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Erectile dysfunction (ED) or impotence is the inability to achieve and maintain a full erection during sexual arousal. It affects an estimated 10-20 million men, including 25% of men older than 50.
The cause of ED can be primarily organic, psychogenic in nature, or a mixture of the two. In 85% of cases affecting men aged 50 and older, organic factors such as vascular disease and atherosclerosis of the penile artery are the cause.
These can include abnormal fears of the vagina, sexual guilt, fear of intimacy, or depression. ED may be situational (involving place, time or a particular partner), some perceived competitive defeat, or damage to self-esteem. Counseling may be required to resolve these issues. Psychological factors are strongly implicated if the patient has situational impotence, night or morning erections, or can achieve a firm erection by stimulation.
Viagra may help men who have been left impotent by prostate disease, diabetes or atherosclerosis, but some doctors are still prescribing it with caution, if at all. First, correct any lifestyle problems: reduce alcohol consumption, get sufficient exercise, watch what you eat, stop smoking, optimize your health, and improve your circulation with ginkgo, if needed. Don't use it with any form of heart disease. If you decide to try Viagra, discuss it with your spouse first and then work with your doctor to find the lowest effective dose. A 50mg tablet may be too little or too much.
Men get erections when sexual thoughts, originating in the brain, initiate a flow of nerve signals, some of which are parasympathetic, down the spinal cord to the arteries and smooth muscle in the penis. The arteries that supply the penis then dilate, and the muscles that control the two rods of sponge - like tissue filling the core of the penis - the corpora cavernosa and the corpus spongiosum - relax. As they relax, they allow the increased flow of blood through the penile arteries to fill the spongy space with blood. The increasing pressure in the penis compresses the veins that drain blood from the penis, preventing outflow. The more blood that fills the penis, the larger and harder the erection will be, because as long as blood is flowing through the arteries, the out flow remains severely restricted. The penis returns to a flaccid state when the penile arteries constrict, relaxing pressure on the veins and allowing the blood to drain out.
All these activities are under the control of NO molecules. The nerves that serve the spongy tissue and the penile arteries are rich in NO, so when you become sexually aroused, the NO rich nerves quickly convert L-arginine to NO. These NO molecules diffuse to nearby arteries and smooth muscle, causing them to dilate and relax. Erection is reversed by contraction of the arteries involved, and that in turn occurs with stimulation by other nerves (sympathetic), either with ejaculation, anxiety or other causes of inhibition.
NO can be activated by a number of common substances released from the nerves. Especially important is the neurotransmitter acetylcholine.
Laboratory analysis of 22 sexual enhancement products available in the United States found nine (41%) were properly labeled, contained the claimed ingredients, and were not spiked with the prescription drug Viagra. [Consumer Labs Report]
"Gingko biloba Extract in the Therapy of Erectile Dysfunction," M. Sohn and R. Sikora, Journal of Sex Education Therapy, Vol. 17, 1991, pp.53-61.
|Weak or unproven link|
|Strong or generally accepted link|
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Acetylcholine: A neurotransmitter widely distributed in body tissues with a primary function of mediating synaptic activity of the nervous system and skeletal muscles.
Adrenal Insufficiency: Also known as Adrenal Exhaustion or Low Adrenal Function, this is a condition where the adrenal gland is compromised in its production of epinephrine, norepinephrine, cortisol, corticosterone or aldosterone. Symptoms include primarily fatigue, weakness, decreased appetite with ensuing weight loss, as well as nausea, vomiting, abdominal pain, diarrhea or constipation, or increased pigmentation of the skin. Cortical insufficiency (low or no corticosteroids) produces a more serious condition called Addison’s Disease, characterized by extreme weakness, low blood pressure, pigmentation of the skin, shock or even death.
Aneurysm: Localized enlargement of an artery.
Anxiety: Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Atherosclerosis: Common form of arteriosclerosis associated with the formation of atheromas which are deposits of yellow plaques containing cholesterol, lipids, and lipophages within the intima and inner media of arteries. This results in a narrowing of the arteries, which reduces the blood and oxygen flow to the heart and brain as well as to other parts of the body and can lead to a heart attack, stroke, or loss of function or gangrene of other tissues.
Cardiovascular: Pertaining to the heart and blood vessels.
Cholesterol: A waxy, fat-like substance manufactured in the liver and found in all tissues, it facilitates the transport and absorption of fatty acids. In foods, only animal products contain cholesterol. An excess of cholesterol in the bloodstream can contribute to the development of atherosclerosis.
Diabetes Mellitus: A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
High-Density Lipoprotein: (HDL): Also known as "good" cholesterol, HDLs are large, dense, protein-fat particles that circulate in the blood picking up already used and unused cholesterol and taking them back to the liver as part of a recycling process. Higher levels of HDLs are associated with a lower risk of cardiovascular disease because the cholesterol is cleared more readily from the blood.
Hypertension: High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.
Hypothyroidism: Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Milligram: (mg): 1/1,000 of a gram by weight.
Multiple Sclerosis: Demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord, manifested by loss of normal neurological functions, e.g., muscle weakness, loss of vision, and mood alterations.
Neurotransmitters: Chemicals in the brain that aid in the transmission of nerve impulses. Various Neurotransmitters are responsible for different functions including controlling mood and muscle movement and inhibiting or causing the sensation of pain.
Parasympathetic: Usually Parasympathetic nervous system: Portion of the autonomic nervous system that is generally associated with increasing digestion and intestinal muscle activity; decreasing blood circulation and respiration.
Pituitary: The pituitary gland is small and bean-shaped, located below the brain in the skull base very near the hypothalamus. Weighing less than one gram, the pituitary gland is often called the "master gland" since it controls the secretion of hormones by other endocrine glands.
Prostate: The prostate gland in men that surrounds the neck of the bladder and the urethra and produces a secretion that liquefies coagulated semen.
Prostatectomy: Removal of the prostate gland.
Psychogenic: Of a psychological origin.
Syphilis: A sexually-transmitted disease, with symptoms in the early contagious stages being a sore on the genitalia, a rash, patches of flaking tissue, fever, a sore throat, and sores in the mouth or anus.