Contents 1 Signs and symptoms 2 Causes 3 Pathophysiology 4 Diagnosis 5 Treatment 5.1 Medication 5.2 Pumps 5.3 Surgery 5.4 Alternative medicine 6 History 7 Lexicology 8 References 9 External links


Signs and symptoms Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection.


Causes Medications (antidepressants, such as SSRIs,[2] and nicotine[citation needed] are most common) Neurogenic disorders[3] Cavernosal disorders (Peyronie's disease[4]) Psychological causes: performance anxiety, stress, and mental disorders[5] Surgery[6] Aging. It is four times more common in men aged in their 60s than those in their 40s.[7] Kidney failure Diseases such as diabetes mellitus and multiple sclerosis (MS). While these two causes have not been proven they are likely suspects as they cause issues with both the blood flow and nervous systems. Lifestyle: smoking is a key cause of erectile dysfunction.[8][9] Smoking causes impotence because it promotes arterial narrowing.[10] Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Erectile dysfunction is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation, although the prostate gland itself is not necessary to achieve an erection. As far as inguinal hernia surgery is concerned, in most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of patients with preoperative sexual dysfunction, while, in most cases, it does not affect patients with a preoperative normal sexual life.[11] ED can also be associated with bicycling due to both neurological and vascular problems due to compression.[12] The increase risk appears to be about 1.7-fold.[13] Concerns that use of pornography can cause erectile dysfunction[14] have not been substantiated in epidemiological studies according to a 2015 literature review.[15] However, another review and case studies article maintains that use of pornography does indeed cause erectile dysfunction, and critiques the previously described literature review.[16]


Pathophysiology Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both cases, an intact neural system is required for a successful and complete erection. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems.[17] Spinal cord injury causes sexual dysfunction including ED. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light.


Diagnosis This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (May 2010) (Learn how and when to remove this template message) It is analyzed in several ways: Obtaining full erections at some times, such as nocturnal penile tumescence when asleep (when the mind and psychological issues, if any, are less present), tends to suggest that the physical structures are functionally working.[18][19] Other factors leading to erectile dysfunction are diabetes mellitus (causing neuropathy). There are no formal tests to diagnose erectile dysfunction. Some blood tests are generally done to exclude underlying disease, such as hypogonadism and prolactinoma. Impotence is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease such as coronary artery disease and peripheral vascular disease. Therefore, a thorough physical examination is helpful, in particular the simple search for a previously undetected groin hernia since it can affect sexual functions in men and is easily curable.[11] A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection. If never, the problem is likely to be physiological; if sometimes (however rarely), it could be physiological or psychological. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence. Duplex ultrasound Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue. Injecting prostaglandin, a hormone-like stimulator produced in the body, induces the erection. Ultrasound is then used to see vascular dilation and measure penile blood pressure. Penile nerves function Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus. Nocturnal penile tumescence (NPT) It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections. Penile biothesiometry This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis. Dynamic infusion cavernosometry (DICC) technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection. Corpus cavernosometry Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualized by infusing a mixture of saline and x-ray contrast medium and performing a cavernosogram.[20] In Digital Subtraction Angiography (DSA), the images are acquired digitally. Magnetic resonance angiography (MRA) This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a "contrast agent" into the patient's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies.


Treatment This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (November 2013) (Learn how and when to remove this template message) Treatment depends on the cause. Exercise, particularly aerobic exercise during midlife is effective for preventing ED; exercise as a treatment is under investigation.[21]:6, 18–19 For tobacco smokers, cessation results in a significant improvement.[22] Oral pharmacotherapy and vacuum erection devices are first-line treatments,[21]:20, 24 followed by injections of drugs into the penis, and penile implants.[21]:25–26 Medication The PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally.[21]:20–21 A cream combining alprostadil with the permeation enhancer DDAIP has been approved in Canada as a first line treatment for erectile dysfunction.[23] One of the following medications maybe injected into the penis: papaverine, phentolamine, and prostaglandin E1.[21]:25 Pumps Main article: penis pump A vacuum erection device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available with a doctor's prescription. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants may be fitted surgically. Surgery Main article: Penile prosthesis Often, as a last resort if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.[21]:26 Alternative medicine The FDA does not recommend alternative therapies to treat sexual dysfunction.[24] Many products are advertised as "herbal viagra" or "natural" sexual enhancement products, but no clinical trials or scientific studies support the effectiveness of these products for the treatment of erectile dysfunction, and synthetic chemical compounds similar to sildenafil have been found as adulterants in many of these products.[25][26][27][28][29] The United States Food and Drug Administration has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant.[30]


History This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (May 2010) (Learn how and when to remove this template message) An unhappy wife is complaining to the Qadi about her husband's impotence. Ottoman miniature. During the late 16th and 17th centuries in France, male impotence was considered a crime, as well as legal grounds for a divorce. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677.[31] John R. Brinkley initiated a boom in male impotence cures in the U.S. in the 1920s and 1930s. His radio programs recommended expensive goat gland implants and "mercurochrome" injections as the path to restored male virility, including operations by surgeon Serge Voronoff. Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley dropped his trousers and demonstrated to a shocked Urodynamics Society audience his papaverine-induced erection.[32] The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. The effect that Brindley discovered established the fundamentals for the later development of specific, safe, and orally effective drug therapies.[33][better source needed][34][better source needed]


Lexicology The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina; it is now mostly replaced by more precise terms, such as erectile dysfunction (ED). The study of erectile dysfunction within medicine is covered by andrology, a sub-field within urology. Research indicates that erectile dysfunction is common, and it is suggested that approximately 40% of males with erectile dysfunction or impotence, at least occasionally.[35] The condition is also on occasion called phallic impotence.[36] Its antonym or opposite condition is priapism.[37][38]


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A Review with Clinical Reports". Behavioral Sciences. 6 (3): 17. doi:10.3390/bs6030017. PMC 5039517 . PMID 27527226. CS1 maint: Uses authors parameter (link) ^ Rany Shamloul; Anthony J Bella (2014-03-01). Erectile Dysfunction. Biota Publishing. pp. 6–. ISBN 978-1-61504-653-9.  ^ Levine LA, Lenting EL (1995). "Use of nocturnal penile tumescence and rigidity in the evaluation of male erectile dysfunction". Urol. Clin. North Am. 22 (4): 775–88. PMID 7483128.  ^ "Tests for Erection Problems". WebMD, Inc. Retrieved 2007-03-03.  ^ Dawson C, Whitfield H (April 1996). "ABC of urology. Subfertility and male sexual dysfunction". BMJ. 312 (7035): 902–05. doi:10.1136/bmj.312.7035.902. PMC 2350600 . PMID 8611887.  ^ a b c d e f Wespes E (chair), et al. Guidelines on Male Sexual Dysfunction: Erectile dysfunction and premature ejaculation. European Association of Urology 2013 ^ Pourmand G, Alidaee MR, Rasuli S, Maleki A, Mehrsai A (2004). "Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study". BJU Int. 94 (9): 1310–13. doi:10.1111/j.1464-410X.2004.05162.x. PMID 15610111.  ^ Bujdos, Brian. "New Topical Erectile Dysfunction Drug Vitaros Approved in Canada; Approved Topical Drug Testim Proves Helpful for Erectile Dysfunction". Retrieved 15 April 2011.  ^ "Dangers of Sexual Enhancement Supplements".  ^ Gryniewicz CM, Reepmeyer JC, Kauffman JF, Buhse LF (2009). "Detection of undeclared erectile dysfunction drugs and analogues in dietary supplements by ion mobility spectrometry". Journal of pharmaceutical and biomedical analysis. 49 (3): 601–06. doi:10.1016/j.jpba.2008.12.002. PMID 19150190.  ^ Choi DM, Park S, Yoon TH, Jeong HK, Pyo JS, Park J, Kim D, Kwon SW (2008). "Determination of analogs of sildenafil and vardenafil in foods by column liquid chromatography with a photodiode array detector, mass spectrometry, and nuclear magnetic resonance spectrometry". 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Norton & Co. pp. 149–52. ISBN 9780393334791.  ^ Klotz L (Nov 2005). "How (not) to communicate new scientific information: a memoir of the famous Brindley lecture". BJU Int. 96 (7): 956–57. doi:10.1111/j.1464-410X.2005.05797.x. PMID 16225508.  ^ Brindley GS (October 1983). "Cavernosal alpha-blockade: a new technique for investigating and treating erectile impotence". Br J Psychiatry. 143 (4): 332–37. doi:10.1192/bjp.143.4.332. PMID 6626852.  ^ Helgason AR, Adolfsson J, Dickman P, Arver S, Fredrikson M, Göthberg M, Steineck G (1996). "Sexual desire, erection, orgasm and ejaculatory functions and their importance to elderly Swedish men: a population-based study". Age Ageing. 25 (4): 285–91. doi:10.1093/ageing/25.4.285. PMID 8831873.  ^ Schouten BW, Bohnen AM, Groeneveld FP, Dohle GR, Thomas S, Bosch JL (July 2010). "Erectile dysfunction in the community: trends over time in incidence, prevalence, GP consultation and medication use – the Krimpen study: trends in ED". 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External links Classification V · T · D ICD-10: F52.2, N48.4 ICD-9-CM: 302.72, 607.84 MeSH: D007172 DiseasesDB: 21555 External resources eMedicine: med/3023 Patient UK: Erectile dysfunction Erectile dysfunction at Curlie (based on DMOZ) v t e Mental and behavioral disorders (F00–F99 & 290–319) Neurological/symptomatic Dementia Mild cognitive impairment Alzheimer's disease Vascular dementia Pick's disease Creutzfeldt–Jakob disease Huntington's disease Parkinson's disease AIDS dementia complex Frontotemporal dementia Sundowning Wandering Autism spectrum Autism Asperger syndrome Savant syndrome PDD-NOS High-functioning autism Other Delirium Post-concussion syndrome Organic brain syndrome Psychoactive substances, substance abuse, drug abuse and substance-related disorders Intoxication/Drug overdose Physical dependence Substance dependence Rebound effect Double rebound Withdrawal Stimulant psychosis Schizophrenia, schizotypal and delusional Psychosis and schizophrenia-like disorders Schizoaffective disorder Schizophreniform disorder Brief reactive psychosis Schizophrenia Disorganized (hebephrenic) schizophrenia Paranoid schizophrenia Simple-type schizophrenia Childhood schizophrenia Pseudoneurotic schizophrenia Delusional disorders Delusional disorder Folie à deux Mood (affective) Mania Bipolar disorder (Bipolar I Bipolar II Cyclothymia Bipolar NOS) Depression (Major depressive disorder Dysthymia Seasonal affective disorder Atypical depression Melancholic depression) Neurotic, stress-related and somatoform Anxiety disorder Phobia Agoraphobia Social anxiety Social phobia (Anthropophobia) Specific phobia (Claustrophobia) Specific social phobia Other Panic disorder Panic attack Generalized anxiety disorder OCD stress (Acute stress reaction PTSD) Adjustment disorder Adjustment disorder with depressed mood Somatic symptom disorder Somatization disorder Body dysmorphic disorder Hypochondriasis Nosophobia Da Costa's syndrome Psychalgia Conversion disorder (Ganser syndrome Globus pharyngis) Neurasthenia Mass psychogenic illness Dissociative disorder Dissociative identity disorder Psychogenic amnesia Fugue state Depersonalization disorder Physiological/physical behavioral Eating disorder Anorexia nervosa Bulimia nervosa Rumination syndrome NOS Nonorganic sleep disorders (Nonorganic hypersomnia Nonorganic insomnia) Parasomnia (REM sleep behavior disorder Night terror Nightmare) Sexual dysfunction sexual desire (Hypoactive sexual desire disorder Hypersexuality) sexual arousal (Female sexual arousal disorder) Erectile dysfunction orgasm (Anorgasmia Delayed ejaculation Premature ejaculation Sexual anhedonia) pain (Vaginismus Dyspareunia) Postnatal Postpartum depression Postpartum psychosis Adult personality and behavior Gender dysphoria Sexual maturation disorder Ego-dystonic sexual orientation Sexual relationship disorder Paraphilia (Voyeurism Fetishism) Other Personality disorder Impulse control disorder (Kleptomania Trichotillomania Pyromania Dermatillomania) Factitious disorder (Munchausen syndrome) Disorders typically diagnosed in childhood Intellectual disability X-linked intellectual disability (Lujan–Fryns syndrome) Psychological development (developmental disabilities) Specific Pervasive Emotional and behavioral ADHD Conduct disorder (ODD) Emotional/behavioral disorder (Separation anxiety disorder) social functioning (Selective mutism RAD DAD) Tic disorder (Tourette syndrome) Speech (Stuttering Cluttering) Movement disorders (Stereotypic) Symptoms and uncategorized Catatonia False pregnancy Intermittent explosive disorder Psychomotor agitation Stereotypy Psychogenic non-epileptic seizures Klüver–Bucy syndrome v t e Male diseases of the pelvis and genitals (N40–N51, 600–608) Internal Testicular Orchitis Hydrocele testis Testicular cancer Testicular torsion Male infertility Aspermia Asthenozoospermia Azoospermia Hyperspermia Hypospermia Oligospermia Necrospermia Teratospermia Epididymis Epididymitis Spermatocele Hematocele Prostate Prostatitis Acute prostatitis Chronic bacterial prostatitis Chronic prostatitis/chronic pelvic pain syndrome Asymptomatic inflammatory prostatitis Benign prostatic hyperplasia Prostate cancer Seminal vesicle Seminal vesiculitis External Penis Balanoposthitis/Balanitis (Balanitis plasmacellularis Pseudoepitheliomatous keratotic and micaceous balanitis) Phimosis Paraphimosis Priapism Sexual dysfunction Erectile dysfunction Peyronie's disease Penile cancer Penile fracture Balanitis xerotica obliterans Other Hematospermia Retrograde ejaculation Postorgasmic illness syndrome v t e Human sexuality and sexology Sexual relationship phenomena Asexuality Gray asexuality Bisexuality Casual relationship Casual sex Celibacy Celibacy syndrome Committed relationship Free love Foreplay Herbivore men Heterosexuality Homosexuality Hypersexuality Marriage One-night stand Polyamory Promiscuity Female Romantic love Romantic orientation Flirting Sex life Sexual abstinence Sexual partner Single person Swinging Sexual dynamics Hypergamy Intersex Physical attractiveness Sexual attraction Sexual ethics See also Sexual addiction Sex Addicts Anonymous Sexual surrogate Retrieved from "https://en.wikipedia.org/w/index.php?title=Erectile_dysfunction&oldid=818868428" Categories: Behavioural syndromes associated with physiological disturbances and physical factorsNon-sexualityPenis disordersSexual disordersPsychiatric diagnosisPenile erectionMen's healthHidden categories: All articles with dead external linksArticles with dead external links from December 2016Articles with permanently dead external linksCS1 maint: Uses authors parameterWikipedia indefinitely semi-protected pagesWikipedia indefinitely move-protected pagesInfobox medical condition (new)All articles with unsourced statementsArticles with unsourced statements from February 2017Articles needing additional references from May 2010All articles needing additional referencesArticles needing additional references from 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