“Communication is to relationships what breath is to life” – Virginia Satir

Erectile Dysfunction

Erectile dysfunction (ED) is defined as a consistent or recurrent inability to achieve or maintain penile erection sufficient for satisfactory sexual function. A common disorder for men of all ages and ethnic and cultural groups, ED affects an estimated 152 million men worldwide and 50% of men aged 40-70 in the United States. Not only does ED adversely affect quality of life for millions of aging men, but this condition can also be the first warning sign of more serious underlying problems such as heart disease or diabetes.

Physiology of Normal Erection
Penile erection occurs through the synchronized action of psychological, neuronal, hormonal, vascular, and cavernous smooth muscle systems. Normal erection requires a dynamic balance of excitatory and inhibitory forces. The sympathetic nervous system works in one direction, the parasympathetic works in the other.

Erection is produced by the trapping of blood in the corpus cavernosum (corporal body) of the penis. Stimulation of the sympathetic system works in the opposite direction, maintaining the penis in a flaccid condition. The sympathetic nervous system can be stimulated by stress, exercise, and low temperature.

Causes of Erectile Dysfunction
Erectile dysfunction can have both psychological and organic (physical) causes. The latter may involve various bodily pathologies or the effects of medications or alcohol. In addition, ED can be a symptom of numerous conditions, including cardiovascular disease.

In cases of psychological ED, most often the condition is related to depression, anxiety, psychiatric diseases, marital or relationship problems, or financial difficulties. Erectile dysfunction attributable to psychological factors most frequently occurs at a younger age.

Organic ED can have numerous causes. Age appears to be a strong risk factor, as organic erectile dysfunction becomes more prevalent as men grow older. Organic ED may be due to vascular causes when blood flow to and from the penis is disrupted. Medical conditions such as cardiovascular diseases (atherosclerosis, or hardening of the arteries, as well as hypertension and high cholesterol) and diabetes may lead to vascular dysfunction. Men with these conditions represent the largest group of ED patients. Penile injury and surgery in the pelvic and abdominal area can also cause reduced penile blood flow and erectile dysfunction. Smoking is an additional factor that can indirectly reduce genital blood flow by accentuating the effects of other risk factors such as cardiovascular disease and hypertension.

Organic erectile dysfunction can also have neural causes. Disorders such as stroke, multiple sclerosis, Parkinson’s disease, spinal cord damage, and, again, diabetes can lead to nerve damage and affect normal response to sexual stimulation. ED is also common in men who have had surgical treatment for prostate enlargement or prostate cancer.

Hormonal deficiencies or imbalances are another major component of organic erectile dysfunction. Low levels of hormones such as testosterone, DHEA, pregnenolone and thyroid hormones likewise may contribute to ED

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Medications may contribute to organic erectile dysfunction. Prescription medications for treating high blood pressure (beta-blockers), anti-depressants, heart disease medication(statins), prostate enlargement or cancer (and other conditions have side effects that may include ED. Excessive alcohol consumption can also negatively affect sexual function.

Diagnosis
A diagnosis of erectile dysfunction can be based on general medical history, sexual history, physical examination, and laboratory testing.

Health conditions such as heart disease, diabetes mellitus, hypertension (high blood pressure), endocrine disorders, depression, and insomnia, as well as factors such as smoking, alcohol consumption, and prescription drugs can play a role in ED. Use of over-the-counter medications and nutritional and herbal remedies must also be evaluated.

Treatment Options
There are many options for treating erectile dysfunction. Managing ED may involve psychological, medical (oral, transdermal, or injected drugs), nutritional (supplements), and surgical therapies. To correct ED, it is essential to address any underlying chronic conditions and modify lifestyle factors such as obesity, smoking, alcohol consumption, and lack of exercise. Psychological therapy such as counselling behavioural therapy, psychotherapy and relationship therapy can be effective if psychological factors are contributing to erectile dysfunction. It is important for men to remain physically and sexually active for as long as possible.

Today, men are exposed to information and advertisements touting a wide variety of drugs and supplements that may help restore sexual function. The most popular option is a class of drugs called phosphodiesterase type 5 inhibitors such as Viagra® and Levitra®. These drugs dilate blood vessels in the genital region, leading to an erection; unfortunately, however, they do very little to increase libido (sexual desire). While these medications are valuable tools in the symptomatic treatment of erectile dysfunction, they may produce multiple side effects such as headaches, changes in blood pressure, irregular heart rhythm, flushing, nasal congestion, and others, and their long-term risks are unknown.

Men whose blood test indicate hormonal deficiencies or imbalances can use bio identical hormones to help manage ED. Replacement of androgens can be crucial in restoring normal sexual function. While testosterone is available by prescription only, over-the-counter hormones such as DHEA and Pregnenolone may help boost testosterone levels and thus improve erectile dysfunction.

Emerging evidence and case reports suggest that naturally occurring agents such as L-arginine, Korean red ginseng, zinc, DHEA, Maca root, and Tribulus terrestris may help improve sexual function and thus ED. A naturally occurring alkaloid called yohimbine, derived from the African tree, Pausinystalia yohimbe, has been used for over 70 years as a pharmacological agent in treating ED. It is important to note that studies of these herbal plants have often yielded inconsistent results, and clinical evidence to support herbal agents in managing ED is still minimal.

Those who do not benefit from drugs, supplements, or psychological treatment may see improvement with intracavernosal injections, vacuum/constrictive devices, penile prostheses, or vascular surgery.

It is important to know that Erectile Dysfunction can be treated successfully. It might however be an indication of a serious heart incident in three to five years’ time so it is crucial to seek professional advice.

Elmari specialises in the following:
  • Sexology
  • Individual Psychotherapy
  • Clinical Hypnotherapy
  • Sex therapy
  • Couples Therapy
  • Relationship/Marital Enrichment
  • Pre-marital Counselling
  • Conflict Resolution and Effective Communication Skills
  • Divorce Counselling
  • Trauma Counselling

 
The diagnoses and treatment of male and female sexual dysfunction, eg
  • Loss of sexual desire
  • Libido differences
  • Sexual Pain Disorders:
    Vaginismus,
    Dyspareunia,
    Vulvadinia ext
  • Inability to reach orgasm
  • Erectile dysfunction
  • Ejaculation control and timing
  • Sexual behaviour disorders
  • General Sexual Problems
  • Sexual Enrichment
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