Erectile Dysfunction Causes and Treatment Options

Erectile dysfunction is a condition that is far more common than you may realise with a reported 1 in 5 Australian men experiencing erectile problems and 1 in 10 being unable to have erections at all. Erectile dysfunction is not well understood and men find it difficult to discuss with their partners, doctors or even acknowledge to themselves.

If a man isn’t able to attain or maintain an erection for sex with a partner, it is considered erectile dysfunction. The experience may feel be humiliating, and although the problem itself causes tension in a relationship, and impacts self-esteem, some men prefer to suffer in silence instead of facing what they fear will be an awkward conversation with their doctor. We will discuss in depth erectile dysfunction causes and treatment options.

Causes of Erectile Dysfunction

The brain, hormones, muscles, blood vessels, nerves, and even emotions are all part of the complex process of male arousal which can make it difficult to pinpoint the particular cause. An issue with any one of these parts of the process can interfere with a man’s ability to get an erection. Your problem can be physical or psychological in nature or both and is different from man to man.

Temporary Erectile Dysfunction

If the incident is isolated, there are many varieties of factors that can explain the cause. It is likely that erectile dysfunction may not be a permanent part of your sex life.

Simple explanations such as stress, exhaustion, excessive alcohol, or anxiety can cause temporary inability to maintain an erection.

If you experience very occasional erectile dysfunction, it isn’t a cause for concern, although it may be a signal from your body that you should take steps to correct the cause. If you are drinking too much, working too hard, or straining your relationship, your body may be sending you a message to take better care of yourself.

Long Term Physical Causes

If your erectile dysfunction is frequent or prolonged, it is very important to speak to your doctor. Before your doctor begins to test for diseases he will discuss your lifestyle with you to rule out variables that may influence your sexual performance.

Obesity, smoking, substance abuse and chronic alcoholism can contribute to or exacerbate erectile dysfunction.

Since erectile dysfunction is a symptom and not a disease, which means the doctor will want to do a wide variety of tests to check for heart disease, high cholesterol, high blood pressure, diabetes, Parkinson’s disease, and metabolic syndrome.

Long Term Psychological Causes

Sexual pleasure begins in the brain, and erectile dysfunction often isn’t caused by a physical symptom. Psychological distress can be a very powerful deterrent to sexual arousal. Depression or other kinds of psychological conditions can make it difficult for men to perform in the bedroom. Additionally, if a couple has had difficulty having a baby or experienced relationship problems in general, erectile dysfunction may be a symptom of those pressures and can be very difficult to overcome and sometimes even more difficult to address.

Treatment Options

There are several effective treatment options available for those dealing with erectile dysfunction. The best course of treatment will depend on your specific causes and needs.

Pharmacological treatment options

The most popular oral erectile dysfunction treatment options at the moment are very similar and come in three different varieties:

• Sidelnafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra)

Whilst none of these medications work right away, they work in much the same way and have been successful for a large portion of men. The drug relaxes the muscles in the penis while simultaneously allowing for an erection. These medications do not produce the erection itself, they rather increase the likeliness and strength of an erection in response to stimulation.

If you find pills have negative side effects or are ineffective, there are other relatively non-invasive treatment options.

Alprostadil is a vasoactive mediator

Administration is available two ways:

• For self-injections which you can inject into the base of side or your penis the needle is very, small and the injection is almost painless. Although there are few side effects, you might have bleeding from the injection site or possibly form a growth at the site of injection.
   
• Alprostadil suppository via the penile urethra. Using an applicator, you can insert the suppository and after 10 minutes you can expect an erection that generally lasts from 30-60 minutes, although there are reports of erections that last for 2-3 hours after ejaculation.

Vacuum Device

One option to consider if medication doesn’t work is a vacuum erection device or a “penis pump”. A penis pump works by using a tube to create suction to pull blood into the penis, and with the help of a small ring, the penis is held erect long enough to have sex with a partner.

Surgical treatment options

Surgery is most often considered to be a last resort once other treatment options have been exhausted without resolving the impotence. There are a couple of different surgical options available with the most common being penile implants. Penile implant surgery involves placing rods on each side of the penis. There are two types of rods available:

• semi-rigid rods keep the penis firm but still able to bend
• inflatable rods let you control your erections and how long they last by squeezing a specific part of the device

The other surgical treatment option available, though rarely used, is vascular surgery. This invasive surgery repairs the blood vessels that supply blood to the penis and is only used in extreme cases involving damage to the vessels due to trauma, such as that experienced in a car accident. Both types of surgery have a high risk of infection and complication and involve a potentially long and painful recovery period.

Psychological treatment strategies

You can perform a simple test to identify if the erectile dysfunction is physical or psychological.

Before falling asleep, a ring of paper is placed around the penis, if the paper is torn overnight, it is an indicator that an erection took place overnight and erection was achieved, and the cause is psychological. It is best to repeat this test over repeated nights to increase its accuracy.

If the cause of erectile dysfunction is psychological, then underlying psychological issues will need to be explored with a psychologist, psychiatrist, or therapist.

An assessment with a doctor to effectively diagnose specific issues such as depression or anxiety that could be causing your impotence will allow for individualised treatment. In some cases the cause may be more complex and related to problems in the relationship or even past sexual abuse.

Herbal treatments

Although there is limited research to support the effectiveness of herbal remedies, there are several supplements available as possibilities for treatment of erectile dysfunction. Options include:

• Korean red ginseng. Ginsengs are adaptogenic herbs, which help increase the body’s resistance to mental and physical stress.
• Dehydroepiandrosterone (DHEA): A naturally occurring hormone, administered orally or topically. A precursor for many of the human sex hormones including testosterone.
• L-arginine: Available orally, this amino acid is thought to play an important role in sex hormone release and regulation.

Acupuncture 

Finally, some believe that acupuncture can cure erectile dysfunction. This treatment strategy when administered appropriately by a qualified and trained professional is considered a safe option. Its effectiveness is open to much debate, however with many people supporters of the treatment, whether an effective placebo or not, is providing a viable treatment option.

Lifestyle Changes

While there are a variety of contributing factors to erectile dysfunction, there are things a man can be aware of to ease or prevent erectile dysfunction.

• Excess weight can contribute to erectile dysfunction, and hence weight loss itself can provide an effective treatment option for erectile dysfunction problems.
• Exercise, while maintaining weight, also manages stress (which helps ward off psychological problems which may contribute to ED) and increases circulation. 
• Smoking, alcohol, and drug problems directly aggravate erectile dysfunction, and getting help for them is an important first step. 
• Address relationship issues between sexual partners, it could be as simple as finding couples therapy.

References

1. Lording, Doug, BMedSci MBBS FRACP. (January 2014). Erectile Dysfunction - Impotence and Related Health Issues. Andrology Australia (The Australian Centre of Excellence in Male Reproductive Health). Retrieved May 19, 2014, from https://www.andrologyaustralia.org/wp-content/uploads/Erectile-Dysfunction-Guide-WEB.pdf
2. Mayo Clinic Staff. (February 2012). Erectile Dysfunction. Mayo Clinic. Retrieved May 19, 2014 from http://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/basics/causes/con-20034244
3. Erectile Dysfunction. (August 2013). State Government of Victoria - Better Health Channel. Retrieved May 19, 2014 from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Erectile_dysfunction
4. Smith, Ian A R, McLeod, Nicholas, Rashid, Prem. (May 2010). Erectile Dysfunction - When Tablets Don’t Work. Australian Family Physician, Volume 39, No 5. Page 301-305. Retrieved May 19, 2014 from http://www.racgp.org.au/download/documents/AFP/2010/May/201005smith.pdf
5. Causes of Erectile Dysfunction. Sexual Health Australia. Retrieved May 19, 2014, from http://www.sexualhealthaustralia.com.au/page/causes.html