Erectile dysfunction is the inability for a man to make, have or sustain an erection during sexual activity. It is a common cause of male infertility/subfertility. Erection is necessary for penetration of the Vagina as well as in ejaculation, in achieving a good erection or sustaining one, it will involve an interplay of a lot of factors: the nervous system, vascular system, gonads, sex hormones must all be in good functional state. This also entails that possible causes of erectile dysfunction will amount from any disruption or dysfunctions in the working of the above factors necessary to make an erection. Visual triggers, tactile triggers as well as olfactory triggers, picked up and processed by the central nervous system which travels down the parasympathetic aspect of the nervous system, a sub class of the autonomic nervous system to the sacral nerves of S2- S4 ( gives it's root fibers that forms the pudendal nerve, this supplies the genitalia and perineum as well as the nerve in charge of initiating erection- nerve erigentes). The impulse generated passes via the pudendal nerve with a branch supplying the penis, at the ends of the nerve fibers, acetylcholine which is the chief neurotransmitter of the parasympathetic system is released causing a development in the cascade of opening of calcium gated channels allowing for calcium influx to bring to action the calmodulin calcium complex.
The calcium calmodulin complex triggers activation of the enzyme neuronal nitric oxide synthase a consitutive subtype of nitric oxide synthase. This enzyme effects the formation of nitric oxide one of the sole drivers of erection from Arginine a primary amino acid and also from intermediate products of Arginine catabolism or break down, being Citrulline and Ornithine which are secondary amino acids, formed nitric oxide diffuses into the smooth muscles, binds to them, stimulating guanylycyclase an enzyme in charge of forming cyclic guanosine monophosphate (GMP) a form of messenger that carries out the action of nitric oxide causing smooth muscles to relax as well as vasodilation of the penile blood vessels as such, there is a situational blood surge to the penis, causing the penis to rise, enlarge and go erect following the increasing penile blood flow with arrest of blood leaving the filled sinusoids in the corpora cavernosa this process or Cascades of events explains how erection occurs, and a break in this chain hampers effective erection. Certain drugs used in treatment of erectile dysfunction were made from understanding of this principle behind penile erection.
Risk Factors of Erectile Dysfunction
These factors contribute to the development and increases the chance of developing erectile dysfunction.
- Age: chances of developing erectile dysfunction increases with age, more in elderly
- Obesity and poorly controlled Diabetes mellitus
- Certain pelvic surgeries and laser therapy
- Depression and mental issues
Effects of Erectile Dysfunction on an Individual
Erectile Dysfunction poses negative effects on one's health status.
- Could trigger person's low self-esteem
- Issues in relationship
- Affects the persons overall quality of life
- Decreases sexual performance and libido
Causes/Etiology of Erectile Dysfunction
They are many factors causing erectile dysfunction which could arise due to vascular issues, certain systemic diseases, nervous issues, respiratory diseases, endocrine conditions, change in penile structure, psychological causes, pelvic surgeries, trauma and medications.
- Vascular factors: Atherosclerosis, peripheral vascular disease, hypertension, damage to penile support tissues, nerves and blood vessels following radiation therapy to pelvis and prostate.
- Endocrine factors: diabetes mellitus, hypoganadism( less blood levels of the male sex hormone, testosterone) low libido and in rare cases hypothyroidism.
- Respiratory disease: sleep apnea syndrome in adult males has been linked to be a potential cause of erectile dysfunction.
- penile condition: severe Peyronie's disease (formation of fibrous plagues in one or both corpora cavernosa tissues of the penis resulting in a distortion/deflection of an erect penis)
- Mental disorder: Depression, fear of intimacy, performance anxiety, guilt and stress
- pelvic surgeries: prostate surgery for benign prostate hyperplasia one of the complications could be erectile dysfunction due to nerve damage, also seen in radical prostatectomy
- medications: erectile dysfunction could be an adverse effect of certain medications, example: antihypertensive, antidepressants, antipsychotics etc.
Overall, conditions causing reduced nerve and endocrine functions like aging, hypertension, smoking, hypercholesterolemia ( high levels of cholesterol in blood), poorly controlled Diabetes mellitus posses as risk factors as well as potential causes of erectile dysfunction which could result in changes affecting, circulation to penis and penile tissue structure thereby hindering penile erection. These factors are most times the commonest causes of erectile dysfunction and could present as the first noticeable symptoms of these diseases. For example an man in his late forties presenting to the clinic with a case of erectile dysfunction, one key point of care investigation to quickly do is a random plasma glucose test it could arguably give a picture which points towards diabetes mellitus as the possible cause with a complication affecting the nerve erigentes, as such preventing erection in this patient.
Treatment of Erectile Dysfunction
In cases of erectile dysfunction see a professional ( your doctor) for proper evaluation. In addition the following are also necessary to take note of;
- Encourage exercise
- Weight loss
- Cease smoking
- Cease alcoholism
- Reduce stressors
- Patient health education
- Discourage use of concoctions as in most cases they remain harmful to the person's liver and kidneys.
- Encourage prompt medical care and assistance
Most cases of erectile dysfunction whose potential or actual etiology have been identified by a doctor are treatable, there's is no room for allowing negative effects of the condition eat one up especially depression. There are several effective treatment measures to this condition.