The Problem of Erectile Dysfunction: Causes, Symptoms, and Treatment

Erectile Dysfunction Overview by Canadian Health&Care Mall: Causes, Facts, Medications for Treatment, Treatment Methods and FAQs

Table of Contents:

 ED

The Definition of Erectile Dysfunction

Erectile dysfunction (ED), also called impotence, is persistent inability of a man to have or maintain a penile erection during sexual intercourse with his sexual partner (at least in 25% of intercourses). Troubles with erection may happen from time to time, which is normal and not a reason for concern. But if this problem takes place systematically, the man should pay attention to his health. Erectile dysfunction is a common problem among men - approximately around one third of all men aged between 40 and 70 experience some degree of erectile dysfunction, both occasionally and regularly. In medicine ED is covered by urology’s sub-field – andrology.

Erection of the penis occurs when blood enters sponge-like bodies of the penis and is being retained there. It is caused by sexual arousal, which is a result of signals transmission to the penis nerves from the brain. So, anything that impairs blood flow in the penis or causes injury to the nerves is potentially able to cause ED.

What Causes Troubles with Erection?

What Causes Troubles with Erection?

It is important not to panic and to understand that ongoing troubles with erection are not necessarily the consequence of disease. There is such term as psychological impotence, which means failure of erection or penetration due to psychological reasons – feelings or thoughts, for example when a man is afraid that he is not that good for his sexual partner. Another reason may be systematic stress and chronic fatigue, depression, hypertension, unresolved sexual orientation, conflicts with the sexual partner, sexual boredom. Erectile dysfunction, in its turn, may negatively affect a man’s confidence, his self-image, cause stress, relationship problems. In psychological cases placebo treatment shows good response.

Organic causes of ED can be the following: hormonal insufficiencies (for example, hypogonadism), neurological problems or traumas, diabetes, cardiovascular diseases, or drug side effects. ED can also be caused by kidney failure, aging, cavernosal disorders, neurogenic disorders, spinal cord injury, surgical intervention, drugs (as anti-depressants) consumption. Smoking is a wide spread cause of impotence, because nicotine promotes arterial narrowing and deterioration of penile blood circulation.

Generally impotence is related to poor health, obesity, poor nutrition, unhealthy dietary habits. By the way, the men who ride the bicycle too often are vulnerable to increased risk of temporary erectile dysfunction, though cyclists in general are healthier than the men avoiding sport. The special saddles can make the risk lower.

Diagnosis: How Do You Know Your Erection Needs Help?

Diagnosing erectile dysfunction can be in some way difficult, because there aren’t any formal tests. First of all, it is important to exclude underlying diseases as prolactinoma or hypogonadism, and for this purpose blood tests are done.

During the first visit the physician usually offers the patient to complete a questionnaire with a set of specific questions that indicate many causes of ED. According to the answers, the physician determines whether the patient has severe, moderate or mild erectile dysfunction, and what its underlying cause is.

A man should pass a thorough physical examination, which can reveal problems that may cause erection problems, such as undetected groin hernia. Based on this information appropriate treatment options can be offered.

The doctor also has to find out whether his patient has psychological or physiological impotence. If a man has full penile erection at some times, for example, when asleep, it means his problem is not physical and functionally everything is ok. If the patient never has erection, the problem is probably physiological.

The following tests can help to get more information about the problem:

  • Bulbocavernosus reflex test and other penile nerves function tests are used to find out whether nerve sensation in the penis is sufficient. The head of the penis is squeezed by the physician, and if the nerve function is ok, the anus immediately contracts. To measure it, the physician inserts a gloved finder in the anus.
  • Duplex ultrasound is used to evaluate signs of atherosclerosis, venous leak, blood flow, calcification or scarring of erectile tissue. To induce erection, a hormone-like stimulator prostaglandin is injected, and then ultrasound helps to measure penile blood pressure and see vascular dilation.
  • Penile biothesiometry test evaluates sensitivity, as well nerve function in the shaft and glans of the penis.
  • Nocturnal penile tumescence test (NPT) measures changes in penile circumference and rigidity during nocturnal erection. During sleep and rapid eye movement a man may have 5-6 erections, if he doesn’t it can indicate trouble with penis blood supply or nerve function, though not necessarily.
  • Corpus cavernosometry (cavernosography) is made to measure the vascular pressure in the corpus cavernosum. For this purpose saline is infused into the corpus cavernosum, and the venous leakage degree is indicated the flow rate necessary for maintaining erection.
  • Magnetic resonance angiography (MRA) allows to see the blood vessels on detailed images that are made using radio waves and magnetic fields. Better visibility can be reached by injecting some "contrast agent" into the bloodstream of the patient.
  • Dynamic infusion cavernosometry (DICC) is used to measure the vascular pressure in the corpus cavernosum during an erection. It is made by pumping fluid into the penis at a certain pressure and rate.

Treatment - from Generic Viagra to Intimate Exercises

Intimate Exercises

Healthy Lifestyle and Underlying Diseases Treatment

It is obvious that the treatment methods are chosen depending on the cause of the problem.  In some cases it can be solved quite easily. For example, if you are a smoker, quit this habit and you are likely to experience significant improvement. If you have troubles with blood circulation and lead a sedentary lifestyle, it makes sense to start doing physical exercises, particularly aerobic exercises.

Treating underlying diseases and physical conditions and healthy lifestyle changes should be the first line of treatment and take place before oral medications. Hormonal supplements can be prescribed to men who have low level of testosterone, when such lack of testosterone is the cause of erectile dysfunction. Usually in such situation men have low sexual desire. If impotence is caused by some medication taken by the patient, the problem can be solved by its alteration. In case if groin hernia is a cause of erection problems, surgical hernia repair is used.

Food that Provides Good Erection

There are products that are considered helpful for men’s sexual health:

  • Watermelon fruit is able to have positive effect on the blood vessels and thus improve erection. Lycopene antioxidant in it is good for skin, heart and prostate.
  • Oysters are full of zinc and boost testosterone levels and sex drive.
  • Walnuts are full of arginine. The body uses this amino acid to make nitric oxide. Folic acid, vitamin E, and fiber are also present. Nuts are high in calories, so it is recommended to eat no more than a few small handfuls a day.
  • Garlic keeps your arteries clear and healthy, thus providing adequate blood flow.
  • Leafy greens give omega-3, minerals and vitamins. Kale is a booster of nitric-oxide and helps sex life.
  • Chili peppers relax the arteries and allow the blood flow to the organs, including the penis, as well as lower cholesterol, blood pressure and prevent blood clots.
  • Olive oil increases testosterone production in the body and removes bad cholesterol. Extra-virgin olive oil is the best choice.

Kegel exercises

Kegel exercises

They are also called pelvic floor exercises. Kegel exercises can be made both by men and women and are able to improve blood circulation, make the orgasms more intense, strengthen muscles below the bladder and prevent urinary incontinence, improve production of hormones by testicles and ovaries, keep the men’s prostate healthy, provide longer lasting sex.

They also help to significantly improve erectile function in 6 months at least for 40% of men, according to studies the University of the West in the U.K. Kegel exercises strengthen the bulbocavernosus muscle which helps empty the urethra after urination, pumps during ejaculation and engorges penis with blood during erection. There's no other way to train these intimate muscles, as common physical exercises do not have effect on them.

If you don’t feel the muscle that should be trained, try to stop your stream in the middle of urination, do it several times. The muscles clenched are the right ones. You should squeeze those muscles, then hold for five seconds, and finally relax. Sometimes try to hold your muscles squeezed for as long as a minute. Repeat this three times a day, at least 10 to 20 times. If you want you can do more repetitions (50-100) – you should gradually increase the amount of reps. They can be made in different positions – standing, sitting in a chair, lying down with knees up. The frequency of squeezes can also be alternated. The result can be seen in 1-3 weeks.

Your stomach, thigh muscles, or buttocks should not be strained. Don’t hold your breath. Relax well after each squeeze. Do both short and long squeezes. But don’t overdo, any muscle needs time to heal. You can do kegels 5-6 days a week and take one or two days off. At first you can feel discomfort, irritation and the desire to quit – it’s because your intimate muscles are weak and unmanageable. But after two or three days of training it will become easier.

Kegel exercises have significant advantages: you don’t have to pay money for them and they take minimum of time during the day. You can do them once or several times a day for several minutes, including when you are busy or you are watching TV. Kegel exercises can be made both as a treatment and as a preventive measure.

There’s one warning. Some men in chronic stress have a chronically tight pelvic floor. In this case, kegels can make the pelvic floor even tighter and worsen the situation. So, it is recommended that you consult a physician before starting kegel exercises. If he finds out that your pelvic floor is chronically tight, then massage, relaxation techniques and stretching will be useful. These measures can help get rid of premature ejaculation, hard-flaccid and other discomfort.

Oral Pharmacotherapy

Oral medications include a group of phosphodiesterase type 5 inhibitors – the cyclic nucleotide phosphodiesterases. These are a group of enzymes existing in various molecular forms and unevenly distributed in the body. They are used because of their ability to destroy the cyclic nucleotides - cyclic guanosine monophosphate (cGMP) and cyclic adenosine monophosphate (cAMP). PDE5 is one of such enzyme forms, which increases blood flow by increasing cGMP in the blood supply to the penis. The PDE5 inhibitors are well-known: sildenafil (active constituent of Viagra), tadalafil (Cialis), and vardenafil (Levitra). Levitra, Cialis and Viagra are prescription drugs taken orally.

Medications

Topical medications are also used to treat erectile disfunction. Among them are topical creams like Vitaros (Canadian brand) that include alprostadil and DDAIP (enhancer of permeation).

Another treatment method is injection therapy. Medications as phentolamine, prostaglandin E1 and  papaverine are injected into the penis. They relaxe the blood vessels, increase blood flow and produce an erection within 15 minutes.

Extracorporeal shockwave

Extracorporeal shockwave therapy is a non-surgical and non-drug method, and its advantage is absence of variety of side effects. This kind of therapy is used as well in cardiology, orthopedics and urology. It has been approved in Canada and most other countries in South America, Middle East, Europe, but not in U.S.A. yet.

Vacuum pumps

Vacuum erection devices (pumps) apply negative pressure on the penis and thus draw blood into it. Penis pumps can be used just before sexual intercourse, if pharmacological methods turn out to be ineffective. After erection is attained by vacuum pump, it is maintained by means of compression ring which is placed around the base of the penis. Sometimes this method can cause slight bruising, so the majority of men prefer to try other methods first.

Surgery

Surgery Treat

Surgery may be necessary in cases when erectile dysfunction results from injury - a car accident, etc., and repair (revascularisation) or removal of the penises’ blood vessels is necessary. This operation is usually made to young men, as in older age damaged blood vessels are more difficult to repair and there can be extensive damage. Only specially trained and experienced surgeons should do revascularisation operations.

Alternative Methods

Some men resort to alternative therapies and take medicines consisting of herbals and other natural products. It should be mentioned that such medications sometimes turn out to include synthetic chemical compounds. Besides, there were no scientific studies or clinical trials held to prove the effectiveness of alternative therapies.

Penile implants

If all treatments have failed, prosthetic implants (penile prostheses) are inserted into the penis. Such operation lasts for half an hour under general anesthesia. Implants can be made from various materials, for example, from silicone. Salt water (saline) fills up its cylinders. The cylinders act as a reservoir holding the saline next to the bladder. The patient uses the button in the scrotum to pump the device, and salt water from the reservoir fills the cylinders. This causes erection. To stop erection, the patient should press the button once more. Besides cylinder, another type of implant is a bendable rod making the penis rigid enough to have sex, but at the same time flexible enough to lie unobtrusively in the pants. The implant cannot be seen from the outside of the penis. There is no need to replace the implant, as these modern devices are made to work for many years. It is not recommended to insert an implant if there is an opportunity that some other treatment can help and that the sexual function can be regained, because such operation is an ‘end-of-the-line’ procedure. There’s a minor risk of the device’s mechanical failure, when it has to be repaired or removed from the penis, and a risk of infection and possible blood loss.

Psychotherapy

Psychotherapy

Psychotherapy or behavioral therapy will be helpful for those men whose troubles with erection come from psychological causes, when physical treatments give no effect. Psychotherapy can restore the lost sexual confidence and self-esteem which is very important for men. A man should not perceive his sexual dysfunction as a reflection of his masculinity or blame himself – it only makes the situation worse. He should not blame his partner either. Your sexual partner can also take part in your sex therapy; this can make you emotionally closer to each other. Another advice is not to focus on the intercourse itself, and to pay attention to other expressions of sexual intimacy as kissing, cuddling, massaging and caressing. This will help to reduce anxiety. A more relaxed approach to sex is what a man with erectile dysfunction needs. It can also make sense to completely refrain from penetrative sex for some weeks, concentrating on the foreplay and one’s sensations. This will lead to reduction of psychological pressure and anxiety, restoration of confidence, growth of passion and restoration of normal erection.

You should choose the appropriate treatment method together with your doctor.

Generic Viagra, Levitra and Cialis at Canada Pharmacy

Use of Generic Viagra (Sildenafil)

Viagra

Sildenafil is Viagra’s active constituent. Its peak effect comes at 30-90 minutes after you’ve taken the tablet and lasts for 3-5 hours, so the sexual activity needs to be adjusted to it. If you haven’t had sex for a long time (some years), the anxiety concerning the event can affect the chances to succeed, so be ready for it. Yes, sometimes the initial attempt of ED treatment fails. Sometimes a higher dosage may help in such situation. Anyway, there’s no need to worry - subsequent attempts can be successful.

100mg, 50mg and 25mg are the dosages available. The recommended dose is 50mg a day. Alcohol and food can slow absorption of Viagra through the stomach, so it is not a good idea to take it on a full stomach or when you are drunk. It is important to understand, that Viagra enhances and maintains the normal erectile mechanism, and to see the effect you need to be sexually aroused. Viagra does not cause erotic stimulation and spontaneous! It’s a common misunderstanding.

Use of Generic Levitra (Vardenafil)

Levitra

Generic Levitra and Cialis belong to the same therapeutic group of drugs, as Viagra. Levitra’s active ingredient is vardenafil. The dosages are 5mg, 10mg and 20mg. Like Viagra, it relaxes muscles and blood vessels in the penis and increases blood flow to it. It should be taken about 30-40 minutes before sexual activity, with or without food. The effect lasts for 4-5 hours. The recommended dosage is 20mg. The pill does not cause erection; it only enhances and maintains it in case of existing sexual stimulation. 24 hours should pass between doses. If your erection lasts for more than four hours or is painful, if you feel dizzy, have heart rhythm problems, or sudden vision loss, contact your doctor. To avoid side effects, do not take Levitra together with grapefruit, nitroglycerin, antibiotics, antifungal medicines, HIV/AIDS medicine, heart rhythm medicine, riociguat (Adempas).

Use of Generic Cialis (Tadalafil)

Cialis (Tadalafil)

Tadalafil is an active ingredient of Cialis. It has the similar action with Viagra and Levitra. It should be taken only once a day, just before sexual activity, with or without food. A tablet should not be broken or split, but swallowed whole. Cialis will help you to achieve an erection only if sexual stimulation occurs. The effect comes after 15 minutes and lasts for 36 hours. The dosages are 5mg, 10mg and 20mg. The recommended dosage is 10mg.Taking Cialis with Adcirca, antibiotics, nitrates, antiviral or antifungal medicines, alcohol, grapefruit, can provoke unwanted side effects because of unpredicted interaction with tadalafil. If you have side effects, contact your doctor.

Do not take similar medicines like Viagra, Levitra and Cialis in combination. And it should be understood that oral medications do not work for everyone.

Ordering GenericViagra Online: Canadian Pharmacy

If you have decided to use Generic Viagra, Cialis or Levitra, you can find it in the local pharmacy or online. Buying Viagra online is very popular among men because it allows them to preserve confidentiality, save time and money. Online shopping is often very profitable. One of the popular and reliable online pharmacies selling generic Viagra and many other drugs is Canadian Pharmacy, whose website is at www.canadahealthcaremall.com. The service has plenty of advantages:

  • It deals with high-quality generic medicines produced by reliable manufacturers
  • Reasonably low prices, discount codes and coupons allow to save money
  • All customers’ information is kept confidential
  • It is easy to find what you need due to convenient website design and product categories organization
  • The contact information and support team are available for questions and help.

5 Interesting Facts about Erectile Dysfunction

  1. Sexually active men have better erection. According to the research made in 2008, regular sexual activity helps to prevent ED. A group of about one thousand men aged between 55 and 75 was investigated by The American Journal of Medicine. The risk of developing erection troubles was twice higher for those who didn’t have sex for a week or more, in comparison with men having sex once a week. Another good news: men making love with their partners three times a week have by 50% lower risk of cardiovascular disease.
  2. If you are overweight, you are at risk. Erectile function is likely to decline by 3% with every 9 kg of excess weight, so says Brand Company. It is a good motivation to reduce consumption of fast food and run in the morning, isn’t it?
  3. Sometimes erectile function can return to normal without any treatment. This happens when the ED was caused by a stressful situation and this situation has been resolved. Sometimes the cause is an injury that can also heal by itself.
  4. Most men who think they have ED actually have so called erectile dissatisfaction. For example, older men suffering because their erection is not as good as it used to be. But they have erection anyway, so it is not impotence.
  5. Erections is not required for orgasms. A man who fails to achieve erection can still have an orgasm.

FAQ about Erectile Dysfunction

How Can ED be prevented?

First of all, try to adopt a healthy way of life. Stop smoking (if you do), drinking less alcohol or don’t drink it at all. Alcohol can reduce testosterone levels, increase female hormones and damage the nerves leading to the penis. Be physically active and do sports, hold on to a healthy diet, sleep for at least eight hours and learn to cope with stress. All these measures will reduce risk factors for Erectile Dysfunction .

Is impotence a normal part of aging?

Actually, one cannot say so. Older men often need more stimulation to get an erection because of lower testosterone and atherosclerosis, but it is normal for men of any age to enjoy sex and have erection. It is worth mentioning, though, that older men tend to face blood vessel problems more often connected with high blood pressure and high cholesterol. According to statistics, ate least one third of men in the age from 40 to 70 experience erectile dysfunction to some extent, which means that young men should take care of their future health and try to lead a healthy way of life.

Can medications like Viagra really help?

Oral medications, including Viagra, are often effective therapy and cause a minimum of side effects. In general, in more than 90% cases erectile dysfunction can be cured by medicines, but only about 10% of men discuss this problem with the doctor. The others wait that the issue be solved by itself or they feel embarrassed to talk about it. For such cases online consultations free telephone helplines exist, where qualified specialists can anonymously answer the men’s questions concerning erectile dysfunction and methods of its treatment.

What should I tell my wife about my erection problem?

It is often difficult for men to discuss their health issues with wives or sexual partners.  Another problem is that a woman can think she is a cause of her partner’s erectile dysfunction, blame herself, consider herself unattractive or boring. Explain your wife that it is not her fault and ask for her support, if you need it.

Are there any side-effects caused by medications?

There can be minor side effects including headaches, upset stomach, facial blushing, temporary vision disturbances.

Are there any contraindications for medications such as Viagra?

To avoid drop in blood pressure, men with coronary artery disease, especially taking nitroglycerine or nitrates, should not take such medications as Viagra. You should also know that if you have problems in relationships with your sexual partner and your ED is caused by psychological reasons, you may not get the desired effect with Viagra or other drugs producing erection, and it can even become worse.

Is there a relation between infertility and erectile dysfunction?

No. A man having troubles with erection may become a father, as well as a man who easily achieves erection and ejaculates may be infertile.

Can masturbation cause erectile dysfunction?

No. On the contrary, the proverb 'if you don't use it, you lose it' is more appropriate here.

Does tight underwear cause ED?

It is considered that tight underwear can lead to infertility because of the increased temperature of the testicles. However, no medical research was made that could prove an association between impotence and tight underwear.

Do men with erectile dysfunction have sexual desire?

Actually there is no direct association between ED and sexual desire, because the last one depends on the hormones. Lack of sexual desire and ED can come together when they are caused by lack of testosterone. And sometimes men avoid sex because they fear not to be able to erect.