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Erectile Dysfunctions

How Common is Erectile Dysfunction?
Data from the Massachusetts Male Aging Study has indicated that the prevalence of erectile dysfunction of any degree is 50% in men between the ages of 40 to 70 years.

Understanding the Causes of Erectile Dysfunction
Erectile dysfunction can be classified simply under two headings. Psychological erectile dysfunction: that is, mental; or Organic erectile dysfunction: that is, due to some form of physical or medical problem. Organic erectile dysfunction becomes more common as men get older.

Psychological causes of Erectile Dysfunction
The causes of psychological erectile dysfunction are numerous, and it is difficult to list them all, but most often erectile dysfunction is related to depression, performance anxiety, marital stress or relationship problems, marital boredom, life crisis, financial difficulties, religious repression, or some type of mental illness. Improving erectile dysfunction in these cases may require addressing the underlying causes.

Organic causes of Erectile Dysfunction
There are four major causes of organic erectile dysfunction: Vascular, Neural, Hormonal, and Drug-induced. The type of erectile dysfunction determines the treatment approach.

1. Vascular causes of Erectile Dysfunction
Alterations in the flow of blood to and from the penis are thought to be a common cause of male erectile dysfunction. For instance, medical conditions such as atherosclerosis (hardening of the arteries), high cholesterol, hypertension, or diabetes reduce blood flow to the penis and genital organs thus leading to difficulty with erection or genital swelling.  Erectile dysfunction could be an early indication of oxidative stress and vascular dysfunction. A vascular problem in the penis may precede a wider, systemic problem in other blood vessels in the body. Patients with cardiovascular disease and patients with diabetes represent the largest group of patients with erectile dysfunction. Lowering cholesterol through diet, supplements, or medicines improves erectile dysfunction.
   Metabolic syndrome can increase inflammatory markers in blood and negatively influence endothelial function resulting in poor vasodilation and a higher incidence of erectile dysfunction.
  
Additional factors that can impede blood flow include penile injury and surgery in the pelvic and abdominal area. Smoking can reduce genital blood flow. Some men with erectile dysfunction may have an underlying vascular disease such as atherosclerosis.
   Men who smoke risk developing erectile dysfunction — and the more cigarettes they smoke, the greater the risk of erectile dysfunction.

2. Neural causes of Erectile Dysfunction
Nerve damage from disorders such as multiple sclerosis, Parkinson’s disease, diabetes, and stroke affect the brain’s ability to respond to sexual stimulation and cause erectile dysfunction. In women, abdominal or pelvic operations can occasionally lead to nerve damage. Erectile dysfunction is common in men undergoing surgical treatment for prostate enlargement or cancer.

3. Hormonal causes of Erectile Dysfunction
Low levels of androgens, such as testosterone, are sometimes a component of erectile dysfunction. Testosterone levels decline about 1 percent each year in men, which may contribute to erectile dysfunction with aging. Testosterone also declines with age in women leading to a decrease in female libido. Replacement of androgens can sometimes be helpful in those with age related erectile dysfunction. Testosterone is available by prescription only. An over the counter hormones, such as DHEA, converts into testosterone and thus has a positive influence on erectile dysfunction. Pregnenolone is another over the counter hormone that may increase testosterone levels and thus improve erectile dysfunction. Many herbal aphrodisiacs also have a positive influence on erectile dysfunction. Routine hormone blood studies for erectile dysfunction evaluation are not needed during the initial evaluation but perhaps later if treatment modalities are not successful. Prominent diseases of the endocrine system, such as diabetes mellitus, hypogonadism, and hyperprolactinemia, may cause erectile dysfunction. Sometimes erectile dysfunction treatment with hormones such as DHEA or testosterone can be effective.

4. Drug or Medication-induced Erectile Dysfunction
Drugs that interfere with erectile function include some anti-hypertensives, SSRIs (like Prozac), sedatives, and beta-blockers. SSRIs - treatment for depression - cause erectile dysfunction mostly due to their effect on serotonin metabolism. Serotonin has an inhibitory effect on erectile function and sexuality. Beta blockers such as propranolol, atenolol, and others, are some of the most common medications that cause erectile dysfunction.
     Surprisingly, NSAIDs such as ibuprofen and naproxen also cause erectile dysfunction. Regardless of the reason for taking them, painkillers classified as non-steroidal anti-inflammatory drugs (NSAIDs) apparently increase the likelihood that middle-aged and elderly men will develop erection difficulties. A study involved 1126 men, between 50 and 70 years of age, without erectile dysfunction in 1994 when they completed a questionnaire that included, among other things, questions about erectile function and medication usage. The questionnaire was then re-administered five years later. The investigators found that the erectile dysfunction rate was 93 cases per 1000 persons per year among NSAID users compared with just 35 cases among nonusers.
     Some chemicals involved in the human sexual response include dopamine, acetylcholine, and nitric oxide. All these three natural chemicals and others can be manipulated n the treatment of erectile dysfunction. Alcohol's negative affect on sex drive increases with age. Heavy smoking is an important risk factor for erectile dysfunction in men..

Erectile Dysfunction and Medical conditions
Certain medical conditions cause erectile dysfunction or reduce libido, performance, or enjoyment. These include hypertension, diabetes, high cholesterol, cardiovascular disease, obesity, peripheral vascular disease, neurologic disorders, and insomnia.
        Sitting on a bicycle too long. Men who log several thousand miles a year on their mountain bikes suffer scrotal damage that could reduce their fertility or cause erectile dysfunction.
       
Erectile Dysfunction and Cardiac Patients
Erectile dysfunction is common in cardiac patients and shares the same risk factors - smoking, hypertension, hyperlipidemia and diabetes mellitus. Sexual activity is not unduly stressful to the heart and, providing patients are properly assessed using established guidelines, sexual intercourse can be enjoyed without increased risk. Erectile dysfunction in asymptomatic patients may be a marker of silent vascular disease or increased vascular risk factors and should alert the physician to the need for cardiac risk screening.
     Physical fitness positively influences sexual desire and performance. Moderate exercise may help boost sexual function in men with heart failure. The results may be good news for some men with erectile dysfunction, because Viagra and other similar erectile dysfunction drugs can have dangerous interactions with medications commonly prescribed to treat heart failure.
    
Erectile Dysfunction and Heart Disease
A large study of men age 55 and older adds to evidence that erectile dysfunction can be a warning sign for heart disease. Men with erectile dysfunction were more likely than other men to experience chest pain, a heart attack or a stroke during the next seven years, the study found. The results suggest that men who see their doctors for erectile dysfunction drugs also should consider getting screened for heart disease.

A note about Viagra and erectile dysfunction pills
Viagra (sildenafil), approved by the FDA in 1998, has been the most popular medicine for the treatment of erectile dysfunction. Viagra works very well in dilating blood vessels in the genital region leading to an erection or increased blood flow to the vaginal tissues, however it does little to directly increase libido or sexual arousal. The effect of Viagra is often noticed within an hour after taking a pill of 50 or 100 mg, and ease of erection may last up to 12 hours. Side effects of Viagra include headache, flushes, nasal congestion or runny nose, malaise, nausea, changes in blood pressure, irregular heart beats, visual disturbances including rare cases of blindness, and chest pain. Viagra may cause stickiness of blood platelets. Trimetazidine, a drug that prevents heart-related chest pain, is a better choice than "nitrate" drugs, such as Nitro-DUR and Isordil, for men with heart disease who are taking Viagra (sildenafil) for erectile dysfunction treatment. There have been concerns about dangerously low blood pressure when Viagra is combined with nitrates, the authors explain, yet many men with heart disease are currently seeking treatment for erectile dysfunction.
   I personally find natural sex boosters quite effective and preferable to pharmaceutical erectile dysfunction drugs.
   A Houston man filed a lawsuit in June 2005 in federal court against Pfizer, claiming he suffered blindness after taking its best-selling erectile dysfunction drug Viagra. James Thompson filed the civil suit against Pfizer in the U.S. District Court for the Southern District of Texas on Tuesday and is seeking more than $75,000 for his vision loss. He is also seeking class-action status because it has been estimated that since 1998, 23 million people have taken the erectile dysfunction drug Viagra, the trade name for sildenafil.

Erectile Dysfunction and Alcohol
Problem drinking may dampen both a man's sex life and his chances of having children. Researchers in India found that men being treated for alcoholism had lower testosterone levels and more sperm abnormalities than non-drinkers did. They also had a far higher rate of erectile dysfunction (ED) - 71 percent, versus 7 percent of abstainers. Therefore, a natural remedy for erectile dysfunction is to reduce alcohol intake.