| A
decade ago it would have been impossible to imagine a major public
figure admitting to erectile dysfunction. Wide spread misconceptions
about the causes of this affliction, unnecessary shame, and a lack
of treatment options combined to make it a "secret" shared by up to
52% of all men at some point in their lives.
Former
presidential candidate Bob Dole's willingness to discuss and later
endorse his use of Viagra, one of the most popular treatments for
erectile dysfunction, has now brought this once shadowy affliction
out into the open. Bob Dole's brave step could not have come at
a better time for the millions of men whose quality of life has
been eroded by erectile dysfunction.
Recent
research shows that the up to 80% of cases have a physiological
basis, and up to 95% of all cases are treatable. Yet despite this
good news, as few as one in ten men suffering this condition seek
treatment.
Diagnosis
Erectile
dysfunction is defined by the National Institutes of Health Consensus
Panel as "the persistent inability to achieve or maintain an erection
sufficient for satisfactory sexual performance." That definition
is somewhat subjective, which emphasizes that the first diagnosis
is a self-diagnosis.
An
erection is achieved through a complicated series of muscular and
vascular responses to various stimuli. The failure to achieve or
maintain an erection can stem from a failure at any point in this
series. Once a man brings his concerns to the attention of his doctor,
the doctor will attempt to identify this underlying cause.
It
is important to note that while the instance of erectile dysfunction
increases with age, it is not a consequence of aging, and should
not be accepted as inevitable or a "natural" loss of sexual function.
Treatment
Your
doctor will want to know of any diseases, injuries, or exposures
(such as radiation) that might have a bearing on the dysfunction.
The doctor will also review your use of alcohol, tobacco and drugs,
both legal and illegal. He or she may about ask your non-sexual
activities, such as bicycle riding. (A small number of avid bicycle
riders report erectile dysfunction due to the strain placed on the
urinary track by hard, narrow bicycle seats.)
It
will also be important to learn your erectile history:
when
was your last erection achieved?
When did you last have sexual intercourse?
Do you experience spontaneous erections, for example, upon waking?
Does the dysfunction only occur with certain partners or in certain
positions?
A physical
exam will be conducted to eliminate nerve damage, hormonal disorders
or a build up of scar tissue (Peyronie's disease). The doctor may
also want to eliminate the possibility of prostrate cancer by conducting
a rectal exam. An ultrasound may be performed to observe vascular
flow. Estimates suggest that as many as one half of erectile dysfunctions
are vascular in origin.
A number
of tests may be ordered, including urinalysis, blood counts, or
measurements of liver enzymes, creatinine, testosterone, and glucose.
The doctor may suggest a nocturnal penile tumescence, which counts
the number of erections achieved during sleep. If a specific cause
of the erectile dysfunction has been determined, treatment will
target the underlying problem and erectile function will be monitored.
For dysfunctions caused by nonspecific vascular and neurogenic problems,
treatment may include medication, vacuum devices, injections or
implants.
The
most successful drug therapy has been sildenafil, popularly known
as Viagra, which increases cyclic guanosine monophosphate in the
penis, which in turn increases blood flow into the penis. There
are potential side effects that your doctor will discuss with you.
Sildenafil should not be prescribed to men who suffer from angina.
Prostaglandin-E1 is an alternative that may be injected directly
into the penis or placed into the urethra as a suppository, although
it too has potential side effects as well.
Topical
formulations of prostaglandin-E1 are being investigated. Vacuum
devices simulate an erection by drawing blood into the penis and
securing it with a plastic band. There are two types of penile implants.
One is an inflatable implant filled with a saline solution through
a pump concealed below the scrotum. The other is the insertion of
flexible metal rods that are manipulated to angle the penis for
sexual activity.
Surveys
of implant users find a high degree of satisfaction with the devices.
Even though the great majority of erectile dysfunctions have physical
causes, many men suffer psychologically as well when experiencing
the problem. Perhaps that is why studies show that the success rate
is significantly higher when men include their sexual partners in
the discussion and determination of the treatment.
References:
Lue,
T.F. (1992) Physiology of Erection and Pathophysiology of Impotence
in Campbells Urology. Chapter 16, 6th Ed. Editors Welsh et al,
Saunders, Phila. pp 709-728.
Melman,
A. and Gingell, J.C. (1999) The Epidemiology and Pathophysiology
of Erectile Dysfunction. J. Urol 161:5-11.
Laumann,
E.O., Paik, A. and Rosen, R.C. (1999) Sexual Dysfunction in the
United States JAMA 281:537-544.
Rosen,
R.C., et al (1997) The International Index of Erectile Function.
Urol 49:822-830.
Feldman,
H.A. et al (1994) Impotence and its Medical and Psychosocial Correlates.
J. Urol 151:54-61.
Goldstein,
I. et al (1998) Oral Sildenafil in the Treatment of Erectile Dysfunction.
N. Engl. J. Med. 338:1397-1404.
Althof,
S.E. and Seftel A.D. (1995) The Evaluation and Treatment of Erectile
Dysfunction. Psychiatric Clin N Am 18:171-192.
Dewire,
D.M. (1996) Evaluation and Treatment of Erectile Dysfunction. Am
Fam Physician 53:2101-2108.
Greiner,
K.A. and Weigel, J.W. (1996) Erectile Dysfunction. Am Fam Physician
54:1675-1682.
Copyright
© 1999 PersonalMD.com. All rights reserved.
|
Feature Archives