17 Nov 09
The average male has four to eight spontaneous erections every night while he sleeps. They usually occur during the REM stage, when dreaming is most common.
When a doctor wants to know whether a patient’s difficulty achieving an erection is due to physical or mental reasons, one way to find out is to fit the patient’s penis with a sensor and see whether or not the patient’s dream erections are working properly. If not, the problem is probably physical.
When things are working properly, ejaculation is a three-step process:
- The man becomes sexually aroused.
- The penis responds by becoming erect.
- Stimulation of the penis causes ejaculation.
That sounds simple enough, but in many cases, step two doesn’t happen, making step three difficult or impossible. Although the man is stimulated, the penis doesn’t become erect. To understand why, you need to understand the technology of an erection.
When you want to move nearly any part of your body, you do it using muscles. Whether you are moving your fingers, toes, arms or legs, muscles do the work. Even when you stick your tongue out, you do it using muscles:
- You think about moving some part of your body
- The appropriate muscles contract
- That part of the body moves
Muscles let you move your body voluntarily with precise control.The penis, on the other hand, is completely different. There are no muscle contractions involved in making the penis erect. To become erect, the penis instead uses pressure.
Probably the easiest way to understand how the penis becomes erect is to think about a balloon. If a balloon has no air in it, it’s limp. As you inflate a limp balloon with just a little air, it becomes elongated and rigid.
The penis uses a similar mechanism, but instead of using pressurized air to become rigid, the penis uses pressurized blood. The penis contains two cigar-shaped structures, called corpora cavernosa (singular: corpus cavernosum), that it uses to become erect.
Think of the corpora cavernosa as balloonlike tubes. Arteries bring blood into these two tubes, and veins carry blood away from them. The penis can be either limp or erect, depending on the flow of blood:
- In a non-erect state, the arteries that bring blood into the corpora cavernosa are somewhat constricted, while the veins that drain the blood from the penis are open. There is no way for pressure to build inside the penis. In this state, the penis is limp.
- When a man becomes aroused, the arteries leading into the penis open up so that pressurized blood can enter the penis quickly. The veins leaving the penis constrict. Pressurized blood is trapped in the corpora cavernosa, and this blood causes the penis to elongate and stiffen. The penis is erect.
If the arteries leading to the penis don’t open up properly, it is difficult or impossible for a man to become erect. This problem is the leading cause of erectile dysfunction (ED).
To solve an erection problem when the cause is poor blood flow, you need to open the arteries. Let’s take a look at how this can be done — and how it was done before Viagra.
17 Nov 09
A variety of options exist for treating erectile dysfunction. They range from medications and simple mechanical devices to surgery and psychological counseling. The cause and severity of your condition are important factors in determining the best treatment or combination of treatments for you.
Oral medications
Oral medications available to treat ED include:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
All three medications work in much the same way. Chemically known as phosphodiesterase inhibitors, these drugs enhance the effects of nitric oxide, a chemical that relaxes muscles in the penis. This increases the amount of blood flow and 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. Many men experience improvement in erectile function after taking these medications regardless of the cause of their impotence.
These medications share many similarities, but they have differences as well. They vary in dosage, duration of effectiveness and possible side effects. Other distinctions — for example, which drug is best for certain types of men — aren’t yet known. No study has directly compared these three medications.
Not all men benefit
Although these medications can help many people, not all men can or should take them to treat erectile dysfunction. You should not take these medications if:
- You take nitrate drugs for angina, such as nitroglycerin (Nitro-Bid, others), isosorbide mononitrate (Imdur) and isosorbide dinitrate (Isordil)
- You take a blood-thinning (anticoagulant) medication
- You take certain types of alpha blockers for enlarged prostate (benign prostatic hyperplasia) or high blood pressure
Viagra, Levitra or Cialis may not be a good choice for you if:
- You have severe heart disease or heart failure
- You’ve had a stroke
- You have very low blood pressure (hypotension)
- You have uncontrolled high blood pressure (hypertension)
- You have uncontrolled diabetes
Don’t expect these medications to fix your erectile dysfunction immediately.
Work with your doctor to find the right treatment and dose for you. Dosages may need adjusting. Or you may need to alter when you take the medication.
Before taking any medication — including Viagra, Levitra or Cialis — make sure to discuss with your doctor:
- Potential benefits and side effects of the medication you are considering
- Any illnesses or serious health problems you have now or have had in the past
- Any prescription or over-the-counter medications you take (including herbal remedies)
Prostaglandin E (alprostadil)
Two treatments involve using a drug called alprostadil. Alprostadil is a synthetic version of the hormone prostaglandin E. The hormone helps relax muscle tissue in the penis, which enhances the blood flow needed for an erection. There are two ways to use alprostadil:
- Needle-injection therapy. With this method, you use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of your penis. This generally produces an erection in five to 20 minutes that lasts about an hour. Because the injection goes directly into the spongy cylinders that fill with blood, alprostadil is an effective treatment for many men. And because the needle used is so fine, pain from the injection site is usually minor. Other side effects may include bleeding from the injection, prolonged erection and formation of fibrous tissue at the injection site. The cost per injection can be expensive. Injecting a mixture of alprostadil and other prescribed drugs may be a less expensive and more effective option. These other drugs may include papaverine and phentolamine.
- Self-administered intraurethral therapy (Muse). This treatment involves using a disposable applicator to insert a tiny alprostadil suppository, about half the size of a grain of rice, into the tip of your penis. The suppository, placed about two inches into your urethra, is absorbed by erectile tissue in your penis, increasing the blood flow that causes an erection. Although needles aren’t involved, you may still find this method painful or uncomfortable. Side effects may include pain, minor bleeding in the urethra, dizziness and formation of fibrous tissue.
Hormone replacement therapy
For the small number of men who have testosterone deficiency, testosterone replacement therapy may be an option.
Penis pumps
This treatment involves the use of a hollow tube with a hand-powered or battery-powered pump. The tube is placed over the penis, and then the pump is used to suck out the air. This creates a vacuum that pulls blood into the penis. Once you achieve an adequate erection, you slip a tension ring around the base of your penis to maintain the erection. You then remove the vacuum device. The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse.
Vascular surgery
This treatment is usually reserved for men whose blood flow has been blocked by an injury to the penis or pelvic area. Surgery may also be used to correct erectile dysfunction caused by vascular blockages. The goal of this treatment is to correct a blockage of blood flow to the penis so that erections can occur naturally. But the long-term success of this surgery is unclear.
Penile implants
This treatment involves surgically placing a device into the two sides of the penis, allowing erection to occur as often and for as long as desired. The inflatable device allows you to control when and how long you have an erection, the semirigid rods keep the penis in a rigid state all the time. These implants consist of either an inflatable device or semirigid rods made from silicone or polyurethane. This treatment is often expensive and is usually not recommended until other methods have been considered or tried first. As with any surgery, there is a small risk of complications such as infection.
Psychological counseling and sex therapy
If stress, anxiety or depression is the cause of your erectile dysfunction, your doctor may suggest that you, or you and your partner, visit a psychologist or counselor with experience in treating sexual problems (sex therapist). Even if it is caused by something physical, erectile dysfunction can create stress and relationship tension. Counseling can help, especially when your partner participates.
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Filed under ED treatment | Tagged: Cialis, Erectile Dysfunction, Levitra, Needle-injection therapy, Penile implants, penis pump, Prostaglandin E, Psychological counseling and sex therapy, Pump, Self-administered intraurethral therapy, Sildenafil, Tadalafil, Treatments, Vardenafil, Vascular surgery, Viagra