Erectile Dysfunction - Dissertation Example

 Erectile Dysfunction Introduction This paper presents a critique of how erectile dysfunction (ED) is treated. It also compares pharmacological versus surgical treatment. To begin with is an explanation of what erectile dysfunction is and how it occurs. It is a condition that many people refer to as impotence in men, which is characterized by the inability to uphold an erection that is required for sexual intercourse. It is not necessarily the lack of sexual desire or inconsistent ejaculation. Rather, it is a condition that on its own can lower the desire for sex. The severity of the condition is different among different people. Some may not be in a capacity to have an erection while in other men it occurs from time to time. There are also other men who have erections that are sustained for a short while such that they can not undertake a satisfactory sexual activity. The problem may affect men at all ages although the aged are affected to a greater extent. Studies indicate that the onset age for the elderly is around 45 years and the number of victims increases at the age of 70 years. Generally, it has been found to vary from moderate to harsh as age increases (McAllister et al. 2003). Many causes of ED are known, and some may combine to generate a severe condition. Diabetes is one of the known causes, although not all diabetic men suffer from the problem. High blood pressure and diseases of the arteries such as atherosclerosis may also cause the problem. Discomfort due to stress and related conditions as well as drug and substance use, obesity and smoking are among the risk factors. The same case applies to medications for reducing stress as well as pain relievers. Exhaustion may also affect the ability to have an erection although it might not last for long. Brain and spinal injury and stroke are among the permanent causes of ED. Severe injury to the penis or prostrate surgery may also cause a permanent condition of ED (Steggall et al. 2005). In many victims of erectile dysfunction, the problem is suppressed due to trauma that may result from the societal attitudes as regards the inability to be sexually active. It is usually an awkward situation that not many would reveal to the doctor; hence a good number of men remain undiagnosed. It is a condition that determines the stability of marriages especially during the age when spouses are expected to be sexually active. The most severe cases may lead to impotence and therefore it is important for research to be undertaken to determine the appropriate treatment for the malfunction. On the other hand, the known pharmacological and surgical treatments have strengths and weaknesses. Comparing them is important to determine the method that is better in terms of efficiency, cost effectiveness and side effects among other important aspects (Fillingham and Balliere, 2004). Treatment of Erectile Dysfunction The treatment of Ed is varied depending on the causative factors. There are a number of risk factors that may need to be avoided to help in dealing with ED. For example, Edelman (2002) observes that if a diagnosis for the dysfunction reveals that it is as a result of drug and substance use, the victim may be advised to change the lifestyle such as loosing weight and increasing physical exercises, quitting alcohol and smoking as well as shunning substance use. If the problem is caused by medication such as drugs for high blood pressure and antidepressants, a physician may decide to change the drugs (Willke et al. 1998). Psychotherapy Psychotherapy is also a method used to treat moderate cases of ED whereby the victim may be suffering from anxiety associated with lack of confidence in the sexual partner. Intimacy development between the man and his partner are known to treat ED. Physical stimulation by the partner may also work as a treatment. The psychotherapy treatment is also important when the person is undergoing drug therapy (Padma-Nathan et al. 1997). Drug Therapy Oral medications may be prescribed for the affected person. These include vardenafil, tadalfil, Viagra, Levitra and Cialis among other drugs that are being administered in the UK for treatment of ED. According to Williams et al. (1998) the oral drugs are mainly ingested several hours before sexual intercourse, which allows the production of nitric oxide that is responsible for increased blood flow in the penis thereby causing an erection. Apart from the oral medications, there are also other medications administered in the form of injections on the penis or through the urethra. Such drugs include Aprostadil, which is among the pharmacological treatments that have been proved to work in the same way as prostaglandin E (Chen et al. 1998). Hellstrom et al. (1996) argue that the oral drugs are slower in facilitating an erection than injections. The treatments depend on the nature of the patient and the physician recommends the dosage over a particular range. Each of the medications has a particular dosage and hence the victims should not use them without the physician’s recommendation. Baldwin and Mayers (2003) argue that the PDE inhibitors may have adverse effects on a person if used more than once in 24 hours. According to Smith (2004), the PDE inhibitors can not be used together with nitrate based drugs for heart patients. The reaction is known to lead to a rapid drop in blood pressure. Such drugs include nitroglycerine and isosorbide dinitrate among others. Abbasian (2002) observes that blood pressure can also be lowered suddenly by combining the PDE inhibitors with the alpha blockers, which are drugs administered to treat high blood pressure or prostrate defects. Some physicians target testosterone that is the male sexual hormone accountable for several body functions, among them being sexual desire. They prescribe oral testosterone that supplement the natural hormone thereby minimizing the impact of ED. However, Smith and Henderson (2000) observe that this treatment has a downside of damaging the liver in certain situations. Some drugs are in form of pellets that are inserted in the urethra such as aprostadil that is put in the urethra for at least a depth of one inch. This treatment generates an erection in less than 10 minutes and lasts for an hour (Kockott and Pfeiffer, 1996). External application of Nitroglycerin on the penis can be used to treat moderate ED. Vacuum Devices Vacuum devices are also used to generate a fractional vacuum in the arteries, which triggers the flow of blood in to the space in the penis thereby causing an erection. The devices usually comprise of three elements which include a plastic cylinder that acts as the surface for placing the penis, a moderate pump that removes air from the cylinder by drawing it slowly thereby causing the penis to erect after which the third element that is the elastic band is used to fasten the base of the penis to maintain the erection through out the intercourse. This is accomplished by preventing blood in the penis to flow out to the body (Dorey, 2001). A penis pump may also be used to uphold erection. It comprises of a plastic tube that covers the penis and several constriction bands. The pump is powered through a battery. It is also referred to as a vacuum constriction device. It may be used whenever a person needs to engage in intercourse. Surgery Surgery is a complicated process that involves inserting a device in the penis or the area around it to cause erection. These devices are referred to as prostheses (Blair & Simpson, 1966). They can provide a permanent solution to erectile problems in men suffering ED. Some of them such as the malleable implants comprise of paired rods that are inserted in the penis through surgery. A person may adjust the position of the rods manually whenever need arises (Shubulade et al. 2002). There are also a group of inflatable implants that comprise of cylindrical rubber that is inserted in the penis through surgery. Before intercourse, the cylinders are inflated with pressurized fluid that is contained in a fluid reservoir also inserted in the body. The pump is also inserted under the skin of the scrotum where the person can easily press to pump the fluid. This generates an erection while maintaining the natural state of the penis (Carson et al. 2008). The flow of blood in to the penis can be facilitated through surgery whereby the obstacles are removed from the arteries. Peate (2005) observes that such obstructions are usually successful in young men who suffer crotch injuries or fissure in the pelvis, which causes a distinctive blockage of the artery. The Stem Cell Erectile Dysfunction treatment This is a complicated procedure that involves collection of autologous mature stem cell from the victim’s bone marrow. Bryan (2005) defines autologous as the removal of cells from a different part of the same person that they are going to be used to treat another part. He argues that this strategy is important in the avoidance of immune reactions, in contrast to when the stem cells may be removed from a different person. The theory behind this treatment is that the stem cells are capable of developing in to new tissue that may be useful in the replacement of damaged tissue such as arteries as well as nerves that are significant for an erection (Hawton, 2002). The process therefore helps to restore the damaged tissue of the penis and to rejuvenate the existing cells thereby recovering vascularization to enhance regular erections (Carey and Wincze, 2003). Natural Remedies There are also some natural elements that have been found to treat ED such as L-Arginine that is a significant amino-acid which facilitates the build up of nitric oxide needed to stimulate an erection (Leiblum, 2007). The amino-acid is present in common protein based food such as meat, chicken, fish and milk. L-Arginine is known to cause problems in the digestive system if taken in large amounts. It leads to a rise in stomach acid as gastrin increases and hence it may not be effective for people suffering from stomach ulcers. It is also known to have an effect on the amount of potassium in the body and may aggravate liver problems (Metz and McCarthy, 2001). Carnitine is also a natural element that is found in animal flesh. It is also significant in promoting the production of nitric oxide. Herbs such as ginkgo and the Indian Ginseng have been found to yield positive results in treating ED (Lehmann and Kirby, 2008). Zinc is also an important element in the treatment of ED. It can be obtained naturally from shellfish, liver, whole grains, cheese, beef and nuts. It is reduced in the body by diabetes and kidney ailments (Steggall et al. 2005). Pharmacological versus Surgical Treatment The choice of treatment is mainly based on the victim’s preferences. However, the physician’s recommendations supersede the client’s wishes. This is because of the various reactions of medical interventions with different bodies. Both pharmacological and surgical treatments are aimed at improving the capability of a person to erect. However, the surgical interventions are more permanent and are uphold the natural state of the penis (Grace et al. 2005). The drugs administered to the person suffering from ED are usually effective over a short period of time and are ingested a few hours before sexual intercourse. This means that without them, the problem prevails. Drugs have a downside in regard to their reactions with the body especially when a person is under medication such as treatment for high blood pressure and diabetes. It might be risky to solve ED while endangering the life of the individual. On the other hand, the dosage is very important and in case a person purchases the drugs from a vendor without a doctor’s prescription, there might be health risks. Oral testosterone is known to be unsuccessful some times leading to damage of the liver. This generates severer problems to the user than any the original problem. Surgery is a one time event and once the person heals, there are no risks as in drugs (Lehmann and Kirby, 2008). The negative aspect of surgery is the fact that it is a risky process that involves tampering with tissues and body cells. Injuries might occur especially if the surgeon is not careful in carrying out the procedure. Moreover, the drugs that are injected directly in the penis are painful and may also cause injuries and infections especially if the needles used are not sterile. The person might become impotent for good if the cells are damaged in the process or infected with germs. Ford (2010) views the introduction of foreign items such as the vacuum pumps as endangering the life of an individual especially if he is at risk of contacting a heart or blood disease. Drug therapy is user friendly in the sense that medications can be used when need arises and they do not have to become part of the body. Moreover, the cost involved in surgery is high compared to medications. For example, the cost of ED stem cell treatment might go up to €8,925. This means that not every person can afford it (Harrison and Dignan, 1999). Surgery is more effective in treatment of ED especially due to the fact that individuals may not be confused with the placebo effect of treatment. According to (Slowinski, 2002), the placebo effect is a situation whereby an individual believes that he has been treated by the mere conviction that there will be a difference after ingesting the drug. Surgical treatments practically deal with the problem by inserting devices whose functioning is controlled by the user for example by pressing the pump in the scrotum. There is also a possibility of individuals using drugs experiencing importunate erection (priapism) that might be uncomfortable especially when the sexual desire has been satisfied. Zilbergeld (1999) cites priapism condition as ne of the side effects of using drugs such as phentolamine and papaverine hydrochloride. The user may acquire phobia and may never use the drugs once more after experiencing the unending erection. The process of inserting a pellet in the urethra may also cause injury especially if a person is not assisted by a physician. Moreover, the alprostadil pellet has numerous side effects that make the user uncomfortable, such as aching inside the penis, scrotum and the rectal area. In other users, the urethra experiences a burning feeling and increased reddening of the penis due to rising blood levels in the penis. Severe cases may be evidenced by blood spots or hemorrhage. As noted earlier, surgery for artery repair is usually successful among young men and may not work in older men who usually have more pronounced blockage of the arteries. This is relatively disadvantageous compared to pharmacological treatments whereby all drugs can be used by men in all ages (Denman, 2003). Conclusion There are several treatments that physicians can recommend for ED. Lifestyle change is among the cheap treatments that can be used such as regular physical exercise to loose weight and quitting alcohol and other drugs associated with the occurrence of ED. pharmacological treatment is applied to a large extent for the treatment of ED. However, moderate levels of ED can be treated through psychotherapy. Oral medications include vardenafil, tadalfil, Viagra, Levitra and Cialis. Some medications such as aprostadil can be administered through injections in the penis. Oral testosterone is also used to supplement the natural testosterone produced by the body. Nitroglycerine can be applied externally on the penis to stimulate an erection. ED can also be treated through surgery that involves insertion of artificial devices that facilitate erection. Natural therapy can also be used for treatment whereby certain foods such as beef, chicken and milk are taken to provide amino-acids such as Arginine. Pharmacological treatment and surgery have both benefits and downside. Whereas drugs have the capacity to treat ED, they usually have no permanent impact in treating the problem. They both have potential side effects especially depending on the nature of the client’s body as well as the other drugs that he may be taking. Surgery has the potential of causing injuries in the process of treatment. The findings in this paper are significant in improving care for men who suffer from erectile dysfunction. Understanding the various treatments for ED is important for professionals in this field. The knowledge helps in making an informed judgment when choosing the appropriate treatment to prescribe for the client. For example, a physician may have to evaluate various factors that may influence the outcome of treatment before making recommendations. Such factors include; other medications that the client may be using, liver disease, stomach ulcers, heart and blood problems, age, historical use of ED medication, alcoholism, smoking and substance abuse, client lifestyle for issues such as feeding habits, obesity, physical exercise and stress. These are among the factors that have been portrayed in this paper as having a significant impact on the results of various kinds of treatments. They are associated with moderate to severe side effects of treatments.   References Abbasian, C. (2002). “Sexual dysfunction and antipsychotics” The British Journal of Psychiatry, Vol. 181(4): pp 352 - 352.  Baldwin, D. and Mayers, A. (2003). “Sexual side-effects of antidepressant and antipsychotic drugs”, Adv. Psychiatr, Vol. 9(3): pp 202 - 210.  Blair, J. H. and Simpson, G. M. 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