Erectile dysfunction
[14] ED is characterized by the persistent or recurring inability to achieve or maintain an erection of the penis with sufficient rigidity and duration for satisfactory sexual activity.
[14] It is defined as the "persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months.
[16] Causes of or contributors to ED include the following: Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply.
Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system.
As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems.
[4] Obtaining full erections occasionally, such as nocturnal penile tumescence when asleep (that is, when the mind and psychological issues, if any, are less present), tends to suggest that the physical structures are functionally working.
[4] In some cases, the simple search for a previously undetected groin hernia can prove useful since it can affect sexual functions in males and is relatively easily curable.
Before the Doppler sonogram, the penis should be examined in B mode, in order to identify possible tumors, fibrotic plaques, calcifications, or hematomas, and to evaluate the appearance of the cavernous arteries, which can be tortuous or atheromatous.
The use of prostaglandin E1 is contraindicated in patients with predisposition to priapism (e.g., those with sickle cell anemia), anatomical deformity of the penis, or penile implants.
Some authors recommend the use of sildenafil by mouth to replace the injectable drugs in cases of contraindications, although the efficacy of such medication is controversial.
After injection, systolic and diastolic peak velocities should increase, decreasing progressively with vein occlusion and becoming negative when the penis becomes rigid (see image below).
[12] Medications by mouth and vacuum erection devices are first-line treatments,[10]: 20, 24 followed by injections of drugs into the penis, as well as penile implants.
[54] Additionally, a cream combining alprostadil with the permeation enhancer DDAIP has been approved in Canada as a first line treatment for ED.
[56] Focused shockwave therapy involves passing short, high frequency acoustic pulses through the skin and into the penis.
When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the base of the penis to maintain it.
[66] Often, as a last resort, if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.
[78] In the early 20th century, medical folklore held that 90-95% of cases of ED were psychological in origin, but around the 1980s research took the opposite direction of searching for physical causes of sexual dysfunction, which also happened in the 1920s and 30s.
[79] The first successful vacuum erection device, or penis pump, was developed by Vincent Marie Mondat in the early 1800s.
Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley dropped his trousers and demonstrated to a shocked Urodynamics Society audience showing his papaverine-induced erection.
[82] The current most common treatment for ED, the oral PDE5 inhibitor known as sildenafil (Viagra) was approved for use for Pfizer by the FDA in 1998, which at the time of release was the fastest selling drug in history.
[88] A common theme amongst the interviewees showed that respectable older males shifted their focus toward the domestic sphere into a "second stage of life".
[88] The Mexican males of this generation often pursued sex outside of marriage; decreasing erectile function acted as an aid to overcoming infidelity thus helping to attain the ideal "second stage" of life.
[88] Wentzell found that treating ED as a pathology was antithetical to the social view these males held of themselves, and their purpose at this stage of their lives.
In offering a range of clinical treatments to 'correct' a person's ability to produce an erection, biomedical institutions encourage the public to strive for prolonged sexual function.
Anthropologists argue that a biomedical focus places emphasis on the biological processes of fixing the body thereby disregarding holistic ideals of health and aging.
[89] In rejecting biomedical treatment for ED, males can challenge common forms of medicalized social control by deviating from what is considered the normal approach to dysfunction.
