What is erectile dysfunction?

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Many drugs used to treat high blood pressure like Atenol have been linked to erectile dysfunction

Dr Alex Danso Consultant Urologist
“From the very origins in time, man has been beleaguered by the problem of erectile dysfunction. As a real organic syndrome, a less tangible force from the imagination, or as a clever mixture of both, fantasy and knowledge have been elegantly brought together all through age-old tale of male strength and weakness, potency and impotence.”(Philippe Brenot).

Today, erectile dysfunction is better understood scientifically. Today we see erectile dysfunction as a problem of significant proportions which the patients bring to the consulting rooms of the doctor.

What is erectile dysfunction?

Erectile dysfunction is when a man is unable to get and maintain an erection for sexual intercourse. Men tend to have a lot of fear about erectile dysfunction but when it happens once in a while it may mean nothing. It is only when it is persistent that medical advice must be sought. When ED happens frequently it may be a sign of other health problems or as a result of some medication that one is taking.

The erectile dysfunction may be due primarily to a disease like diabetes or hypertension — then we call it Organic Erectile Dysfunction or may be due to stress, fatigue anxiety and depression when we call it Psychogenic Erectile Dysfunction.

How Does Erection Occur?

When a man is aroused or stimulated there occurs a complex reaction initiated by the brain (central, autonomic and somatic nervous) systems,  and blood circulatory systems. This causes blood to flow into the penis and the blood is trapped in the male organ by the relaxation of smooth muscle in the organ .

Therefore, the nervous system , blood vessels, smooth muscles in the male organ and blood flow play an important role in the erection (rigid).The engorgement of the male organ is called tumescence and the escape of the blood from the penis when it becomes flaccid is called detumescence.

 Causes of E.D.

Diabetes: Almost 70 percent of men with diabetes will encounter ED. A good controlled diabetes will solve the problem.

Vascular Disease: Any disease of the blood vessels hardening, widening or narrowing which will cause a change in the flow of the blood will also affect the erectile function .

Hypertension: Currently many of the drugs used to treat high blood pressure have been linked to erectile dysfunction, some are much less likely to cause problems.

Certain high blood pressure drugs may even improve erectile dysfunction for some men.

For this reason because the drugs affect the blood vessels differently, it is good to discuss the particular medication with your doctor. Not all the high blood pressure medications will cause ED.

Atherosclerosis

The hardening of the body’s arteries do after blood flow and consequently affect the erectile function. As a man ages the blood vessels may be clogged or hardened and will contribute to erectile dysfunction

Prostate Cancer

Prostate cancer per se does not cause ED but the medication used to treat prostate cancer may lead to erectile dysfunction. In treating prostate cancer hormonal therapy may be applied and these hormones may lead to erectile dysfunction .

Diabetes: Nerves and blood vessels that aid in getting you ready for sex are damaged by diabetes. Your chances of ED can double if your diabetes is not well-controlled.

Kidney disease: Diseases of the kidney may lead to erectile dysfunction. Advanced kidney disease leading to renal failure or requiring dialysis may lead to erectile dysfunction

Central Nervous System 

Nerve and brain disorders: You can’t get an erection without help from your nervous system. Diseases like stroke, multiple sclerosis, Alzheimer’s disease, and Parkinson’s disease disrupt vital signals and therefore lead to erectile dysfunction

Blood vessel diseases: These can slow the flow of blood, making your body’s preparation for sex difficult. Narrowed or blocked arteries, high blood pressure, and high cholesterol are among the most common causes of ED.

 Other reasons for ED can include

Surgery: Nerves and tissue needed for an erection can be affected during procedures to treat prostate, large intestines  and bladder cancer. The problem often clears up, but it may take months. In some cases, the damage is permanent. If it is, there are treatments available to help you be ready for sex.

Injury: pelvic fractures, bladder, spinal cord, or penis injuries may result in erectile dysfunction

Hormone problems: Hormones fuel sex drive. An imbalance can make you uninterested in sex. In addition hormone treatment for prostate cancer will lead to erectile dysfunction.

Venous leak: To keep an erection, the blood that flows into your penis has to stay a while. If it flows out too quickly, you’ll lose your erection.

This is usually caused by diseases of the blood vessels, tobacco, alcohol, or drug use: All three can damage your blood vessels. If you have artery problems, smoking will make ED much more likely.

Men who smoke are about twice as likely to develop ED as non-smokers. Smoking hampers circulation to all areas of the body, including the genitals, making it tougher to get and keep an erection.

Prescription drugs: There are more than 200 prescription drugs that can cause erectile dysfunction. Speak with your doctor if you think one of your medications may be causing this in you.

Prostate enlargement may lead to erectile dysfunction

Stress, anxiety,depression,alcohol abuse drug abuse will all cause ED. These make about 10-20 percent of the ED patients.

 Treatment Hypertension

To treat erectile dysfunction (ED), you have to lower high blood pressure. Some people are able to do that through lifestyle changes like exercises but others need to have a change of their prescription

A problem for many men, though, is that some types of blood pressure drugs can cause erectile dysfunction. That may make it tough to stay on medication, especially if high blood pressure never caused any symptoms before. An estimated 70 percent of men who have side effects from high blood pressure medicine stop taking it.

While many drugs used to treat high blood pressure have been linked to erectile dysfunction, some are much less likely than others to cause problems. Certain high blood pressure drugs may even improve erectile dysfunction for some men.

It’s known that diuretics (or water pills, like hydrochlorothiazide) and beta-blockers (like Atenolol) can also cause erection problems. These are also the first drugs that a doctor is likely to prescribe if you are not able to lower your high blood pressure through diet and exercise.

If you take a diuretic, you should stay on it until high blood pressure is under control. If erection problems persist, or blood pressure goes back up, then your doctor might switch to a drug that’s less likely to cause erectile dysfunction. Or, a combination of medications might work better to control high blood pressure and lower the risk of erectile dysfunction.

If you take a beta blocker, you may also want to ask your doctor if it might cause erectile dysfunction. You might be better off on a medication less likely to cause a problem.

High Blood Pressure Drugs Not Likely to Cause ED

Some families of high blood pressure drugs rarely cause ED as a side effect. They include:

  • ACE inhibitors
  • Alpha-blockers
  • Calcium channel blockers

ACE (angiotensin converting enzyme) inhibitors — such as Capoten, Lotensin, Prinivil, and Zestril for example —  widen blood vessels and increase blood flow. Erectile dysfunction is rarely a side effect, occurring in less than 1 percent of patients. There are several different drugs in this category. This seems to be true of all of them.

 Vacuum Consyrictor

A vacuum constriction device (VCD) is an external pump with a band on it that a man with erectile dysfunction can use to get and maintain an erection.

Penile Implants for ED

A penile prosthesis or implant is an effective treatment for erectile dysfunction. Penile implants take about an hour and are done in an outpatient centre.

ED Surgery

Vascular reconstructive surgery is one way to improve blood flow to the penis to help a man with erectile dysfunction get and keep an erection.

Medication: Cialis, Levitra, Staxyn, and Viagra to treat ED

You may already know most of the names: Cialis, Levitra, Staxyn, Stendra, Viagra. Learn more about these medications that can help men with erectile dysfunction.

Alprostadil for ED: Alprostadil, available as an injection or a suppository, is a drug that makes the blood vessels expand. That boosts blood flow throughout the body, including the penis, so it helps men with ED have an erection. These drugs may have side effects like headaches and nausea therefore new drugs for ED treatments are looking to drugs that have less side effects.

Testosterone: Testosterone Replacement Therapy for ED

Inadequate production of testosterone is not a common cause of erectile dysfunction. But, when ED does occur due to decreased testosterone production, testosterone replacement therapy may improve the problem.

 Alternative Remedies for ED

If you have erectile dysfunction, there are many ways your doctor can help you treat it. But you may want to consider complementary or alternative therapies, such as nutritional supplements, herbal remedies, acupuncture, and talk therapy. Just be sure to talk to your doctor first.

 Yohimbe Bark Supplements for ED

You can buy extract of the bark of the yohimbe tree —  long used as an aphrodisiac in West Africa — as a dietary supplement. Its promoters claim it can help erectile dysfunction but there is no scientific basis for this.

Local extracts from roots and concoctions of herbs: The use of these is a dangerous matter because kidney failure as a constant side effect makes it impossible to recommend these .

Bibliography: management of male impotence. —  Alan H.Bennett

Male impotence a historical perspective. — PhilippeBrenot.

Erectile dysfunction WebMD

Notable: Did you know that a man gets 1-5 times erection during his sleep.

Did you know that smoking is one of the quickest journey towards erectile dysfunction.

Did you know that the beetle and concoction of local roots for erection ends sometimes in fatalities due to irreversible kinder failures.

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