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Causes of Erectile Dysfunction and Their Treatments

Erectile dysfunction (ED) can have many causes.  In this brief paper, three of these causes will be considered.  ED can be caused either by physical problems with the body; with psychological problems; or with a combination of both.  Approximately one-third of ED cases are estimated to fall into each of physical, psychological, and mixed physical/psychological causes (Warren, 2009).  Of all the possible causes of ED, only three will be discussed here:  medication problems (i.e., side effects of drugs taken either for medical or recreational reasons); neuropathy (which may be a result of diabetes, MS, Parkinson’s or other disease); and depression.

Many medications that are used to treat common chronic conditions have a side effect of interfering with the ability of men to achieve an erection.  For example, CVD drugs such as beta-blockers, calcium agonists, digoxin, lipid-lowering drugs, and thiazide diuretics are associated with ED.  Endocrine drugs such as testosterone, lutenising hormone releasers, estrogens, and anti-androgens are also associated with ED, as are various psychoactive drugs such as selective serotonin reuptake inhibitors (SSRIs), tranquilizers, and some antidepressants.  Even recreational drugs such as alcohol, amphetamines, cocaine, and tobacco are associated with ED.  If a drug interaction seems to be the cause for a patient’s ED, the physician may be able to identify alternatives that achieve similar therapeutic effects without the side effect of generating ED (Steggall, 2007).  In the case of recreational drugs, addressing necessary lifestyle changes is key to successful treatment (Steggall, 2007).

Neuropathy is another source of ED problems, with diabetes being the most common reason for the neuropathy.  As many as half of all men with diabetes may also experience ED (Warren, 2009).  Diabetes can injure nerve endings that help control blood supply to the penis.  It is also strongly associated with hypertension, which is also separately associated with ED (prevalence rate about 45%) (Warren, 2009). 

The first stage in assessing a patient with ED is determining the cause because it is clear that the source of the problem determines the best treatment.  This process begins by taking a frank and sympathetic sexual history and taking the problem seriously (Warren, 2009).  Data to be collected includes the speed of onset of the problem, life stresses, circumstances under which ED manifests, whether there is a loss of interest in sex, and how the partner responds to the ED (Warren, 2009).

Depression (or other psychological issue) is often the root cause when ED appears with sudden onset (Warren, 2009). While most cases of ED can be treated with medications, surgery, or mechanical aids, when the root cause is psychological, the underlying problem must be addressed.  For example, if the patient is in an unsatisfactory relationship, solving his ability to get an erection won’t resolve the relationship problems (Steggall, 2007).

General ED Treatments

Because ED virtually always has psychological impacts, even if not directly caused by psychological problems, providing experienced counseling is always a good option for ED patients.  Although the use of phosphodiesterase inhibitors (Viaga, Cialis, etc.) receives wide recognition, reports indicate it may be only effective for about one-third of men (Deadman, 2007).  Alternative treatments include medicated urethral systems for erections (MUSE) in which pellets can be inserted in the urethra, followed by penile massage for 10 minutes (Stegall, 2007).  Corpus cavernosa injections (self administered)  are  another alternative, but creating a hole in the penile skin can make the man vulnerable to STDs or other infections and, as with the MUSE pellets, can exacerbate hypertension or cause urethra irritation (Douglass & Lin, 2010).

Nontraditional and less invasive interventions have been proposed including acupuncture, smoking cessation, special pelvic exercises, and herbal remedies (licorice and ginseng); acupuncture in particular has generated evidence of substantial success with ED in many studies (Deadman, 2007).

Mechanical vacuum devices can be used to pull blood into the penis and a ring can keep it there during sex.  This requires no medications, and thus is safer than other treatments, as well has having a high efficacy (Douglass & Lin 2010).  Finally, a penile prosthesis can be used; these are generally considered up to 90% effective, require no devices or medications, and can permit erections at any time.  The risks of surgery, however, include potential infections, implant failure, pain, and general surgical risks (Steggall, 2007).

Whatever the cause of ED, the treatment of the condition is frequently extended and generally requires a referral to a specialist experienced in treating it (Steggall, 2007).

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