Erectile Dysfunction: What You Should Know

Erectile dysfunction, also known as impotence, is the inability to acquire and maintain an erection in order to be able to engage in sexual intercourse. Men do not have to be concerned about infrequent erection problems that occur occasionally, but erectile dysfunction that is becoming an ongoing issue can be a serious problem, resulting in relationship difficulties, affecting self-confidence and causing stress.

Difficulties in acquiring and maintaining erections may also be an indication of a more serious health problem that may require medical treatment, and can even be a risk factor for heart disease later on.

Symptoms

Symptoms of erectile dysfunction can include difficulty getting and keeping an erection as well as a general reduction in sexual desire. You should see your family doctor if:

  • You are worried about your erections, or have other sexual problems such as delayed or premature ejaculations
  • You have other symptoms that go together with erectile dysfunction
  • You have a known health condition such as diabetes or heart disease that may be linked to erectile dysfunction

Causes

Sexual arousal in males is a complicated process involving the brain, emotions, muscles, blood vessels, hormones and nerves, and problems with any of them can result in erectile dysfunction. Erectile dysfunction can also be caused or worsened by mental health concerns and stress. It can sometimes be caused by a combination of psychological and physical issues, such as the slowing of a sexual response caused by a minor physical complaint causing anxiety and stress, that in turn then makes the condition worse.

Physical causes A physical cause is the most common reason for erectile dysfunction, but there can be any number of conditions responsible such as:

  • Heart disease
  • High cholesterol
  • Obesity
  • Parkinson’s disease
  • The development of scar tissue inside the penis (Peyronie’s disease)
  • Use of tobacco
  • Sleep disorders
  • Injuries or surgeries affecting the spinal cord or pelvic area
  • Atherosclerosis (clogged blood vessels)
  • High blood pressure
  • Diabetes
  • Metabolic syndrome (involving high insulin levels, high cholesterol, high waist body fat and increased blood pressure)
  • Multiple sclerosis
  • Some prescription medications
  • Substance abuse including alcoholism
  • Enlarged prostate and prostate cancer treatments

Psychological causes

The brain has an important role to play in the sequence of physical events that result in an erection, which begins with feelings related to sexual excitement, but those feelings can be interfered with by a number of things that can cause erectile dysfunction or increase its severity, including:

  • Relationship problems caused by poor communication, stress and other factors
  • Stress from work or other sources
  • Anxiety, depression and other mental health conditions

Diagnosis

A physical exam and medical history will be all that is required for doctors to be able to diagnose erectile dysfunction in most men, and recommend a course of treatment. Consultation with a specialist (and sometimes more tests) may be required, if your doctor believes an underlying condition may be responsible, or if you suffer from chronic health problems. These tests could include a physical examination, ultrasound, urine and blood tests and a psychological exam. Another option is an overnight erection test which checks if men are having erections while asleep.

Treatments

There are a number of options for treatment for erectile dysfunction, which will depend both on the severity and the cause of the condition, and whether there are any underlying health problems.

One successful treatment for erectile dysfunction for a lot of men is in the form of oral medications. The medications, including the famous Viagra, increase blood flow and enable an erection to form due to sexual stimulation, by enhancing the normal effects of the natural chemical produced by the body known as nitric oxide, which relaxes the penis muscles. Other medications include self-injections into the penis, testosterone replacement, penis pumps, penile implants and blood vessel surgery, although the latter is very rare. A new analysis from Portugal’s University of Porto has also found that men with erectile dysfunction could benefit from physical activity or exercise, with researchers finding that men who exercised experienced an improvement in their condition. Exercise may be used alone or with medications for erectile dysfunction.

New device may help with urinary incontinence

Urinary incontinence is the term given to poor bladder control. There are a number of different kinds of incontinence that can have different causes, so it is important to consult a doctor if suffering symptoms.

The most common kinds of incontinence are:

  • Stress incontinence
  • Incontinence related to chronic retention
  • Functional incontinence
  • Urge incontinence

Stress incontinence

Stress incontinence refers to small amounts of urine leaking in the midst of activities that cause increased pressure to be put on the abdomen, which then pushes down on the bladder. This usually occurs in women, but it can also happen to men, particularly those who have undergone prostate surgery. Stress incontinence often occurs during activities such as coughing, laughing, playing sport, sneezing or lifting. Diabetes, constipation, obesity and chronic coughing connected to the likes of asthma, bronchitis or smoking can also be a contributing factor to stress incontinence. In women, stress incontinence can also be caused by childbirth, menopause and pregnancy.

Incontinence related to chronic retention

Incontinence related to chronic retention refers to the inability of the bladder to properly empty, which results in the leaking of small amounts of urine on a frequent basis. Indications that the bladder may not be emptying completely can include:

  • The feeling of having to strain in order to pass urine
  • Feeling the urge to urinate even immediately after a toilet visit
  • Passing urine during sleep
  • More urine dribbling out immediately after a toilet visit
  • A slow or weak stream of urine
  • No or little warning prior to an urgent desire to urinate
  • Frequent bouts of cystitis or urinary tract infections

Functional incontinence

Functional incontinence is an extreme form of incontinence where the affected person does not appreciate the desire to urinate or recognise where to urinate, which can result in urine being passed in inappropriate places. Functional incontinence can be caused by a number of factors such as dementia, poor mobility, environmental factors such as low chairs that are hard to get out of, difficult-to-access toilets or poor lighting, poor eyesight, poor dexterity with regard to fine motor skills, or just a refusal to go the toilet because of issues relating to anger, anxiety or depression.

Urge incontinence

Urge incontinence is the term for a sudden and very strong desire to urinate, also sometimes referred to as an overactive or unstable bladder, and as detrusor instability. The bladder muscle, in a bladder that is functioning in the correct manner, stays relaxed as the bladder begins to fill, with the desire to urinate beginning to form when it’s around half full, though the desire is usually not immediately urgent.

With urge incontinence however, the bladder can feel as though it is fuller than it really is; it contracts at an earlier stage than necessary resulting in a sudden and alarming need to urinate and even possible early leaking. Urge incontinence is more common in older people and is also believed to be associated with stress, alcohol and caffeine, although in some cases it can be linked to more serious causes such as stroke, multiple sclerosis, and Parkinson’s disease.

The ATOMS device

The ATOMS device, also known as the adjustable transobturator male system, can help to treat men suffering from incontinence after invasive prostate treatment. A recent study, assessing the efficacy and long-term safety of the device, has found an overall success rate of 90 percent after 31 months, as well as a 64 percent dry rate.

There are some major advantages to the ATOMS device in comparison to other options; dislocation is prevented by the the fixed anchoring as well as the adjustability of the outpatient setting. The most recent generation of the devices came with the non-disturbing and small scrotal port system, which is fully covered with silicon, and demonstrated excellent results with a short median operating time of 26 minutes, and overall ease of implantation. The median daily pad use and test fell from 4 and 400ml to just 1 and 18ml respectively for patients, resulting in a significant improvement in their quality of life.

The survey results leave little doubt that the ATOMS device will play a major future role in the treatment of male stress urinary incontinence.

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