

The defining symptom of erectile dysfunction is the inability to get and keep an erection that is strong enough — and long-lasting enough — for sexual intercourse, according to WebMD.com. Apart from having difficulty getting and/or keeping an erection, another symptom of ED is a noticeable decline in sexual desire.

If erectile problems occur only occasionally, the problem is unlikely to be a serious one, and the symptoms may be traceable to stress, fatigue, overindulgence in alcohol, drug abuse, or a bout of performance anxiety.

For men who still experience morning erections and have no difficulty getting an erection during masturbation but have trouble getting and maintaining an erection for sexual activity with a partner, the ED symptoms in all likelihood are psychological in origin.

Typically, the onset of chronic impotence is gradual and persistent. Roughly 85 to 90 percent of chronic impotence is physiological in nature. To overcome the problem, these physical causes must be addressed. ED drugs enable men with chronic impotence to engage in sexual activity but do not cure the underlying physical causes of this disorder.

The most common erectile dysfunction drugs, based on U.S. and worldwide sales data, are the PDE5 inhibitors, all of which work by temporarily blocking the effects of an enzyme known as phosphodiesterase-5. The PDE5 enzyme can impede blood flow to the penis and make it more difficult — or even impossible — to achieve and maintain an erection hard enough for intercourse.

Among the PDE5 inhibitors, the best-selling drug in the United States during 2013 was Viagra, which had sales of nearly $1.2 billion. Viagra (sildenafil citrate) was only slightly ahead of Cialis (vardenafil), which had 2013 sales of $1.09 billion in the United States. Two different formulations of Cialis are available in the United States: Cialis for Daily Use and Cialis for Use as Needed. The latter is effective for up to 36 hours.

While Viagra and Cialis had the lion’s share of the ED market in 2013, other impotence drugs available included Levitra and Staxyn (both tadalafil) and Stendra (avanafil).

If you’re consistently unable to delay ejaculation for more than a minute after beginning intercourse, you probably are suffering from premature ejaculation, according to MayoClinic.com. In other words, there’s no need to panic if this has happened to you as an isolated incident, but if it’s a regular thing you should probably take your concerns to your doctor.

The average time from the beginning of intercourse to ejaculation is five minutes, says Mayo Clinic. But if you feel you have no control over the ejaculation process or if ejaculation occurs earlier than you’d like, talk to your doctor. Although it’s not always easy to discuss sensitive sexual matters with your doctor, you’ll need to man up in order for the two of you to find a way in which to treat the problem.

In a Sexploration column for NBCNews.com, writer Brian Alexander offers a couple of suggestions on ways to prolong an erection and the pleasure of your partner. Actually, the first one comes from sex therapists Masters and Johnson and requires the participation of your partner. Just as you are about to climax, have your partner squeeze the tip of the penis with the thumb, index finger, and middle finger. Alternatively, the base of the penile shaft can be squeezed. You’ll experience the sensation of orgasm but will not ejaculate and will be able to recover your erection quickly so that you can continue.

The second technique involves a muscle known as the pubococcygeus. It’s the one you can use to slow or stop your urine flow, and it’s the same muscle that some men use to make their penis bounce up and down as a form of self-amusement. With regular workouts of this muscle, you can get to the point where you can experience multiple orgasms. Begin by draping a towel or washcloth over your penis and then use the pubococcygeus muscle to move your penis up and down with that extra weight on it. If you start with only a washcloth, switch to a wet washcloth when lifting the washcloth alone becomes too easy. Alexander recommends doing this exercise at least 100 times daily.

Designed to indicate whether your physical equipment is in good working order, a nocturnal tumescence test tells the doctor whether you’ve had an erection during sleep. Normal, healthy men have three to five nocturnal erections nightly, most of which occur during REM (rapid eye movement) sleep.

If the test indicates you are having nighttime erections, it signals to your doctor that any erectile problems you may be having are likely to be psychological in origin rather than physiological.

The test can be done at home or in a special sleep laboratory, according to WebMD.

In the most simple form of this test, a snap gauge consisting of plastic film is fitted around your penis. The gauge is designed to break when subjected to certain pressures, specifically the pressure caused by an erection.

In a lab setting, your penis can be fitted with an electronic monitoring device that records the number and strength of erections that occur during the night.

Kegel exercises, also known as pelvic floor exercises, are designed to strengthen the muscles that control your bladder, according to WebMD. Although their primary goal is to control urinary leakage, these exercises have a couple of added benefits for men: They can improve the strength of your erection and help you to experience more intense orgasms.

You first must locate the muscles that these exercises target. You may be able to do this during urination. Midway through urination, try to slow down or stop altogether your urine flow without holding your breath or tensing the muscles in your buttocks, legs, or abdomen. When you are able to stop or slow urine flow, you’ve zeroed in on the right set of muscles. Then:

“Contract these muscles for a slow count of five.

“Release these muscles to a slow count of five.

“Repeat 10 times.

“Do a set of 10 Kegels daily, three times a day.”

EverydayHealth.com says the link between depression and sexual dysfunction is clearly established, citing studies that show 35 to 47 percent of all people with depression have problems in their sex lives. Furthermore, antidepressant medications may help to banish the blues, but in doing so they take a toll on sexual satisfaction on up to 40 percent of those taking them.

In looking at the ways in which depression interferes with erectile function, EverydayHealth notes that the sexual urge to get an erection starts in the brain. Erectile dysfunction results when there isn’t a sufficient level of brain chemicals to stimulate blood flow to the penis.

While it’s true that certain antidepressant medications dampen sexual desire and interfere with erectile function, not all drugs cause these reactions. If you’re on an antidepressant and experiencing symptoms of ED, ask your doctor to switch you to a drug less likely to have these effects.

Among the psychological causes of erectile dysfunction, stress and the fatigue induced by stress rank somewhere near the top. Whether caused by marital or money problems or work-related worries, stress can make it difficult to get and keep an erection. In fact, stress can also put a damper on sexual desire, making the ability to get an erection pretty much a moot point.

As part of the body’s reaction to acute stress, the adrenal glands release increased amounts of cortisol, the so-called stress hormone. This cortisol can upset your body’s delicate balance of hormones, among which testosterone is the most important in terms of erectile function.

While it is clearly impossible to remove all of life’s many stressors, you should try to avoid those that you can and adopt a more laid-back attitude when it comes to dealing with those stresses that are unavoidable. If you can act quickly to resolve the issue causing your stress, by all means do it. If not, relax in the sure and certain knowledge that this too shall pass.