Erectile Dysfunction (ED)
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Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex. Having erection trouble from time to time isn't necessarily a cause for concern. But if erectile dysfunction is an ongoing problem, it may cause stress, cause relationship problems or affect your self-confidence.
An erection occurs as a hydraulic effect due to blood entering and being retained in sponge-like bodies within the penis. The process is most often initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis. Erectile dysfunction is indicated when an erection is consistently difficult or impossible to produce, despite arousal. There are various and often multiple underlying causes, some of which are treatable medical conditions. The most important organic causes are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects. It is important to realize that erectile dysfunction can signal underlying risk for cardiovascular disease.
There is often a contributing and complicating and sometimes a primary psychological or relational problem. Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this can often be helped. Notably in psychological impotence, there is a strong response to placebo treatment. Erectile dysfunction, tied closely as it is to cultural notions of potency, success and masculinity, can have severe psychological consequences. There is a strong culture of silence and inability to discuss the matter.  In reality, it has been estimated that around 1 in 10 men will experience recurring impotence problems at some point in their lives.
Penile erection is managed by two different mechanisms. The first one is the reflex erection, which is achieved by directly touching the penile shaft. The second is 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 conditions, an intact neural system is required for a successful and complete erection.
Stimulation of 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. 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.
Medicines that are commonly use are Viagra, Levitra and Cialis. They work by blocking the action of PDE5, which causes cGMP to degrade. CGMP specific phosphodiesterase type 5 causes the smooth muscle of the arteries in the penis to relax, allowing the corpus cavernosum to fill with blood.
Viagra and Cialis are well known due to the constant marketing. They do not increase nitric oxide but rather work by blocking the enzyme that that breaks it down. This is a typical (can be patented) method used by pharmaceutical companies. While this approach often works, it has side effects and does not address the underlying problem.
Natural therapies are available over the counter and work by directly increasing nitric oxide (NO). These approaches have the added benefit of supporting and improving many body functions with little or no side effectsFor many years and for many patients, the first sign of cardiovascular disease was the manifestation of a heart attack. Symptoms included shortness of breath, heavy chest, pain in the chest or jaw, or radiating pain or numbness in the arm. The heart attack and subsequent symptoms indicated patients had developed overt coronary artery disease. At this stage of the disease, most preventative measures prove ineffective. This concerning reality directed scientific research to find subtle cardiovascular warning signs that could be recognized sooner, enabling corrective measures and even reversal of the disease. Cardiovascular medicine may have found its answer in erectile dysfunction (ED). We now know that sexual dysfunction is actually the first sign of insufficient NO production that sets the stage for the progression of heart disease.
Under normal healthy conditions, when stimulated for sexual activity, NO is produced in the penis that signals the blood vessels in the corpus cavernosum to dilate and accommodate more blood flow. It is engorgement from blood flow that causes and sustains an erection. Without sufficient NO production, there is poor circulation, thus no erection or a poor erection that is unsustainable.
The same holds true for women. Without proper blood flow to the clitoris, women cannot have orgasms or enhanced sexual sensitivity. In fact, this is the signaling pathway affected by phosphodiesterase inhibitors (PD5) such as Viagra® and Cialis®. They work to prevent the degradation of the signal that NO turns on. However without NO, Viagra and Cialis will not work and that is the reason it is not effective in 100 percent of the population. Initially, these drugs were being developed for heart disease before it was realized that they worked in such a sexual way. However, this makes sense, since both are a result of endothelial dysfunction.
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