Erectile Dysfunction - Research Paper Example

? Factors inhibiting Erectile Dysfunction Erectile Dysfunction can be regarded as one of the most common sexual problems in men and affects close to 30 million men in the United States. Once referred to as impotence, erectile dysfunction (ED) infers the constant inability to attain, and/or sustain an erection that is sufficient for satisfactory love making. ED shares common risk factors as cardiovascular disease such as lack of exercise, smoking, obesity, metabolic syndrome and metabolic syndrome, most of which can be modified. The association of modifiable behavior aspect with ED, mostly among individuals without recognized comorbidities, presents an opportunity for intervention strategies to prevent and possibly enhance erectile function in individuals suffering from erectile dysfunction. The paper explores the causes and interventions to symptoms of erectile dysfunction. Factors inhibiting Erectile Dysfunction Introduction Erectile disorders can be primary or secondary whereby men suffering from primary erectile dysfunction have never had an erection while those that initially performed successfully, but later on developed a problem, manifest secondary erectile dysfunction. Erectile dysfunction is not essentially an ailment, but a warning sign of some other condition, whether psychological and/or physical. Erectile dysfunction is mainly common in men above the age of 40 whereby with each increase in age, the chances of onset of erectile problems increases. Erectile dysfunction affects about >30% of men aged between 40 and 70 years. Roughly 40% of all cases of ED are organic (physically caused). The remainder of the rest of the cases is psychogenic, deriving from emotional factors (Coon, Mitterer, Talbot & Vanchella, 2010). Erectile Process For a man to have an erection, an intricate process occurs within the body. An erection incorporates the central nervous system, the peripheral nervous system, local factors such as the penis, psychological and stress-related factors, in addition to hormonal and vascular elements. The penile section of the process that leads to an erection can be figured as representing only a solitary component of an intricate process. Erection can occur in response to triggers such as smell, touch, and auditory and visual stimuli that activate pathways in the brain (Wright, 2006). Consequently, information moves from the brain to the nerve centers located at the root of the spine, in which the primary nerve fibers link the penis and control blood flow during erection and afterwards. The smooth muscle, in this case, regulates the flow of blood into the penis whereby, when it relaxes, blood flows dramatically increases, thus yielding an erection. Detumescence derives from stoppage of release of the muscle-relaxing chemicals. The disruption of the process may lead to ED. Causes of Erectile Disorders: Physical (Organic) Causes Nearly all diseases that affect erectile function impact on the nervous, vascular, or hormonal system of the individual. Conditions such as high blood pressure, low hormone level, high cholesterol, heart and vascular disease are significantly linked to ED. Prostate cancer and diabetes also linked to erectile dysfunction. Furthermore, certain systemic and respiratory diseases are linked to ED such as Scleroderma, kidney failure, liver cirrhosis, and chronic obstructive pulmonary disease (Coon, Mitterer, Talbot & Vanchella, 2010). Other organic erectile problems have diverse causes with typical sources of trouble including alcohol and mind-altering agents such as cocaine and marijuana. Erectile Dysfunction, Heart Disease, and Related Vascular Diseases Although erectile dysfunction can be caused by diverse conditions, about 7 out of 10 cases result from the narrowing of the small arteries in the penis. This yields reduced blood flow to the penis. This can be regarded as the same problem that occurs within other blood vessels such as narrowing of blood the blood vessels in the heart (the coronary arteries). The core cause of the narrowing of the arteries is by atheroma, which resembles fatty patches or plaques that form within or inside lining of arteries (Wright, 2006). Risk factors that can enhance the chances of narrowing of the arteries include smoking. Tobacco use can be regarded as a significant risk factor for erectile dysfunction since it is linked to poor circulation (Romeo et al., 2000). Serious health (metabolic problems) such as obesity, high blood pressure, and diabetes also cause erectile dysfunction. An imbalance in hormones such as testosterone, prolactin, or thyroid can also yield erectile dysfunction (Qaseem et al., 2009). Trauma and Neuropathy Trauma to the penis and/or pelvic blood vessels and nerves can also lead to ED, as well as injury triggered by spinal injury or following surgery to nearby structures such as fractured pelvis. A head injury may sometimes influence the functioning of the pituitary gland in the brain that stimulates the testes to make testosterone (Uld & Brock, 2002). The interference with nerve function may be inflicted by Parkinson disease, Alzheimer’s disease, spinal cord trauma, multiple sclerosis, diabetic neuropathy, and pelvic surgery. Similarly, urological problems such as Peyronie disease and pelvic trauma may also lead to ED. Similarly, surgical procedures on the brain and the spinal cord may yield ED. Other procedures frequently associated with ED include cryosurgery of the prostate and cystectomy. Bicycle riding for a prolonged period has in some instances been implicated as a potential cause of ED; furthermore, medications employed to treat other medical disorders may also yield erectile dysfunction. Some of the medications linked to erectile dysfunction include antidepressants (depression), antipsychotics (for psychological illness), and medications for treating prostate cancer, and medications that lower cholesterol (Coon, Mitterer, Talbot & Vanchella, 2010). Mental Health (Psychological) Causes of Erectile Dysfunction Erection problems often produce significant psychological and emotional reaction in most men. This can be demarcated as a pattern of anxiety and stress that can subsequently interfere with usual sexual function. For others, ED may develop with age or may be connected to depression or other psychological causes such as widower syndrome. Various mental health conditions may end up causing the development of ED such as stress, anxiety, relationship difficulties, and depression (Lamina, Okoye & Dagogo, 2009). Secondary erectile disorders may be linked to depression, anxiety about sex in general (performance anxiety), guilt, sexual attitudes, resentment or hostility toward a sexual partner (relationship problems), fear of inability to perform, concerns regarding STDs, psychiatric disorders, and accompanying emotions and conflicts. Initial doubts may become serious fears of failure, which subsequently inhibit sexual exposure. Characteristically, ED develops suddenly if it is a symptom of mental condition. Subsequently, the ED may be resolved when the mental state of the subject improves such as easing of anxiety and depression. Nevertheless, some individuals become more anxious or depressed when they develop ED, which triggers a vicious circle of deteriorating anxiety and persisting erectile dysfunction. Treatment and Prevention of Erectile Dysfunction The first step in treating ED centers on looking for a cause and undertaking a full screen for cardiovascular disease and diabetes. The physician should also explore the potential of psychological factors and recommend sexual counseling for patients who may benefit from therapy. The underlying conditions should be treated first prior to consideration of therapies that may aid to produce an erection (Abdo, Oliveira, Moreira, Abdo & Fittipaldi, 2005). Options for ED treatment include sex counseling, medications, hormonal therapy, external vacuum devices, and penile injections. Phosphodiesterase-5 (PDE inhibitors) ED can be inhibited through medications that work by increasing the blood flow to the penis. Such medications accomplish this by affecting cGMP, or the chemical engaged in dilating (widening) the blood vessels when an individual is sexually aroused. These tablets may encompass sildenafil (trade name Viagra), tadalafil (trade name Cialis), and Vardenafil (trade name Levitra). The individual with ED, in this case, is supposed to take a dose prior to planning to have sex (Tomlinson, & Wright, 2004). Based on the manner in which the medicines work, the medicines are labeled as phosphodiesterase type 5 (PDE5) inhibitors. The PDE5 inhibitors can be regarded as the recommended first-line treatment for ED. Subsequent to sexual stimulation, penile erection manifests through the release of nitric oxide (NO), which yields dilation of the blood vessels of the corpus cavernosum through an accumulation of cyclic guanosine monophosphate (cGMP) (Boolell, Gepi-Attee, Gingell, & Allen, 1996). PDE5, the enzyme that breaks down cGMP can be inhibited, which, in turn, enhances the vasodilatory effect of NO. All PDE5 inhibitors share this overriding mechanism and remain pharmacologically active when cGMP fusion is activated (Tomlinson, & Wright, 2004). Hence, the action of the PDE5 inhibitors demands sexual arousal. Apomorphine (trade name Uprima) works by enhancing the degree of certain chemicals within the brain that are engaged in sending messages down nerves to the penis when an individual is sexually aroused. The individual with ED, in this case, is expected to take a tablet that dissolves under the tongue, twenty minutes prior to planning to have sex. It is essential to note that none of the described tablets can render an erection unless the individual is sexually aroused. There is a significant chance that the outlined medicine will work with an eight in ten chances of working successfully. Nevertheless, there are pros and cons for use of the described medications. For instance, some individuals may not be allowed to take certain tablets for ED if they manifest certain other medical conditions, or are taking certain other medicines. Individuals should not take PDE5 inhibitor if they are presently taking nitrate medicines such as glyceryl trinitrate (GTN) that are frequently employed to treat angina. The utilization of medicines is discouraged in men who bear a recent history of stroke of myocardial infarction, low blood pressure, unstable angina, serious cardiac failure, severe liver impairment, uncontrolled high blood pressure, and end-stage kidney disease. Other forms of treatments include pelvic floor muscle exercises, injection treatment, urethral medication, vacuum devices, and penile prosthesis (Boolell, Gepi-Attee, Gingell, & Allen, 1996). Treating the Underlying Conditions Frequently, one can reinstate sexual health by treating conditions such as high blood pressure with medication, diet and/or exercise. Nutritional states such as zinc deficiency that are frequently linked to erectile dysfunction can be treated with diet. In maintaining a healthy diet, pursuing regular exercise, and taking appropriate medication, individuals can lower their cholesterol and minimize the risk of ED (Wessells, et al., 2007). This is informed by the fact that obese men are predisposed to suffer erectile dysfunction compared to normal weight men. Treating the underlying cause of erectile dysfunction can be one way of inhibiting the condition. Treating depression, anxiety, cutting back on smoking and alcohol intake, changing medication, and treating certain hormonal conditions may aid to cure the associated ED (Qaseem et al., 2009). Poorly managed diabetes (uncontrolled diabetes) can impact blood flow to nerve endings of the penis (Wing, et al., 2010). Individuals suffering from ED should maintain a healthy diet; pursue regular exercise to mitigate diabetes-related ED (Burchardt, et al., 2000). Lifestyle Changes ED is frequently a marker that cardiovascular and heart disease may develop. Thus, individuals with ED should closely review their lifestyle so as to exercise changes that minimize the risk of developing the outlined problems. The symptoms of ED can be enhanced by executing changes to the patient’s lifestyle that reduces the risk of ED by: losing weight, giving up smoking, moderating alcohol intake, minimizing stress, exercising regularly, and not taking illegal drugs (Esposito, Giugliano, & Di-Palo, 2004). Intensive intervention with lifestyle advice centering in the healthy diet, weight loss, and enhanced physical activity is beneficial to men with ED, besides minimizing the markers of inflammation and enhancing endothelial function (Jackson, 2007). Smoking inflicts damages to the blood vessels, which can, subsequently, restrict blood flow and yield erectile dysfunction. Excessive alcohol intake inhibits erectile functioning by orchestrating a restriction in blood flow to the penis, and may even negatively influence the production of the male hormone testosterone, which, in turn, affects sex drive and erections. Illegal drug use such as marijuana and cocaine can equally lead to ED by leading to the damaging blood vessels, and/or constraining blood flow (Jackson, 2007). Thus, the individual with ED should quit smoking, use of illegal drugs, and stop drinking alcohol as this can aid some men partially or fully restore erectile function. Moreover, the individual should adopt regular exercise to enhance range of motion, enhance brain function, and enhance muscle mass. Being overweight enhances an individual’s risk of vascular disease, which is a known cause of ED. Regular exercise can inhibit erectile dysfunction by enhancing blood circulation and keeping the weight down, which ultimately, reduces the risk of ED (Esposito, Giugliano, & Di-Palo, 2004). This is also applicable in cases where individuals have high levels of cholesterol that damages the linings of blood vessels. Counseling Certain feelings may hinder usual sexual function such as feeling nervous about or embarrassed about sex, feeling stressed, having anxiety, depression, guilt, indifference, and low self-esteem, or feeling troubled on the present relationship. In such cases, psychological counseling for both partners can be successful in alleviating ED symptoms. Stress may inhibit relaxation, which in turn, makes it difficult to attain or sustain an erection. Hence, the participation in mind/body activities such as yoga and muscle relaxation that aid the individual to keep himself calm can aid to inhibit ED (Wessells, et al., 2007). Similarly, individuals with erectile dysfunction should also get enough sleep as lack of enough sleep may manifest at both the mental and physical level with excessive fatigue yielding erectile dysfunction (Coon, Mitterer, Talbot & Vanchella, 2010). Loss of stress can enhance erectile functioning as one can be conceived as an inhibiting factor to ED. Psychological factors are responsible for close to 10-20% of all cases relating to erectile dysfunction. For patients whose ED stem from psychological problems, therapy may be imperative. In some instances, couple counseling, or sex therapy may be a useful inhibitor to ED, especially if certain psychological problems are the sole cause of the erectile dysfunction. Counseling responds to psychological causes of ED such as performance anxiety, frustration, inadequacy, humiliation, and depression that represent some of the resultant symptoms, and emotions associated with ED, and which can significantly strain relationships (Uld & Brock, 2002). Some psychogenic therapy (inclusive of behavior techniques such as focus technique) is directed at enhancing mental and emotional factors that contribute to erectile dysfunction. Certain therapies remain guided and tailored to meet the psychogenic cause of the man’s erectile dysfunction (Coon, Mitterer, Talbot & Vanchella, 2010). For instance, if the individual is suffering from depression, psychotherapy may be employed to treat ED symptoms. Antidepressants may aid to relieve depression; however, this may be counterproductive as antidepressants may decrease libido and aggregate ED (Tomlinson & Wright, 2004). In some instances, psychotherapy can minimize anxiety on sexual performance in individuals with ED and can be effective in highly motivated clients. Sex counseling is a critical part of erectile dysfunction management. The therapist is expected to aid the client to overcome feelings of anger and resentment that the patient may naturally experience as this could harm the relationship between the partners. Counseling, in particular, aids individuals with ED to get past the embarrassment or feelings of awkwardness that the client may be experiencing. The therapy may also respond to feelings of guilt and inadequacy that can impact on self-esteem and confidence. Sex therapies (including hypnoanalysis) such as Masters and Johnson’s approach and Kaplan’s approach may aid partners to support each other and sustain intimacy while coping with ED (Jackson, 2007). Conclusion Erectile dysfunction is a prominent complaint among men aged 40 years and incidence increases with age. Comorbidities such as heart disease, dyslipidemia, diabetes, depression, and hypertension have cited as the primary risk factors for the onset of erectile dysfunction. Furthermore, several modifiable lifestyle factors such as smoking, diabetes control, physical activity, excessive alcohol consumption, and obesity have been highly linked to ED. Drugs or surgery may be employed in medical treatment of organic erectile disorders. For instance, Viagra is effective in treating about 70 to 80% of men suffering from erectile disorders. Effective treatment should incorporate counseling to eliminate fears and psychological blocks that play a critical role in psychogenic driven ED. It is equally significant that the man attains confidence, improves the ongoing relationship with his partner, and learns better lovemaking skills. Although there is insufficient, scientific compelling literature demonstrating how modifying lifestyle risk factors can enhance erectile function endeavors such as weight loss may reverse ED via other mechanisms such as reduced inflammation, enhanced serum testosterone levels, and enhanced mood and self-esteem. Patients with ED should aggressively pursue steps that inhibit ED or enhance their condition by embracing healthier lifestyles. References Abdo, C. H., Oliveira, J., Moreira, J., Abdo, J. A. & Fittipaldi, J. A. (2005). The impacts of psychological factors on the risk of erectile dysfunction and inhibition of sexual desire in a sample of the Brazilian population. Sao Paulo Medical Journal, 123 (1), 11-14. Boolell , M., Gepi-Attee, S., Gingell, J. C., & Allen, M. J. (1996). Sildenafil, a novel effective oral therapy for male erectile dysfunction. Br J Urol 78, 257-261. Burchardt,M. et al. (2000). Hypertension is associated with severe erectile dysfunction. J Urol, 164, 1188-1191. Coon, D., Mitterer, J. O., Talbot, S., & Vanchella, C. M. (2010). Introduction to psychology: Gateways to mind and behavior. Belmont, CA: Wadsworth Cengage Learning. Esposito, K., Giugliano, F., Di-Palo, C., et al. (2004). Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA, 291, 2978-2984. Jackson, G. (2007). The importance of risk factor reduction in erectile dysfunction. Current Sexual Health Reports, 4 (3), 114-117. Lamina, S., Okoye, C. G.,& Dagogo, T. T. (2009). Therapeutic effect of an interval exercise training program in the management of erectile dysfunction in hypertensive patients. J Clin Hypertens, 11, 125-9. Qaseem, A., Snow, V., & Denberg, T. D., et al. (2009). Hormonal testing and pharmacologic treatment of erectile dysfunction: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 151 (1), 639-649. Romeo, J. H., Seftel, A. D, Madhun, Z. T & Aron, D. C. (2000). 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