
can steal a man’s ability to achieve and maintain an erection.
occurs when the problem is frequent or continuous. Erectile dysfunction can range from mild to severe. A man with mild erectile dysfunction may sporadically achieve a full erection, but more often than not he achieves and erection that is inadequate for penetration. He may often be unable to achieve an erection at all. A man with severe erectile dysfunction is seldom able to achieve an erection. Erectile dysfunction becomes more common with age but is not part of the normal aging process. About half of men 65 years of age and three out of four men age 80 or older have erectile dysfunction. Causes To achieve an erection, the penis needs both an adequate inflow of blood and a slowing of blood outflow. Disorders that narrow arteries and decrease blood inflow (such as atherosclerosis, diabetes, or a blood clot) or surgery on the blood vessels can cause erectile dysfunction. Also, abnormalities in the veins of the penis can occasionally drain blood back to the body so rapidly that erections cannot be maintained despite adequate blood inflow. Neurologic damage is another possible cause of erectile dysfunction. Damage to the nerves, leading to or from the penis, produces erectile dysfunction. Such damage could result from surgery (most commonly prostate surgery), spinal disease, diabetes, multiple sclerosis, peripheral nerve disorders, stroke, alcohol, and drugs. Occasionally, hormonal changes (such as abnormally low levels of testosterone) cause erectile dysfunction. Also, factors that decrease a man’s energy level (such as illness, fatigue, and stress) can make erections difficult. A great many drugs can interfere with the ability to achieve an erection, especially among older men. Drugs that commonly cause erectile dysfunction include antihypertensives, antidepressants, some sedatives, cimetidine, digoxin, lithium, and antipsychotics. Psychological issues (such as depression, performance anxiety, guilt, fear of intimacy, and ambivalence about sexual orientation) can inhibit the ability to achieve erections. Psychological causes are more common in younger men. Any new stressful situations, such as a change of sex partners or problems with relationships or at work, can also play a role. Sexual Activity and Heart Disease Sexual activity is generally less taxing than moderate to heavy physical activity and is therefore safe (in most cases) for men with heart disease. Although the risk of a heart attack is higher during sexual activity than it is during rest, the risk is still very low during sexual activity. Still, sexually active men with diseases of the heart and cardiovascular system (which include angina, high blood pressure, heart failure, abnormal rhythms of the heart, and a blockage of the aortic valve [aortic stenosis]) need to take reasonable precautions. Usually, sexual activity is safe if the disease is mild, if it causes few symptoms, and if blood pressure is normal. If the disease is moderate in severity or it the man has other conditions that make them susceptible to a heart attack, testing may be necessary to establish how safe sexual activity is. If the disease is severe, or if the man has an enlarged heart that blocks the flow of blood leaving the left ventricle (obstructive cardiomyopathy), sexual activity should be postponed until after treatment reduces the severity of the symptoms. Use of sildenafil may be dangerous; men taking nitroglycerine should not use sildenafil. Sexual activity should also be delayed until at least 2 to 6 weeks after a heart attack. Most often, testing to determine the safety of sexual activity involves monitoring the heart for signs of poor blood supply while exercising on a treadmill. If the blood supply is sufficient during exercise, a heart attack during sexual activity is very unlikely. Symptoms Sex drive (libido) often decreases in men with erectile dysfunction, although some men do maintain a normal libido. Regardless of whether libido changes, men with erectile dysfunction have difficulty engaging in intercourse either because the erect penis is not adequately hard, long, or elevated for penetration or because the erection cannot be sustained. Some men stop having erections during sleep or upon awakening. Others may attain strong erections occasionally but be unable to attain or maintain erections other times. When testosterone levels are low, the result is more likely to be a drop in libido than erectile dysfunction. Low testosterone levels can cause gradual development of many symptoms, including enlargement of the breasts (gynecomastia), raised pitch of the voice, shrinking of the testes (testicles), and loss of pubic hair. Low testosterone may also cause thinning of the bones, loss of energy, and loss of muscle mass. Diagnosis To diagnose erectile dysfunction, a doctor performs a general physical examination and examines the man’s genitals. The doctor may also assess the function of the nerves and blood vessels that supply the genitals. Measurement of blood pressure in the legs may reveal a problem with the arteries in the pelvis and groin that supply blood to the penis. Examination of the man’s rectum may reveal a problem with the nerve supply of the penis.
Dysfunction (ED), and Male Libido |
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