- DIABETES, which progressively damages the
body’s arteries and nerves - peripheral NEUROPATHY, which may damage the
nerves that supply the penis - MULTIPLE SCLEROSIS, a degenerative neurologic
disorder that causes loss of nerve function in
various areas of the body - ATHEROSCLEROSIS, which may occlude the arter-
ies that serve the penis and slow the flow of
BLOODto the penis - chronic LIVERdisease or chronic kidney disease
- SPINAL CORD INJURY or TRAUMATIC BRAIN INJURY
(TBI), either of which may interrupt the flow of
nerve impulses between the CENTRAL NERVOUS
SYSTEMand the PERIPHERAL NERVOUS SYSTEM
Cigarette smoking is a key contributing factor
for neuropathy and atherosclerosis, compounding
the effect these conditions have throughout the
body. Numerous medications may cause erectile
dysfunction as an undesired SIDE EFFECT. The most
common culprits are ANTIDEPRESSANT MEDICATIONS,
antihypertensive medications to treat HYPERTENSION
(high BLOOD PRESSURE), and ANTIHISTAMINE MEDICA-
TIONSto treat seasonal allergies. Fear, stress, anxi-
ety, and DEPRESSIONare among the psychologic and
emotional causes of erectile dysfunction.
ERECTILE DYSFUNCTION AND HEART DISEASE
Studies suggest erectile dysfunction in otherwise
healthy men is a harbinger of HEARTdisease,
notably ATHEROSCLEROSISand CORONARY ARTERY DIS-
EASE(CAD). The small arteries that flood the PENIS
with BLOODduring ERECTIONappear to show the
effects of accumulated arterial plaque earlier
than other arteries in the body. Though other
arteries of similar size likely occlude to similar
extent, men are more likely to notice and pay
attention to circumstances that interfere with
erection.Symptoms and Diagnostic Path
The inability to get or sustain an adequate erection
is the symptom of erectile dysfunction. The diag-
nostic path begins with a thorough physical exam-
ination, including DIGITAL RECTAL EXAMINATION(DRE)
to assess the status of the prostate gland and blood
tests to measure the levels of lipids (cholesterol
and triglycerides), TESTOSTERONE, GLUCOSE(fasting
blood glucose), and liver enzymes. The doctor
may desire additional diagnostic procedures,
depending on the results of these preliminary
tests. Such procedures may include Doppler ULTRA-
SOUNDto assess the flow of blood to and within the
penis, testing of nerve function and reflexes, and
other factors of function. Because a man normally
experiences multiple erections during sleep, some
tests are done when the man is sleeping (such as
the nocturnal penile tumescence test), to measure
the characteristics of nocturnal erections.Treatment Options and Outlook
Treatment targets the underlying cause when it is
identifiable. About 85 percent of erectile dysfunc-
tion results from physiologic causes. Sometimes
treatment is straightforward and relatively easy,
such as changing to a different medication when
the cause of erectile dysfunction is medication side
effect. Often, however, the most effective treat-
ment addresses multiple contributing factors and
encompasses medical interventions, lifestyle modi-
fications, and psychologic therapy or counseling.
Medical interventionsPhosphodiesterase (PDE)
inhibitors, also called selective enzyme inhibitors,
are the least intrusive and often most successful
medical treatment for erectile dysfunction. The
best known of these oral medications to treat erec-
tile dysfunction is sildenafil, first marketed under
the trade name Viagra. Other medications in this
classification include vardenafil (Levitra) and
tadalafil (Cialis). These drugs work by delaying the
enzyme-initiated process through which an erec-
tion subsides, extending the erection. The erection
still requires sexual stimulation to develop; these
medications do not cause spontaneous erection.
Men who take certain medications to treat HEART
disease, such as some antihypertensive medica-
tions to treat high blood pressure, cannot take
PDE inhibitors because the actions of the drugs are
similar and combining them can cause fatally low
blood pressure. PDE inhibitors are most effective
in men who have mild to moderate vascular dis-
ease (such as atherosclerosis) or arterial damage
due to diabetes.
Prescription-strength preparations of the herb-
derived product YOHIMBE/YOHIMBINE also may
extend erections though work through a differenterectile dysfunction 279