Erectile function and dysfunction
Penile Erection Mechanism
The penis consists of two parallel cylinders of erectile tissue, the corpora cavernosa and a smaller, single ventrally placed cylinder, the corpus spongiosum, which surrounds the urethra and distally forms the glans penis.
The corpora cavernosa are composed of a mesh-work of interconnected cavernosal spaces lined by vascular endothelium called lacuna. The erection is a complex biological mechanism based on the interplay of different anatomical structures and cellular signaling. In the flaccid state, these smooth muscles of the lacuna space are tonically contracted, allowing only a small amount of arterial flow for nutritional purposes. The flaccid penis is in a moderate state of contraction, as evidenced by further shrinkage in cold weather.
Sexual stimulation triggers release of neurotransmitters from the brain trough to the penile nerve terminals. This results in relaxation of these smooth muscles of the lacuna space and the following events:
⦁ Dilatation of the arterioles and arteries by increased blood flow
⦁ Trapping of the incoming blood by the expanding lacunar space
⦁ Compression of the subtunical venular plexuses between the tunica albuginea and the peripheral sinusoids, reducing the venous outflow
⦁ Stretching of the tunica to its capacity, which occludes the veins
⦁ An increase ib intracavernous pressure , which raises the penis from the dependent position to the erect state
⦁ A further pressure increase (to several hundred millimeters of mercury) with contraction of the ischiocavernosus muscles (rigid-erection phase)
Erectile dysfunction: what is that?
In medical books, Erectile Dysfunction is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.
Actually, Erectile dysfunction is not so easy to define and can have different degrees. Some men have just a mild condition, other are more seriously affected. By using this questionnaire, you can find out if and how much you are affected.
Do the SHIM questionnaire now
Is it common?
Despite the silence around it, Erectile dysfunction ( or impotence) is very common, affecting more than 50% of men aged 50 to 80 years. More importantly, a recent scientific study among men seeking first-time medical help for new-onset Erectile dysfunction found that one in four men was younger than age 40, and almost 50% of the young men complained of severe ED
Which are the Causes?
Before, many physicians assumed that impotence problems were caused by psychogenic factors, i.e. mental stress, or related to some form of psychological issue. Although a psychological element is often present, up to 80 percent of ED cases have an organic cause.
Organic causes are mainly due to some problems with blood vessels, where either the blood does not circulate properly or there are some obstacles that limit the correct flow.
Erectile dysfunction: what is that?
What the others do not tell you…
Incorrect blood circulation might cause fibrosis of the penis and ultimately lead to a chronic ED. When the elasticity and compliance of the penile internal spongy tissue is reduced, filling with blood will no longer result in the effective erection of the penis. Penile fibrosis leads to the sustained impairment of the erectile mechanism, even when the primary cause has been resolved (for example, after the diabetic treatment is started and the glucose level is under control). Thus, penile fibrosis should be considered as a potential cause of treatment failure in Erectile dysfunction, particularly because when established it becomes a chronic condition.
ED diagnosis is based on the clinical tests:
Clinical examination: useful to ascertain the presence of general and local conditions (phimosis, congenital or acquired penile curvature) which must be related to Erectile dysfunction.
Hormonal profile: useful to ascertain the existence of endocrine conditions (reduction of testosterone, increase of prolactin, alterations of thyroid function) responsible for Erectile dysfunction.
Eco-Color Doppler Penis: during a pharmacologically induced erection with the injection of vasodilators, the speed of blood flow inside the penis is measured. The data required to ascertain a reduction in the arterial flow to the penis, an increase in venous outflow due to malfunction of the “valves” that treats retaining blood inside the penis (“venous escape”).
ED: Which Is the therapy?
As a rule, ED can be treated successfully with current standard treatment options, but it cannot be cured…
The problem with standard treatment options, including drugs like Viagra (PD5 inhibitors) or penile injection, is that they treat Erectile dysfunction as a symptom, but they do not treat the underlying causes. These treatments allow you to achieve on-demand erections before and during sexual intercourse, but they will NOT restore your normal erectile function and DO NOT reduce the penile fibrosis.
The first line of defense must be always the Lifestyle changes! Although there are medical conditions that can regulate Erectile dysfunction, responsibility is often attributed to unhealthy lifestyle habits: changing one’s lifestyle can make a real difference.
Shockwave therapy for Impotence: How it works?
Extracorporeal shock wave therapy (ESWT) is a relatively new and innovative method to treat a vascular Erectile dysfunction. It is painless and many patients report a noticeable improvement of their ability to achieve an erection within a few weeks.