PENILE ERECTION

Penile erection is possible due to two mechanisms:

• Reflex erection (happens when the penis is touched)
• Psychogenic erection (the penis is not touched directly but is stimulated erotically)

In the process of reflex erection the peripheral nerves are stimulated along with the lower parts of the spinal cord. Psychogenic erection is possible due to the functioning of the limbic system of the brain. An intact neural system is necessary in both cases to provide a perfect erection. When nervous system stimulated the brain nitric oxide is secreted. The secretion lets smooth muscles of the penis relax. Therefore erection happens. Testosterone and proper functioning of pituitary gland contribute to the stabilization of the erectile system.

IMPOTENCE OR ERECTILE DYSFUNCTION

The terms “impotence” and “erectile dysfunction” basically mean the same and stand for the inability to achieve an erection. It’s impossible for the partners to get satisfaction from the sexual intercourse when the male suffers from impotence.

There are several main reasons that lead to male erectile dysfunction (ED).

• Hormonal deficiency
• Neural system diseases
• Inadequate blood circulation in the penis
• Psychological diseases

Dysfunction of endothelium may lead to the changes in the penile blood flow and thus lead to impotence. The same impact on the penile has long-term exposure to bright light or high noise levels.

Some medications can also cause ED. Among them are antihypertensives (used for high blood pressure treatment) and certain drugs. These medications change the blood circulation in the body or influence the functioning of the nervous system. Impotence may be a side effect of some medications (for example antidepressants).

Cases of impotence were found as a result of surgeries that removes tissues important to erection or damage nervous system. Controversial opinions exist about the influence of circumcision on erection.

Bicycling has lately been considered another cause of impotence. When a man is riding a bicycle for a long period the pressure of the saddle on the penis affects its proper functioning.

Men who abuse alcohol are more likely to suffer from ED. This problem was described in Shakespeare’s Macbeth and is sometimes called brewer’s droop.

A lot of men don’t want to acknowledge the problem and find different excuses such as “I’m exhausted”, “It happens only from time to time”, “I’m not satisfied with my partner”, “I’m too drunk”, “I don’t feel like doing it today”, “I’m in a bad mood” and so on and so forth.

But impotence can be treated if necessary measures are undertaken immediately. Besides, impotence may be connected with other diseases (diabetes, arteriosclerosis and others).

The Mechanism of Erection

At the first stage of erection nitric oxide is releases. It influences the enzyme guanylate cyclase, which leads to the high level of cyclic guanosine monophosphate. As a result smooth muscles are relaxed and additional blood flows to the penis.

The whole process of erection passes the following stages:

• Sexual excitement
• Smooth muscle relaxation
• Extension of arterioles
• Blood inflow
• Enlargement of the corpora cavernosa
• Veins that drain blood from the penis are narrowed due to high pressure and the blood stays in the penis
• Enlargement of the penis
• Erector muscle makes the penis to move up and forward

Causes of Impotence
Physical disorders are the underlying cause of the erectile dysfunction. And only 20% of all the cases are a result of the psychological problems.

Physical Problems that Cause Erectile Dysfunction

• Vascular Diseases
• Metabolic disorders
• Nerve Disease
• Cancer treatment
• Hormonal Problems
• Side Effects of Medications
• Alcohol: Long-term
• Smoking
• Sedentary Lifestyle

Psychological Problems that Cause Erectile Dysfunction

• Anxiety
• Stress
• Depression
• Relationship Problems

Sometime physical disorders are intensified by psychological disorders.
Diagnosis of ED/Impotence

There’s no a particular test that diagnose erectile dysfunction. But several preliminary tests must be taken in order to understand the cause of the impotence. Among them are blood tests (male hormone levels are measured, other diseases that can influence the erection – diabetes mellitus, etc – are identified), tests that identify whether the penile nerves function properly, ultrasonography (arterial circulation is evaluated), nocturnal penile tumescence (the state of penis during nocturnal erections is examined), cavernosometry (vascular pressure in the penis is measured)

Treatment

Oral Medication
Sildenafil (Viagra®), vardenafil (Levitra®) and tadalafil (Cialis®) are drugs that are taken orally. They are phosphodiesterase type 5 inhibitors and stop degradation of cyclic guanosine monophosphate.

Herbal Remedies
Herbal remedies are taken before the sexual intercourse. They usually consist of several herbs, vitamins and minerals that increase the erectile ability and make no harm to the organism.

Vacuum pump
Due to vacuum pump the penis is engorged and a penis ring maintains this state. But the penis ring must be taken off in a half an hour. The erection achieved by vacuum pump differs from a natural one. For some men drugs and injections are preferable. High-priced pump can guarantee a high level of success. But those who choose cheap pumps will hardly be satisfied with the effect. The prolonged use of a pump may improve the natural erection.

Sex counseling
A sex counselor and psychologist can help to understand and overcome psychological and physical problems that arise during a sexual intercourse.

Penile Injections
Just before the sexual intercourse a medication is injected into the penis to provide the sufficient blood flow to the penis.

Intraurthral Therapy
Special pellets are inserted into the urethra to provide the sufficient blood flow

Penile Implant Surgery
A special device can be implanted to the penis

Controversial Treatment

Bremelanotide
It’s a drug that stimulates sexual desire and can be used by both males and females. It’s produced in the form of a nasal spray. Bremelanotide is an experimental drug now.

hMaxi-K
hMaxi-K is a new gene therapy based on the hSio gene expression by plasmid vector.

Alternative treatments
Most valued for their psychological effect. If the patient expects to reach a good result then any praised remedy can help. Traditional drugs can also increase their effectiveness due to the same result.

Precaution

It’s better to prevent the disease than cure it. Several simple changes to the lifestyle can help to forget about impotence. Doing exercise, quitting smoking, cutting down on alcohol, healthy diet and successful coping with stress provide a great result for those who do not want to suffer from erectile dysfunction.