Impotence:
Men
have always been reluctant to discuss erectile dysfunction(commonly
known as impotence)--and for good reason. Erectile dysfunction can
leave a man feeling hopeless and cause emotional stress for the
couple. But recent and ongoing advances in medical treatment programs
can help.
Impotence: common but treatable.
According
to the National Institutes of Health (NIH), erectile dysfunction
affects as many as 20 million men in the U.S. alone. Once thought
to be caused simply by age, erectile dysfunction is now known to
be related to a number of factors.
Understanding the human sexual response.
The
human sexual response has four phases. All four are experienced
by both men and women.
Desire is defined as an interest is sex; it is a normal part
of life. Thinking about sex, feeling attracted to someone or feeling
frustrated because of a lack of sex are all part of desire.
Excitement is the phase
when you feel aroused
or "turned on". Your heartbeat and pulse speed up, your
blood pressure rises slightly and you breathing gets heavy. Blood
goes to the genital area. In men, this surge of blood creates
and erection; in women, the vagina becomes moist and increase
in both depth and width.
Orgasm is sexual climax. Both men and women experience intense
pleasure in the genital area. The muscles around the genitals
contract, sending waves of feeling through the body. In men, these
muscle contractions cause ejaculation of semen.
Resolution is when the body returns to an unexcited state
a few minutes after orgasm. If a person becomes excited but does
not reach orgasm, resolution still takes place, but more slowly.
In both cases, heartbeat and breathing slow. Blood drains out
of the genital areas. Mental excitement fades.
In men, there is also a "recovery period"-the time period
after one orgasm when a man can't have another one. This period
tends to get longer as a man ages and is a normal part of the
sexual response.
How an erection
occurs.
When
the brain senses something arousing, blood is carried to erectile
tissue in the penis and an erection begins. Various blood vessels,
muscles, nerves and tissue combine to keep blood from leaving
the penis. The trapped blood helps make the penis hard enough
for intercourse.
What is erectile dysfunction?
Erectile
dysfunction is the inability to achieve or maintain an erection
that is hard enough for sexual intercourse. It happens when not
enough blood is supplied to the penis, when the smooth muscle
in the penis doesn't relax or when the penis doesn't "trap"
the blood that flows into it.
When and how does erectile dysfunction
occur?
Erectile
dysfunction can happen at any age to any man. According to studies
by the National Institutes of Health, 5% of men have some degree
of erectile dysfunction at the age of 40, and about 15-25% at
age 65 or older.
Physical causes of erectile dysfunction.
Although
the likelehood of erectile dysfunction increases with age, it
is not an inevitable part of aging. About 80% of erectile dysfunction
has a physical cause: illness, accident, injury or the side effects
of medications used in treating certain diseases. Heavy smoking
and excessive alcohol consumption may also lead to erectile dysfunction.
Listed below are several of the causes:
- Vascular
disease--Arteriosclerosis (hardening of the arteries), hypertension
(high blood pressure), high cholestrol and other conditions can
obstruct blood flow.
- Diabetes--Diabetes
can alter nerve function and blood flow.
- Prescription
drugs--Certain anti-hypertensive and cardiac medications, antihistamines,
psychiatric medications and other prescription drugs.
- Substance
abuse--Excessive smoking, alcohol and illegal drugs constrict
blood vessels and add to other cardiovascular risk factors.
- Neuorlogical
diseases--Multiple sclerosis, Parkinson's disease and other diseases
can interupt nerve impulses to the penis.
- Surgery--Prostate,
colon, bladder and other types of pelvic surgery may damage nerves
and blood vessels.
- Spinal
injury--Interruptions of nerve impulses from the spinal cord to
the penis.
- Other--Hormonal
imbalance, kidney failure and dialysis. Reduced testosterone levels.
Psychological causes of erectile dysfunction.
Erectile
dysfunction can also be caused by psychological factors. These
include unpleasant associations with the past sexual activity,
stress, depression and anxiety. When these kinds of psychological
conditons happen for long periods, they can decrease sexual desire
and result in erectile dysfunction. When both psychological and
physical causes are present, erectile dysfunction is considered
"mixed" in origin.
Sexual activity and aging.
The
normal
aging
process can present some challenges that are often overlooked
by couples. For example, both men and women experience various
physical changes that alter sexual responsivemess.
During therapy for erectile dysfunction, both you and your partner
should try to avoid making comparisons to sexual performance when
you were younger or prior to other changes that may have caused
erectile dysfunction. But most importantly, be patient, maintain
a sense of enjoyment and consider this time an opportunity to
rediscover your sexual initmacy as a couple.
While these changes may present some new challenges, they don't
necessarily mean you have erectile dysfunction. These changes
are perfectly normal and should not interfere with sexual intimacy
between you and your partner.
Changes in women.
The
lower estrogen levels that women have following menopause cause
significant changes. The vagina becomes less lubricated during
sexual excitement; it may also lose some of its flexibility and
thickness. Changes to the uterus, cervix and ovaries often occur.
Because of these changes, a woman's orgasms may become shorter
and less intense than they were in earlier years. And, as with
men, greater stimulation may be needed to produce a sexual response.
However, a woman may still be able to have multiple orgasms.
Low Testosterone Levels In Men.
As
a man ages, testosterone levels begin to decrease, many times
falling below normal levels. As many as 5 million men suffer from
abnormally low testosterone levels (a condition called hypogonadism).
Most of these men never seek treatment because they think the
symptoms they suffer from are a natural part of life.
Common
symptoms of low testosterone levels include:
- Fatigue
or tiredness
- Loss
of muscle mass and muscle strength
- Low
sex drive
- Erectile
dysfunction (ED)
- Depression
(moodiness, sadness, low self esteem)
- Brittle
bones
If
you experience any of these symptoms, see Dr. Schoenfeld for a
simple blood test to check your testosterone levels.
Testosterone Therapy Options
If
Dr. Schoenfeld discovers that your testosterone levels are low,
he may recommend testosterone replacement therapy. Currently there
are several ways to administer testosterone:
There
are several medical options available for resuming sexual intimacy.
Please contact Dr. Schoenfeld's office to schedule an appointment
to discuss these options.
