Erectile Dysfunction (ED)

Erectile dysfunction (ED) is the inability of a man to achieve or maintain an erection sufficient for his sexual needs or the needs of his partner. Most men experience this at some point in their lives, usually by age 40, and are not psychologically affected by it.
Some men, however, experience chronic, complete erectile dysfunction (impotence), and others, partial or brief erections. Frequent erectile dysfunction can cause emotional and relationship problems, and often leads to diminished self-esteem.

Physiology of Erection

The physiological process of erection begins in the brain and involves the nervous and vascular systems. Neurotransmitters in the brain (e.g., epinephrine, acetylcholine, nitric oxide) are some of the chemicals that initiate it. Physical or psychological stimulation (arousal) causes nerves to send messages to the vascular system, which results in significant blood flow to the penis. Two arteries in the penis supply blood to erectile tissue and the corpora cavernosa, which become engorged and expand as a result of increased blood flow and pressure.
Because blood must stay in the penis to maintain rigidity, erectile tissue is enclosed by fibrous elastic sheathes (tunicae) that cinch to prevent blood from leaving the penis during erection. When stimulation ends, or following ejaculation, pressure in the penis decreases, blood is released, and the penis resumes its normal shape.

Causes

There are many underlying physical and psychological causes of erectile dysfunction. Reduced blood flows to the penis and nerve damage are the most common physical causes. Underlying conditions associated with erectile dysfunction include the following:

• Vascular disease- Arteriosclerosis causes a reduction in blood flow throughout the body and can lead to impotence. Smoking is perhaps the most significant risk factor for impotence related to arteriosclerosis.

• Diabetes- About 60% of men with diabetes experience impotence.

• Drugs- Over 200 commonly prescribed drugs are known to cause or contribute to impotence, including drugs for high blood pressure, heart medications, antidepressants, tranquilizers, and sedatives. A number of over-the-counter medications also can lead to impotence. Long-term use of alcohol and illicit drugs may affect the vascular and nervous systems and are associated with erectile dysfunction.

• Hormone disorders- Hormone disorders account for fewer than 5% of cases of impotence.

• Neurologic conditions- Spinal cord and brain injuries can cause impotence when they interrupt the transfer of nerve impulses from the brain to the penis.

• Pelvic trauma, surgery, radiation therapy- Trauma to the pelvic region or spinal cord can damage veins and nerves needed for erection. Surgery of the colon, prostate, bladder, or rectum may damage the nerves and blood vessels involved in erection. Prostate and bladder cancer surgery often require removing tissue and nerves surrounding a tumor, which increases the risk for impotence.

• Peyronie's disease- Peyronie's disease is a rare inflammatory condition that causes scarring of erectile tissue. Scarring produces curvature of the penis that can interfere with sexual function and cause painful erections.

• Venous leak- If the veins in the penis cannot prevent blood from leaving the penis during erection, erection cannot be maintained. Venous leak can be a result of injury, disease, or damage to the veins in the penis.

• Psychological conditions- Depression, guilt, worry, stress, and anxiety all contribute to loss of libido and erectile dysfunction.

Management:

Supplements

Supplements given below may provide nutritional support in erectile dysfunction. A physician should be consulted before using any product.

• Bioflavonoids – Take 1000 mg daily.
• Flaxseed meal – Grind 2-4 tablespoons daily. Flaxseed meal is a better choice due to its fiber and vitamin content.
• Inositol hexaniacinate – Take 1000-3000 mg daily to improve circulation and lower cholesterol. Diabetics should not take this supplement.
• Selenium – Take 200 mcg daily.
• Vitamin C – Take 1000 mg 3 times daily with meals.
• Vitamin E – Take 400 IUs daily.
• Zinc – Take 30 mg daily.

Herbal Medicine

These herbs may be used to treat erectile dysfunction:

• Asian ginseng (Panax ginseng) – Traditionally used for male impotence.
• Damiana (Turnera diffusa) – Traditionally used as an aphrodisiac and for various sexual disorders.
• Ginkgo biloba – Increases arterial blood flow, which may have a positive effect on male sexual function.
• Muira puama (Ptychopetalum olacoides) – Used for erectile dysfunction and lack of libido.

Exercise daily -

• it increases the level of male hormones
• it increases the level of certain neurohormones, which result in mood elevation
• it increases the peripheral blood circulation

Role of diet in Erectile Dysfunction:

Erectile dysfunction occurs when blood flow into the penis is blocked or severely limited. This results in a constant failure to achieve an erection.
The cause of this circulatory slowdown, or lack of blood flow, is atherosclerosis, a hardening of the arteries. This occurs when cholesterol, originating from the foods we eat, "sticks" to the interior walls of the blood vessels, and creates a hard layer of plaque, thus obstructing healthy circulation.
According to Dr. Neal D. Barnard, M.D., a lifestyle rich in meat and dairy foods , will very likely result in high cholesterol levels, thus causing a blockage, and ultimately ED.

Vegetarians, on the other hand, have an average cholesterol level 23 percent lower than nonvegetarians. Vegans, who in addition to being vegetarians, eat neither dairy nor eggs, have an average cholesterol level of 133, which is 37 percent lower than the general population.

Research conducted by Dean Ornish, M.D., at the University of California, San Francisco, proved that a low-fat vegetarian diet is the best way to begin the cleanup of your arteries.

The Physicians Committee for Responsible Medicine has put together an ideal diet comprised of four food groups. These include, fruit, vegetables, legumes, and whole grains. This no-cholesterol, low-fat plan supplies all of an average adult's daily nutritional needs, including substantial amounts of fiber.

Treatment

Both partners and men with ED need to try to remember that ED is most often a treatable physical condition. The first step to treatment, however, is trust and a willingness on the part of both partners to discuss the situation with each other, and with a physician.

Sex Therapy

A significant number of men develop impotence from psychological causes that can be overcome. When a physiological cause is treated, subsequent self-esteem problems may continue to impair normal function and performance.

Qualified therapists (e.g., sex counselors, psychotherapists) work with couples to reduce tension, improve sexual communication, and create realistic expectations for sex, all of which can improve erectile function.

Psychological therapy may be effective in conjunction with medical or surgical treatment. Sex therapists emphasize the need for men and their partners to be motivated and willing to adapt to psychological and behavioral modifications, including those that result from medical or surgical treatment.

Medical Treatment

Oral Medication

Oral medications used to treat erectile dysfunction include selective enzyme inhibitors (e.g., sildenafil [Viagra®], vardenafil HCl [Levitra®], tadalafil [Cialis®]) and yohimbine (Yohimbine®, Yocon®).

Selective enzyme inhibitors are available by prescription and may be taken up to once a day to treat ED. They improve partial erections.

Patients taking nitrate drugs (used to treat chest pain) and those taking alpha-blockers (used to treat high blood pressure and benign prostate hyperplasia) should not take selective enzyme inhibitors.

Drug Therapy: Self Injection

Self-injection therapy is one of several available options for treating impotence. It requires that a man or his partner use a tiny needle to inject a small amount of medicine directly into the side of the penis. The injections are relatively painless and create an erection that begins about 5 to 15 minutes after the injection, and lasts from 30 to 120 minutes.

Not all patients respond to this type of treatment. Still, about 70 % of men find that they achieve satisfactory erections with injections.

The drugs typically used for injection therapy include Prostaglandin, Papaverine hydrochloride and Phentolamine

One of the more common risks of injection therapy is prolonged erection or priapism: an erection of more than 4 hours. Priapism only happens in a small percentage of patients but may require a visit to the doctor or emergency room to receive medication to counteract the self-injection medication and relieve the erection. Men need to be aware that any erection that lasts longer than 4 hours needs to be treated by a physician.

Another complication is the possible development of permanent scarring within the penis. Scarring is generally seen in patients who use the drugs too often.

Drug Therapy: Urethral Suppositories (MUSE)

Uretheral Suppositoriers (MUSE) is another drug treatment for impotence. It is based on the finding that the urethra can absorb certain medications into the surrounding tissues, creating an erection. Muse urethral suppositories use prostaglandin E1 (alprostadil), the same medication used in self-injection therapy.

An erection usually begins within 5 to 10 minutes after administering aprefilled muse dosage. The erection lasts approximately 30 to 60 minutes, though this can vary from person to person.

The most common side effects associated with muse are an aching in the penis, testicles, and legs and in the area between the scrotum and the rectum, a warmth or burning sensation in the urethra, redness of the penis due to increased blood flow, and minor urethral bleeding or spotting due to improper administration.

Medical Device Therapy (vacuum devices)

Vacuum devices are simple mechanical tools that allow a man to develop an erection suitable for sexual intercourse.

Vacuum devices work best in men who are able to achieve partial erections on their own. Vacuum devices work by bringing more blood into the penis and then trapping it.

Surgical Treatments

Penile Implants

Penile implants involve surgical insertion of malleable or inflatable rods or tubes into the penis. A semi-rigid prosthesis is a silicon-covered flexible metal rod.
Once inserted, it provides the rigidity necessary for intercourse and can be curved slightly for concealment. It requires the simplest surgical procedure of all the prostheses.

Vascular Reconstructive Surgery

A small percentage of men undergo vascular reconstructive surgery to improve blood flow to the penis. Revascularization involves bypassing blocked veins or arteries by transferring a vein from the leg and attaching it so that it creates a path to the penis that bypasses the area of blockage. Young men with only local arterial blockage are the best candidates for this procedure. It may restore function in 50% to 75% of men.

Venous ligation

Venous ligation is performed to prevent venous leak. Problematic veins are bound (ligated) or removed, which allows an adequate amount of blood to remain in the penis. It may improve function in 40% to 50% of men, but some men may experience problems over the long term.

HOMEOPATHIC Medicines

Agnus Castus: This remedy is suitable to old men who have spent most of their lives in excessive venery. These so called “old sinners” are just as excitable in their sexual passions at 60 as at 18, and yet they are physically impotent. It is also useful in paralytic impotence, where there is loss of both sexual desire and erection, and there is coldness of the sexual organs.

Calcarea Carbonica: When night sweats follow every emission, and when coitus is followed by weakness in mind and body, calcarea is the remedy. It is especially useful in shattering constitutions where the patient sweats from any exertion. The sexual desire is excessive and the nocturnal emissions occur about three in the morning or later. The erections are weak and excitable; there is sensitiveness of the urethra and irritable impotence. There is tendency to cold clammy sweat on the hands after emissions, there is pain in the back and head and trembling of the legs. Great weakness follows all indulgence. Calcarea suits these conditions in young people who grow too rapidly.

Lycopodium- Lycopodium is the remedy for cases which have gone on to complete impotency; the erections are absent or imperfect and the genital organs are cold and shriveled. Exhausting pollutions without erections. Lilienthal termed Lycopodium “the old man’s balm”. It corresponds especially to the impotence of old age where there is great despondency.

In Homeopathy there are good medicines to treat this condition. But for proper treatment a homeopath must look for the psychological reasons behind the condition. A detailed case history is necessary, including the sexual history and mental characteristics etc. Along with the medicine such patients often need psychological counseling if the disease is of psychological origin.

Some other medicines commonly indicated in such conditions are argentum-nit, china, caladium, causticum, conium, gelsimium, graphites, dioscorea, digitalis, eryngium aquaticum, sabal-serr., selenium, sulphur, sarsaparilla, sepia, strychninum, yohibinum, kali-brom, arnica, baryta-carb, nuphar lutea, nux-vomica, phosphorus, picric acid, phosphoric acid, staphysagria, zincum, etc.