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What is erectile dysfunction (ED)?

Erectile dysfunction is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance. The Massachusetts Male Crumbling Written report surveyed 1,709 men aged forty–70 years betwixt 1987 and 1989 and found there was a total prevalence of erectile dysfunction of 52 percent. Information technology was estimated that, in 1995, over 152 million men worldwide experienced ED. For 2025, the prevalence of ED is predicted to be approximately 322 one thousand thousand worldwide.

In the past, erectile dysfunction was normally believed to be acquired by psychological bug. It is now known that, for most men, erectile dysfunction is caused by physical problems, ordinarily related to the blood supply of the penis. Many advances have occurred in both diagnosis and treatment of erectile dysfunction.

What are the hazard factors for erectile dysfunction?

According to the NIH, erectile dysfunction is also a symptom that accompanies many disorders and diseases.

Direct risk factors for erectile dysfunction may include the following:

• Prostate problems

• Type 2 diabetes

• Hypogonadism in association with a number of endocrinologic weather condition

• Hypertension (high blood pressure)

• Vascular disease and vascular surgery

• High levels of blood cholesterol

• Low levels of HDL (high-density lipoprotein)

• Chronic sleep disorders (obstructive sleep apnea, insomnia)

• Drugs

• Neurogenic disorders

• Peyronie'due south disease (distortion or curvature of the penis)

• Priapism (inflammation of the penis)

• Depression

• Booze use

• Lack of sexual noesis

• Poor sexual techniques

• Inadequate interpersonal relationships

• Many chronic diseases, especially renal failure and dialysis

• Smoking, which exacerbates the effects of other risk factors, such every bit vascular disease or hypertension

Age appears to be a strong indirect risk factor in that it is associated with increased likelihood of direct adventure factors, some of which are listed in a higher place.

Accurate run a risk cistron identification and label are essential for prevention or handling of erectile dysfunction.

What are the different types (and causes) of ED?

The following are some of the different types and possible causes of erectile dysfunction:

Organic Erectile Dysfunction

Organic ED involves abnormalities the penile arteries, veins, or both and is the nearly common cause of ED, especially in older men. When the trouble is arterial, it is usually caused by arteriosclerosis, or hardening of the arteries, although trauma to the arteries may exist the cause. The controllable risk factors for arteriosclerosis--existence overweight, lack of exercise, high cholesterol, high blood pressure, and cigarette smoking--can crusade erectile failure often earlier progressing to affect the middle.

Many experts believe that atrophy, a partial or complete wasting away of tissue, and fibrosis, the growth of excess tissue, of the smooth muscle tissue in the torso of the penis (cavernous smooth muscle) triggers problems with being able to maintain a firm erection. Poor ability to maintain an erection is often an early symptom of erectile dysfunction. Although the condition is called venous leak, the real problem is not with the veins merely malfunction of the polish muscle that surrounds the veins. The cease result is difficulty with maintain a house erection (losing an erection likewise quickly) that is now believe to be an early manifestation of atherosclerosis and vascular disease.

• Diabetes. Erectile Dysfunction is mutual in people with diabetes. An estimated ten.9 million adult men in the U.S. have diabetes, and 35 to 50 percent of these men are impotent. The process involves premature and unusually severe hardening of the arteries. Peripheral neuropathy, with interest of the nerves decision-making erections, is normally seen in people with diabetes.

• Depression. Depression is another cause of ED and is closely related to erectile dysfunction. Because at that place is a triad relationship between depression, ED and cardiovascular disease, men with depression should be fully evaluated for medical disease as well as psychological factors. Some antidepressant medications crusade erectile failure.

• Neurologic causes. There are many neurological (nervus bug) causes of ED. Diabetes, chronic alcoholism, multiple sclerosis, heavy metal poisoning, spinal cord and nerve injuries, and nerve damage from pelvic operations tin can cause erectile dysfunction.

• Drug-induced ED. A swell variety of prescription drugs, such every bit claret pressure medications, antianxiety and antidepressant medications, glaucoma heart drops, and cancer chemotherapy agents are just some of the many medications associated with ED.

• Hormone-induced ED. Hormonal abnormalities, such as increased prolactin (a hormone produced by the inductive pituitary gland), steroid abuse past bodybuilders, too much or too little thyroid hormone, and hormones administered for prostate cancer may cause ED. Low testosterone tin can contribute to ED only is rarely the sole factor responsible for ED.

Premature Ejaculation (PE)

Premature ejaculation is a male sexual dysfunction characterized past:

• Ejaculation which always or well-nigh ever occurs prior to or within about one minute of vaginal penetration.

• Inability to delay ejaculation on all or nearly all vaginal penetrations; and, negative personal consequences, such every bit distress, bother, frustration, and/or the abstention of sexual intimacy.

Premature ejaculation is divided into lifelong and caused categories:

• Lifelong premature ejaculation. With lifelong premature ejaculation, the patient has experienced premature ejaculation since first showtime coitus.

• Acquired premature ejaculation. With acquired premature ejaculation, the patient previously had successful coital relationships and only now has adult premature ejaculation.

• Performance anxiety. Performance anxiety is a grade of psychogenic ED, usually caused by stress.

How is ED diagnosed?

Diagnostic procedures for ED may include the following:

• Patient medical or sexual history. This may reveal weather or diseases that lead to impotence and assist distinguish among problems with erection, ejaculation, orgasm, or sexual desire.

• Concrete examination. To look for show of systemic problems, such every bit the following:

  • A trouble in the nervous system may exist involved if the penis does not answer every bit expected to certain touching.

  • Secondary sexual practice characteristics, such as hair design, tin can point to hormonal problems, which involve the endocrine system.

  • Circulatory bug could be indicated by an aneurysm.

  • Unusual characteristics of the penis itself could suggest the footing of the impotence.

• Laboratory tests. These can include claret counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. Measurement of testosterone in the claret is often done in men with ED, especially with a history of decreased libido or diabetes.

• Psychosocial examination. This is done to help reveal psychological factors that may exist affecting operation. The sexual partner may besides be interviewed to determine expectations and perceptions encountered during sexual intercourse.

What is the treatment for ED?

Specific treatment for erectile dysfunction will be adamant by your physician based on:

• Your age, overall health, and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the illness

• Your opinion or preference

Some of the treatments bachelor for ED include:

Medical treatments:

• Sildenafil. A prescription medication taken orally for the treatment of ED. This drug works best when taken on an empty stomach and many men can become an erection 30 to 60 minutes subsequently taking the medication. Sexual stimulation is required for sildenafil citrate to take the all-time efficacy.

• Vardenafil. This drug has a similar chemical structure to sildenafil citrate and works in a like manner.

• Tadalafil. Studies accept indicated that tadalafil citrate stays in the body longer than other medications in its class. Most men who take this medication find that an erection occurs within 4 to v hours after taking the pill (slow absorption) and the furnishings of the medication may last upward to 24 to 36 hours.

• Avanafil

The FDA recommends that men follow full general precautions earlier taking a medication for ED. Men who are taking medications that contain nitrates, such equally nitroglycerin, should Non utilize these medications. Taking nitrates with ane of these medications can lower blood force per unit area likewise much. In addition, men who take tadalafil or vardenfil should use alpha blockers with intendance and simply as instructed by their physician, as they could result in hypotension (abnormally depression blood pressure). Experts recommend that men have a complete medical history and concrete exam to decide the cause of ED. Men should tell their md nigh all the medications they are taking, including over-the-counter medications.

Men with medical conditions that may crusade a sustained erection, such as sickle cell anemia, leukemia, or multiple myeloma, or a homo who has an abnormally-shaped penis, may not do good from these medications. Besides, men with liver diseases or a affliction of the retina, such as macular degeneration or retinitis pigmentosa, may not be able to take these medications, or may need to take the lowest dosage.

These medical treatments should Non be used by women or children. Elderly men are especially sensitive to the furnishings of these medical treatments, which may increase their chance of having side effects.

Hormone replacement therapy

Testosterone replacement therapy may improve energy, mood, and bone density, increase musculus mass and weight, and heighten sexual involvement in older men who may have scarce levels of testosterone. Testosterone supplementation is not recommended for men who have normal testosterone levels for their age group due to the take chances of prostate enlargement and other side furnishings. Testosterone replacement therapy is available as a cream or gel, topical solution, skin patch, injectable form and pellet form placed under the skin.

Penile implants

2 types of implants are used to treat ED, including:

• Inflatable Penile Prosthesis (3-piece hydraulic pump). A pump and two cylinders are placed inside the erection chambers of the penis, which causes an erection by releasing a saline solution; information technology can too remove the solution to deflate the penis.

• Semi-rigid Penile Prosthesis. Two semi-rigid but bendable rods are placed within the erection chambers of the penis, which allows manipulation into an erect or non-erect position.

Infection is the most common cause of penile implant failure and occurs less that two percent of the time. Implants are commonly not considered until other methods of treatment accept been tried only they have a very high patient satisfaction rate and are an excellent treatment selection in the appropriate patient.

How do couples cope with ED?

Erectile dysfunction can cause strain on a couple. Many times, men will avoid sexual situations due to the emotional pain associated with ED, causing their partner to feel rejected or inadequate. It is of import to communicate openly with your partner. Some couples consider seeking treatment for ED together, while other men prefer to seek treatment without their partner'due south noesis. A lack of communication is the principal barrier for seeking treatment and can prolong the suffering. The loss of erectile capacity tin can have a profound effect on a man. The good news is that ED can ordinarily be treated safely and effectively.

Feeling embarrassed about sexual health problems may prevent many men from seeking the medical attention they need, which can delay diagnosis and treatment of more serious underlying weather. Erectile Dysfunction itself is oftentimes related to an underlying problem, such equally heart disease, diabetes, liver disease, or other medical conditions.

Since ED tin can be a forewarning symptom of progressive coronary disease, doctors should be more direct when questioning patients about their health. By asking patients more straight about their sexual function through conversation or a questionnaire during a checkup, doctors may exist able to notice more serious health conditions sooner.

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Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/erectile-dysfunction

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