Can You Cure Erectile Dysfunction?

Hypogonadism that results in low testosterone levels adversely affects libido and erectile function. Hypothyroidism is a very rare cause of ED. Peyronie disease may result in fibrosis and curvature of the penis. Men with severe Peyronie disease may have enough scar tissue in the corpora to impede blood flow. Mental health disorders, particularly depression, are likely to affect sexual performance.

• Oral medications like sildenafil, tadalafil, and vardenafil are common treatments for erectile dysfunction.
• Lifestyle changes such as exercise, weight loss, and quitting smoking can improve erectile function.
• Psychotherapy may help address psychological causes like anxiety, depression, or relationship issues.
• Vacuum erection devices use suction to draw blood into the penis, helping achieve an erection.
• Penile injections involve injecting vasodilators directly into the penis for an immediate effect.
• Hormone therapy may be prescribed if low testosterone levels are contributing to ED.
• Surgical options include penile implants or vascular surgery to restore blood flow.

The MMAS data indicate an odds ratio of 1.82 for men with depression. Other associated factors, both cognitive and behavioral, may contribute.

• Psychological causes in youth
• Performance anxiety in teens
• Lifestyle factors for young men
• Medication side effects (e.g., antidepressants)
• Pornography-induced ED
• Normalizing sexual development
• Counseling for young adults
• Addressing body image issues
• School and career stress
• Healthy relationship building
• Avoiding premature medicalization

In addition, ED alone can induce depression.

Cosgrove et al reported a higher rate of sexual dysfunction in veterans with posttraumatic stress disorder (PTSD) than in veterans who did not develop this problem.

Can Vacuum Devices Help With Erectile Dysfunction?

Various diseases may produce changes in the smooth muscle tissue of the corpora cavernosa or influence the patient’s psychological mood and behavior. Diseases and Conditions Associated With Erectile Dysfunction (Open Table in a new window) Conditions associated with reduced nerve and endothelium function (eg, aging, hypertension, smoking, hypercholesterolemia, and diabetes) alter the balance between contraction and relaxation factors (see Pathophysiology). These conditions cause circulatory and structural changes in penile tissues, resulting in arterial insufficiency and defective smooth muscle relaxation. In some patients, sexual dysfunction may be the presenting symptom of these disorders. Given the multiplicity of possible etiologic factors, it may be difficult to determine fildena purple pill how much any given factor is contributing to the problem.

ALTERNATIVE THERAPIES

A thorough evaluation is necessary for correct identification of the specific cause or causes in any given individual. Vascular diseases account for nearly 50% of all cases of ED in men older than 50 years. These diseases include atherosclerosis, peripheral vascular disease, myocardial infarction (MI), and arterial hypertension. Vascular damage may result from radiation therapy to the pelvis and prostate in the treatment of prostate cancer. [39] Both the blood vessels and the nerves to the penis may be affected.

Table 2. Medications and Substances That May Cause or Contribute to Erectile Dysfunction

Radiation damage to the crura of the penis, which are highly susceptible to radiation damage, can induce ED. Data indicate that 50% of men undergoing radiation therapy lose erectile function within 5 years after completing therapy; fortunately, some respond to one of the PDE5 inhibitors. Trauma to the pelvic blood vessels or nerves can also lead result in ED. Bicycle riding for long periods has been implicated as an etiologic factor; direct compression of the perineum by the bicycle seat may cause vascular and nerve injury. [40] On the other hand, bicycling for less than 3 hours per week may be somewhat protective against ED. [45] The domains on the International Index of Erectile Function (IIEF) questionnaire that demonstrated the most change included overall sexual satisfaction and erectile function. [46, 47] Men with PTSD should be evaluated and treated if they have sexual dysfunction.

Prostate surgery for benign prostatic hyperplasia has been documented to be associated with ED in 10-20% of men. This association is thought to be related to nerve damage from cauterization.

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Newer procedures (eg, microwave, laser, or radiofrequency ablation) have rarely been associated with ED. Radical prostatectomy for the treatment of prostate cancer poses a significant risk of ED.

A number of factors are associated with the chance of preserving erectile function. If both nerves that course on the lateral edges of the prostate can be saved, the chance of maintaining erectile function is reasonable.

Treatment Options for Erectile Dysfunction

Although these 2 processes certainly overlap in some instances, they are distinct entities. Some 2-21% of men have both hypogonadism and ED; however, it is unclear to what degree treating the former will improve erectile function. [19] About 35-40% of men with low testosterone see an improvement in their erections with testosterone replacement; however, almost 65% of these men see no improvement. One study examined the role of testosterone supplementation in hypogonadal men with ED. These men were considered nonresponders to sildenafil, and their erections were monitored by assessing nocturnal penile tumescence (NPT).

ED Injections

After these men were given testosterone transdermally for 6 months, the number of NPTs increased, as did the maximum rigidity with sildenafil. [20] This study suggests that a certain level of testosterone may be necessary for PDE5 inhibitors to function properly. In a randomized double-blind, parallel, placebo-controlled trial, sildenafil plus testosterone was not superior to sildenafil plus placebo in improving erectile function in men with ED and low testosterone levels. [21] The objective of the study was to determine whether the addition of testosterone to sildenafil therapy improves erectile response in men with ED and low testosterone levels. However, in contrast, a recent systematic review of published studies, the authors concluded that overall, the addition of testosterone to PDE-5 inhibitors might benefit patients with ED associated with testosterone levels of less than 300 ng/dL (10.4 nmol/L) who failed monotherapy.

ED Vacuum Devices

[22] A limitation of existing studies are their heterogeneous nature and methodological drawbacks. The mechanisms by which testosterone plays a role in erectile function are not completely understood. A study evaluating the effect of testosterone on erections in surgically castrated rabbits and control animals, in which the rabbits’ intracavernosal pressures were compared after cavernosal nerve stimulation, determined that castrated rabbits had much lower pressures after stimulation than control rabbits did. [23] Notably, the pressures increased when castrated rabbits received exogenous testosterone replacement. Another study compared the response of surgically and medically castrated rabbits to vardenafil with that of control rabbits. The odds depend on the age of the patient.

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[40] Some of the newer bicycle seats have been designed to diminish pressure on the perineum. Diabetes is a well-recognized risk factor for ED. A systematic review and meta-analysis found that the prevalence of ED was 37.5% in type 1 diabetes, 66.3% in type 2 diabetes, and 52.5% in diabetes overall—a rate approximately 3.5 times higher than that in controls. [42] The etiology of ED in diabetic men probably involves both vascular and neurogenic mechanisms. Evidence indicates that establishing good glycemic control can minimize this risk.

Lifestyle changes

The Massachusetts Male Aging Study (MMAS) documented an inverse correlation between ED risk and high-density lipoprotein (HDL) cholesterol levels but did not identify any effect from elevated total cholesterol levels. [17] Another study involving male subjects aged 45-54 years found a correlation with abnormal HDL cholesterol levels but also found a correlation with elevated total cholesterol levels. The MMAS included a preponderance of older men. Men with sleep disorders commonly experience ED. [43] Heruti et al recommended that in adult male patients, ED should be considered when a sleep disorder—especially sleep apnea syndrome—is suspected, and vice versa. Men younger than 60 years have a 75-80% chance of preserving potency, but men older than 70 years have only a 10-15% chance.

• Age-related ED factors
• Testosterone decline with age
• Vascular changes in aging
• Neurological changes over time
• Managing expectations with age
• Treatment options for older men
• Safety of meds in elderly
• Adjusting dosages for age
• Lifestyle adjustments for seniors
• Quality of life improvements
• Acceptance and adaptation

The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) study, designed to determine whether an individual man’s sexual outcomes after most common treatments for early-stage prostate cancer could be accurately predicted on the basis of baseline characteristics and treatment plans, found that 2 years after treatment, 177 (35%) of 511 men who underwent prostatectomy reported the ability to attain functional erections suitable for intercourse.

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[24] Castrated rabbits did not respond to vardenafil, whereas noncastrated rabbits did respond appropriately. This result suggests that a minimum amount of testosterone is necessary for PDE5 inhibitors to produce an erection. Another study found that castrated rats had erections if given testosterone alone or dihydrotestosterone (DHT) and 5-alpha reductase inhibitors but not if given testosterone and 5-alpha reductase inhibitors. [25] This finding suggests that DHT is the active component and is necessary at a certain level for rats to have an erection. This study also measured intracavernosal pressure to monitor erections and NOS activity in the penile cytosol.

Viagra (Sildenafil)

[25] NO levels correlated with intracavernosal pressure, which suggests that testosterone and DHT act through NOS. Testosterone and DHT may act at the genomic level to stimulate production of NOS. It appears that testosterone has NOS-independent pathways as well. In one study, castrated rats were implanted with testosterone pellets and then divided into a group that received an NOS inhibitor (L-nitro-L-arginine methyl ester [L-NAME]) and a control group that received no enzyme. [26] The castrated rats that were given testosterone pellets and L-NAME still had partial erections, a result suggesting the presence of a pathway independent of NOS activity.

Psychological Causes:

Organic, physiologic, endocrine, and psychogenic factors are involved in the ability to obtain and maintain erections. In general, ED is divided into 2 broad categories, organic and psychogenic. Although most ED was once attributed to psychological factors, pure psychogenic ED is in fact uncommon; however, many men with organic etiologies may also have an associated psychogenic component. Conditions that may be associated with ED include diabetes, [27, 28, 29] hypertension, [30] , atrial fibrillation, [31] and CAD, as well as neurologic disorders, endocrinopathies, benign prostatic hyperplasia, [32] , sleep apnea [33] , chronic obstructive pulmonary disease (COPD), [34] and depression (see Table 1 below). [35, 36, 37, 38] In fact, almost any disease may affect erectile function by altering the nervous, vascular, or hormonal systems. In comparison, 37% of men who had received external radiotherapy as their primary therapy reported the ability to attain functional erections suitable for intercourse, along with 43% of men who had received brachytherapy as primary treatment.