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Erectile dysfunction (ED), also called "impotence", is one of the most common health problems affecting men. Erectile dysfunction can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. Chronic ED affects about 5% of men in their 40s and 15-25% of men by the age of 65. Transient ED and inadequate erection affect as many as 50% of men between the ages of 40 and 70.
Causes
Erectile dysfunction has many underlying physical and psychological causes. Most men with physical causes usually have an associated psychological component. Underlying conditions of erectile dysfunction include the following:
* Physical health conditions Problems with the nervous system can affect the transmission of signals from the brain to the blood vessels in the penis. This occurs in conditions including multiple sclerosis, spinal cord injury and Parkinson's disease. The nerves involved in sexual arousal can also be damaged in surgery to the pelvic area, such as removal of the prostate.
o Vascular diseases account for nearly half of all cases of erectile dysfunction in men older than 50 years. These include atherosclerosis, veno-occlusive disease, peripheral vascular disease, arterial hypertension, history of heart attacks, blood vessel trauma, high cholesterol levels.
o Systemic diseases associated with erectile dysfunction: Diabetes mellitus is a major cause of erection problems (about 60% of men with diabetes experience erectile dysfunction), scleroderma, kidney failure, liver cirrhosis, hemachromatosis, dyslipidemia, hypertension.
o Neurologic diseases. Problems with the nervous system can affect the transmission of signals from the brain to the blood vessels in the penis. Diseases that affect the nervous system and are commonly associated with erectile dysfunction include: multiple sclerosis, spinal cord and brain injuries, parkinson's disease, alzheimer's disease, epilepsy, Guillain-Barre syndrome.
o Respiratory disease associated with erectile dysfunction include: chronic obstructive pulmonary disease, sleep apnea
o Conditions of the penis: Peyronie's disease (a rare inflammatory condition that causes scarring of erectile tissue), epispadias, priapism, Infections.
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Traumatic Causes. Trauma or injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to erectile dysfunction by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa. Bicycle riding for long periods has also been implicated as a cause of erectile dysfunction.
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Some types of prostate or bladder surgery. Surgery of the colon, prostate, bladder, or rectum may damage the nerves and blood vessels involved in erection.
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Medications. A great variety of prescription medication are known to cause or contribute to erectile dysfunction:
o blood pressure medication (especially beta-blockers)
o heart medication
o antihistamines
o antidepressants
o tranquilizers
o antipsychotics
o anticonvulsants
o appetite suppressants
o anti-ulcer medications
o sleeping pills
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Psychological conditions. Experts believe that psychological factors cause 10 to 20 % of erectile dysfunction cases. Anxiety and guilt are the most common psychological causes of erectile dysfunction. Depression, worry, stress, low self-esteem, and fear of sexual failure all contribute to loss of libido and erectile dysfunction.
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Substance abuse.
o Alcoholism. Drinking too much alcohol interferes with the production of the male hormone testosterone, which can reduce libido.
o Smoking is considered an important risk factor for erectile dysfunction because it is associated with poor blood circulation and its impact on cavernosal function.
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Hormone Disorders account for fewer than 5% of cases of erectile dysfunction. An imbalance in hormones, such as testosterone, prolactin, or thyroid, can cause erectile dysfunction.
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Age. Erection problems tend to become more common with age, but it can affect men at any age and at any time in their lives. Physical causes are more common in older men, while psychological causes are more common in younger men.
Treatment options
Erectile dysfunction is treatable at any age. In around 95% of the cases, a suitable treatment can be found.
There are three oral medications approved for the treatment of erectile dysfunction: sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). All three medications belong to a class of drugs called phosphodiesterase (PDE) inhibitors. They block the enzyme phosphodiesterase-5 (PDE-5) and this helps maintain the levels of cyclic guanosine monophosphate (GMP), a chemical produced in the penis during sexual arousal. Balanced levels of GMP causes the smooth muscles of the penis to relax and increases blood flow. This allows a natural sequence to occur - an erection in response to sexual stimulation. These medications don't automatically produce an erection. Instead they allow an erection to occur after physical and psychological stimulation.
Viagra, Levitra, and Cialis vary in dosage, duration of effectiveness and possible side effects. All three drugs are generally well tolerated. They are a good choice for men at any age and in any ethnic group who are in good health and who do not have conditions that preclude taking it (such as the use of nitrates or alpha-blockers). The success rates of all three drugs vary between 70% and 90%.
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