Erectile dysfunction is treatable or not
In some cases the penis becomes partly erect but not hard enough to have sex properly. In other cases, there is no swelling or fullness of the penis at all. Both can have a significant effect on your sex life. ED is sometimes called impotence.VIDEO ON THE TOPIC: Erectile Dysfunction 101 - #UCLAMDChat Webinars
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- Is there a cure for erectile dysfunction?
- What is Erectile Dysfunction?
- Impotence (Erectile Dysfunction)
- Journal logo
- Erectile Dysfunction
- The treatment of erectile dysfunction in patients with neurogenic disease
- Treatment for Erectile Dysfunction
- Coronavirus (COVID-19)
- Is erectile dysfunction (ED) treatable?
Is there a cure for erectile dysfunction?
Erectile dysfunction ED related to compromise of the nervous system is an increasingly common occurrence. This may be due to the multifactorial nature of ED, the myriad of disorders affecting the neurotransmission of erectogenic signals, and improved awareness and diagnosis of ED. Nevertheless, neurogenic ED remains poorly understood and characterized.
Disease related factors such as depression, decreased physical and mental function, the burden of chronic illness, and loss of independence may preclude sexual intimacy and lead to ED as well. The amount of data regarding treatment options in subpopulations of differing neurologic disorders remains scarce except for men with spinal cord injury.
The treatment options including phosphodiesterase inhibitors, intracavernosal or intraurethral vasoactive agents, vacuum erection devices VED and penile prosthetic implantation remain constant.
This review discusses the options in specific neurologic conditions, and briefly provides insight into new and future developments that may reshape the management of neurogenic ED. Neurogenic erectile dysfunction NED is a traditional classification of erectile dysfunction ED encompassing disorders impairing erections via neurologic compromise or dysfunction. The disorders compromising erections may act centrally, peripherally or both.
However, several classically defined neurogenic processes may affect several components of the normal pathway to achieve erection e. Each disease state has its own unique characteristics that require acknowledgement to fully understand their effect on ED.
Much of the emphasis on erectile pathophysiology has been placed on penile smooth muscle function and cavernosal hemodynamics. The neuroanatomy and neurophysiology of erection can be characterized but its full extent is poorly understood. Neurologic disease does not always reproducibly affect erections in a uniform manner compared to other types of sexual dysfunction SD.
This offers many obstacles to understanding the role the nervous systems plays in SD and consequently obscures what treatment options readily optimize erections specific to the neurologic insult. Treatment strategies for ED usually target the corporal smooth muscle to augment its relaxation or replace its function via prosthesis implantation. Nevertheless, to treat ED related to a neurologic disorder, assessments of function and disease related factors are recommended, as ED in these men is often multifactorial in origin.
A comprehensive understanding of the neural pathways for erection is necessary for assessing whether neurogenic ED exists and how to appropriately address the ED. As stated previously, neurologic disease may affect multiple neural pathways leading to ED, sensation deficits and ejaculatory dysfunction. Nerves originating in the spinal cord and peripheral ganglia innervate the penis. There are autonomic parasympathetic and sympathetic , and somatic separate and integrated pathways. The autonomic pathways neurons originate in the spinal cord and peripheral ganglia from the sympathetic and parasympathetic systems, respectively.
They merge to form the cavernous nerves that travel alongside the prostate, enter the corpora cavernosa and corpus spongiosum to affect the neurovascular events required for tumescence and detumescence. The somatic nerves send sensory information from the penile skin, glans, and urethra via the dorsal penile nerve and pudendal nerve to the spinal cord.
The somatic nerves also initiate contraction of the ischio- and bulbocavernosus muscles. The sympathetic pathway originates from the 11 th thoracic to the 2 nd lumbar spinal segments and goes via the white rami to enter the sympathetic chain ganglia. Subsequently nerves travel through the lumbar splanchnic to inferior mesenteric and superior hypogastric nerves to the pelvic plexus.
The T10 through T12 segments are most often the origin of sympathetic fibers, and the sympathetic chain ganglia that innervate the penis are located in the sacral and caudal ganglia 3. Parasympathetic pathways originate from the intermediolateral cell columns of the 2 nd , 3 rd and 4 th sacral spinal cord segments.
Preganglionic fibers pass through the pelvic plexus where they coalesce with sympathetic fibers from the superior hypogastric plexus. The cavernous nerves that innervate the penis arise from the portion of the pelvic plexus. The pelvic plexus also contains nerves that innervate the rectum, bladder and urinary sphincter and the nerve projections can be damaged during radical excision of the bladder, prostate and rectum, leading to iatrogenic ED 4. Induction of erection occurs after stimulation of the cavernous and pelvic nerve plexus.
Conversely, stimulation of the sympathetic trunk leads to detumescence. The reflex erectile response requires that the sacral reflex arc remain intact. Tactile and sensory signals are received by the somatic sensory pathways and integrate with parasympathetic nuclei within the sacral spinal cord S leading to induction of erection via cholinergic signaling. These reflexogenic erections remain intact with upper motor neuron injuries.
Psychogenic erections do not require that the sacral reflex arc remain intact. Psychogenic erections occur via induction of central pathways traveling from the brain through the sympathetic chain. Non-penile sensory pathways induced by sight, sound, touch and smell travel through the MPOA to the erection centers within the cord TL2, and S2-S4 to induce erections 7. When a sacral lower motor neuron injury is present in men, below T12 these types of erections are more likely to occur 8.
Spinal cord lesions above T9 are not associated with psychogenic erections 9. Rigidity of erections is less with psychogenic erections because the thoracolumbar sympathetic outflow may contain a decreased concentration of neurons compared to the parasympathetic outflow from the sacral spinal cord. The somatosensory pathways for erections originate in the penile skin, glans and urethra.
The nerve endings coalesce to form the dorsal penile nerve along with other sensory nerve fibers. Through the pudendal nerve they enter the S nerve roots to terminate on spinal neurons and interneurons. The dorsal nerve is not purely somatic, however. Nerve bundles within the dorsal nerve contain nitric oxide NO synthase, found typically in autonomic nerves, and stimulation of the sympathetic chain can leak to evoked potentials from the dorsal nerve and vice versa 10 - These nerves travel to the ischiocavernosus and bulbocavernosus muscles when activated lead to contraction necessary for the rigid-erection phase.
Several animal studies show that stimulation of the somatomotor pathways may also be under sympathetic control, and adrenergic stimulation may lead to contraction of these muscles during ejaculation 13 , Somatomotor spinal reflexes may also be initiated by genital stimulation. For instance, the well-known bulbocavernosus reflex is evidence this reflex exists; however the clinical significance of its absence in the neurological assessment of ED has not been substantiated Erections are initiated and maintained via integration of afferent inputs in the supra sacral regions of the central nervous system.
Regions of the brain cited to have key roles in the integration of signals include the medial amygdala, MPOA, periaqueductal gray matter, paraventricular nucleus PVN , and ventral tegmentum among others Studies in animal models, particularly in rats, have been paramount in identifying these key areas of signal integration and control. Marson et al. Stimulation of the rat dorsal nerve led to increased firing in the MPOA not found elsewhere Axonal tracing in animals have shows direct projections from the hypothalamus to the lumbosacral autonomic erection centers.
Oxytocin and vasopressin have been identified as central neurotransmitters within the hypothalamic nuclei and may have a role in penile erection The supraspinal pathways are likely activated via central neural activation during sexual arousal. Positron emission tomorgraphy PET , and functional magnetic resonance imaging fMRI have led to a greater understanding to which center are activated during arousal.
These imaging studies measure increases in cerebral blood flow or changes in cerebral activity on a real-time basis. Studies are performed when male subject are aroused by visual cues usually sexual explicit photos or videos and compared to images obtained during exposure to sexually neutral cues differences can be measured.
Several studies have identified that the inferior frontal lobes, inferior temporal lobes and insular gyrus, and occipital lobes are involved with processing arousal cues, although each are likely to process different stimuli 20 - Different degrees of ED may occur depending on the spinal cord level of injury LOI , extent of lesion and timing from injury.
Reflexogenic erections can occur with lesions above L3 or L4 when the erectile spinal reflex arc remains intact.
Psychogenic erections can occur with low lesions in the sacral and lumbar spinal cord but may not occur in complete lesions above T9 that can damage sympathetic outflow. Additionally, reflexogenic erections are not likely to occur in the spinal shock period that occurs after the initial cord trauma. Conversely, their occurrence may signal that the period of shock is over A CVA can occur anywhere through the brain, midbrain, brainstem and spinal cord leading to varying degrees of SD depending on location.
Right hemispheric infarcts seem to affect erections more so than left-sided ones. The exact effects of CVA on sexual function are complex and multifactorial, as disability, psychological and emotional status can affect sexual function aside from the location of the CVA.
The cause of ED is likely multifactorial, with neurologic, endocrine, iatrogenic, psychiatric and psychosocial factors leading to varying degrees of ED ED can occur in periods surrounding active seizures ictal or in the periods unrelated to seizure activity post-ictal as well Men with MS and ED may continue to have nocturnal erections, and psychogenic erections; however, this does not mean they have psychogenic ED but could be an indicator that MS involves the spinal cord SD in MS can be classified into three categories.
Primary SD is due directly due to MS-related neurological deficits, secondary SD is related to physical impairments and symptoms or drugs used for MS treatment, and tertiary SD is due to the psychological, social and cultural problems attributed to MS These classifications are important, and underscore the importance of addressing all the issues leading to SD not just the neurologic impairment. Ejaculatory and orgasmic function are also impaired.
PD affects the dopaminergic pathways leading to erection and arousal. Dopaminergic therapy for PD can improve ED, and sometimes therapy may lead to hypersexuality 43 , A comparison of married men with PD to age matched controls with non-neurologic chronic disease such as arthritis did not show any discrepancy in ED rates This suggests that ED in certain groups with PD may occur from disease related factors common in chronic illness, in general. ED occurs in the majority of patients and the exact cause of it is unknown Orthostatic hypotension OH as a causal factor has been refuted by evidence that sildenafil can overcome reduced filling pressures, and the ED usually precedes the development of OH 46 , 49 , Similar to other neurologic disorders that lead to ED, other disease related factors such as psychosocial stress, the burden of chronic illness, changed appearance, fatigue, decreased fine motor movement of fingers, immobility and diminished self-esteem due to loss of independence may contribute as well With appropriate medical and surgical therapy, men with SB have increased life expectancy into adulthood where sexual function becomes an important part of life The level of the neurologic lesions usually corresponds to sensation and penile sensation indicates pudendal nerve signaling.
With absent sacral reflexes ED is variable. Furthermore, Diamond et al. It has also been suggested that ED may be underreported due to lack of sexual education even in men without associated cognitive impairment ED may also occur for damage to the peripheral nerves from pelvic and prostate surgery, as well as diabetes mellitus. These topics are quite broad, deserve their own discussion and are out of the scope of this review. Sildenafil, the first oral PDE5i, was introduced in and has revolutionized ED therapy due to its broad applicability, effectiveness and safety profile.
Oral therapies via the PDE5i sildenafil, vardenafil, and tadalafil have been proven to be generally safe and effective in select NED populations. The majority of the treatment effectiveness data has been generated in the SCI population. Furthermore, the ED that exists in the population with neurologic disorders is often multifactorial and may be caused by psychogenic, psychosocial, hormonal, medication-related and disability-related factors.
A careful evaluation of each patient must be performed to isolate these factors prior to initiating vasoactive therapy. Three of the four PDE5i currently available in the U.
What is Erectile Dysfunction?
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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs. Is erectile dysfunction ED treatable? School of Medicine, Family Medicine.
Impotence (Erectile Dysfunction)
COVID is an emerging, rapidly evolving situation. Get the latest public health information from CDC: www. You can work with a health care professional to treat an underlying cause of your erectile dysfunction ED. Choosing an ED treatment is a personal decision. However, you also may benefit from talking with your partner about which treatment is best for you as a couple. Your health care professional may suggest that you make lifestyle changes to help reduce or improve ED. You can.
Impotence means that a man's penis doesn't get hard enough to have sexual intercourse. The man cannot get or maintain an erection. The medical term is erectile dysfunction ED. A man with impotence has either a problem getting an erection or difficulty maintaining one.
Depending on the cause, erectile dysfunction ED may be curable, but the condition is almost always treatable for most men. The first step is to visit your doctor, because several health conditions -- and the medications that treat them -- can cause ED. For example, cardiovascular heart and blood vessel disease causes arteries to narrow, which decreases blood flow to the penis and can cause trouble getting or maintaining an erection. And diabetes can cause damage to both nerves and blood vessels that can lead to ED.
Erectile dysfunction is a common, treatable medical problem that affects millions of men in the United States. Erectile dysfunction is present in 1 of 2 men older than 40 years. Other types of male sexual dysfunction can include problems with libido sexual interest , orgasm, or ejaculation. Erectile dysfunction has many possible causes and can be the first symptom of an undiagnosed condition.
Erectile dysfunction is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance. The Massachusetts Male Aging Study surveyed 1, men aged 40—70 years between and and found there was a total prevalence of erectile dysfunction of 52 percent. It was estimated that, in , over million men worldwide experienced ED. For , the prevalence of ED is predicted to be approximately million worldwide. In the past, erectile dysfunction was commonly believed to be caused by psychological problems. It is now known that, for most men, erectile dysfunction is caused by physical problems, usually related to the blood supply of the penis.
The treatment of erectile dysfunction in patients with neurogenic disease
Erectile dysfunction ED related to compromise of the nervous system is an increasingly common occurrence. This may be due to the multifactorial nature of ED, the myriad of disorders affecting the neurotransmission of erectogenic signals, and improved awareness and diagnosis of ED. Nevertheless, neurogenic ED remains poorly understood and characterized. Disease related factors such as depression, decreased physical and mental function, the burden of chronic illness, and loss of independence may preclude sexual intimacy and lead to ED as well. The amount of data regarding treatment options in subpopulations of differing neurologic disorders remains scarce except for men with spinal cord injury. The treatment options including phosphodiesterase inhibitors, intracavernosal or intraurethral vasoactive agents, vacuum erection devices VED and penile prosthetic implantation remain constant.
For many people, a physical exam and answering questions medical history are all that's needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist. This test is usually performed by a specialist in an office.
Treatment for Erectile Dysfunction
Хейл невинно улыбнулся: - Просто хотел убедиться, что ноги меня еще носят. - Понимаю. - Стратмор хмыкнул, раздумывая, как поступить, потом, по-видимому, также решил не раскачивать лодку и произнес: - Мисс Флетчер, можно поговорить с вами минутку. За дверью.
В боковое зеркало заднего вида он увидел, как такси выехало на темное шоссе в сотне метров позади него и сразу же стало сокращать дистанцию. Беккер смотрел прямо перед. Вдалеке, метрах в пятистах, на фоне ночного неба возникли силуэты самолетных ангаров.
Он подумал, успеет ли такси догнать его на таком расстоянии, и вспомнил, что Сьюзан решала такие задачки в две секунды.
Беккер беззвучно выругался и повесил трубку.
А что, - спросила она, не отрываясь от монитора, - нам с Кармен нужно укромное местечко. Бринкерхофф выдавил из себя нечто невразумительное. Мидж нажала несколько клавиш. - Я просматриваю регистратор лифта Стратмора.
Is erectile dysfunction (ED) treatable?
Это означало, что тот находится на рабочем месте. Несмотря на субботу, в этом не было ничего необычного; Стратмор, который просил шифровальщиков отдыхать по субботам, сам работал, кажется, 365 дней в году. В одном Чатрукьян был абсолютно уверен: если шеф узнает, что в лаборатории систем безопасности никого нет, это будет стоить молодому сотруднику места. Чатрукьян посмотрел на телефонный аппарат и подумал, не позвонить ли этому парню: в лаборатории действовало неписаное правило, по которому сотрудники должны прикрывать друг друга.
В шифровалке они считались людьми второго сорта и не очень-то ладили с местной элитой. Ни для кого не было секретом, что всем в этом многомиллиардном курятнике управляли шифровальщики.
Сотрудников же лаборатории безопасности им приходилось терпеть, потому что те обеспечивали бесперебойную работу их игрушек.
Он почувствовал, как этот удар передался на руль, и плотнее прижался к мотоциклу. Боже всевышний. Похоже, мне не уйти. Асфальт впереди становился светлее и ярче.