Erectile Dysfunction

ERECTILE DYSFUNCTION 

Erectile dysfunction is defined as having difficulty achieving or maintaining an erection of the penis.  The man is unable to produce an erection necessary to perform or complete sexual intercourse.  Normally, an erection begins with mental and sensory stimulation.  The muscles of the penis relax and allow blood to flow into the copora cavernosa, large vessels along the shaft of the penis, thereby expanding the penis.  The erection is reversed when the blood is allowed to drain out, usually after orgasm.  From time to time, some men experience brief periods of impotence that may be related to psychological factors such as depression, stress, relationship problems and anxiety.  True erectile dysfunction, on the other hand, is related to physical problems such as medication side effects, injury to nerves and arteries near the penis (e.g. prostate surgery), or diseases that impair circulation within the penis like diabetes, kidney disease, atherosclerosis (hardening of the arteries) and endocrine disorders.

As men age, we may notice that erections are not as firm as they once were or maintaining erections becomes difficult or has diminished. This is often the result of several factors especially low testosterone, chronic alcohol abuse; drug abuse or chronic narcotic use; smoking; use of high blood pressure medications, antihistamines, antidepressants, appetite suppressants, sedatives, and ulcer treatments, nervous system disorders (spinal cord injury, multiple sclerosis, and stroke); cardiovascular disease and many of the medications used in its treatment.

Symptoms may include:

Three categories:

• Inability to achieve an erection of the penis at all
• Unpredictable ability to achieve an erection (ability varies)
• Sustains erections for only a brief amount of time

What we can do:

• Diagnose the problem through history and physical exam, laboratory blood tests, saliva tests, testosterone and other hormone levels, urinalysis
• Rule out psychological vs. physical causes
• Neurotransmitter evaluation may be helpful
• Review current medications to determine if impotence could be a pharmaceutical side effect. We may suggest dosage adjustment to improve impotence after discussion with your internist or cardiologist.

Possible treatment options:

• Restore testosterone to healthy physiologic levels
• Optimize adrenal gland function
• Extracorporeal Shockwave Treatment (GAINSWave™). GAINSWave is a drug & surgery free, non-invasive technique that uses pulse waves to improve sexual performance.  Treatments are offered at The Blend Institute. 
• Psychotherapy and counseling to reduce stress and anxiety; teaches coping strategies.
• Balance neurotransmitters, limiting psychotropic medication that can affect erections.
• Medications such as Viagra or Cialis that relax penile muscles and increase blood flow. This can also be achieved with the use of Arginine(an amino acid supplement)
• Direct injections of vasodilators "the Boston Method". In this method,a specific concentration of "trimix" or "bimix" is used to help you achieve the desired erection.
• Urethral dissolvable pellets, known as "muse" (relaxes penile muscles and increases blood flow), are placed in the tip of the penis to help achieve erection.
• Mechanical vacuum devices (creates vacuum around penis and draws blood inside penis to produce erection) especially after surgery or in conjunction with GAINSWave therapy.
• GAINSWave
• Surgical implants by referral to a urologist if all else fails.

What you can do:

• Talk to your doctor if you experience sexual health changes, especially after starting a new medication.
• Reduce stress with relaxation, counseling or lifestyle changes.
• Avoid alcoholic beverages and stop smoking. Ask us for help.
• Use medications as directed by your doctor. These medications may cause serious side effects if not taken as directed. 
• Do not use Viagra if you are currently taking nitroglycerin (heart medication) or if you suffer from episodes of angina (chest pain).
• Start an exercise program with your doctor’s permission and advice.
• We at The Blend Institute have the expertise to manage any of the above situations and can help communicate with your doctor if necessary.

What you can expect:

• Erectile dysfunction may cause depression, low self-esteem and relationship problems.
• Currently, erectile dysfunction affects between 10 and 15 million men of all ages. It is not, however, only associated with aging.   
• Psychological counseling helps to identify stressors and provides recovery in many cases.
• Treatment of the underlying factors helps to improve and limit erectile dysfunction, especially the use of testosterone (see our Andropause blog).

If you develop signs and symptoms of erectile dysfunction, please contact us to talk about it.  Complimentary consultations are available by appointment.

Author

Dr. Timothy Blend Triple Board Certified Physician in Emergency Medicine, Internal Medicine and Anti-Aging Medicine.