Erectile Dysfunction, Who Is To Blame?

Erectile dysfunction (ED), also known as impotence, is a form of sexual dysfunction defined as the inability of the penis to attain or retain an erection during sexual intercourse. The most common treatment for this is Viagra made by Pfizer, but you can also get Cilais/Tadalafil, Levitra and Spedra. You can read about the difference here.

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Research shows that ED is quite common with almost 40% of males suffering or having suffered from it, at least occasionally. It is very likely that most men will experience a form of impotence in their lifetime. However, this is generally due to psychological effects, such as social concerns or anxiety. It is therefore only regarded and diagnosed as a treatable medical condition if the symptoms persist.

So how does ED happen?

BrainUnder normal physiological conditions, the sexually-aroused brain transmits signals to penile nerves. These signals induce the release of neurotransmitters triggering a rush of blood towards the sponge-like penile body, causing a hydraulic effect as blood enters and is retained there.

In instances of erectile dysfunction, this mechanism is altered as signals passing from the brain to penile nerves are either interrupted or sporadic. Physical problems with blood vessels and with the tissue of the penis could also interfere with an erection.

Erectile dysfunction can be divided into two broad categories, medical and psychological:

  • Medical impotence – This is directly caused by medical conditions such as cardiovascular disease, diabetes, hormonal disturbances, etc. which physically impair the body’s ability to have an erection.
  • Psychological impotence – rather than being caused by physical factors, dysfunction is indirectly caused by psychological effects like thoughts, feelings, social relationships, or in some cases due to the indirect psychological impact of underlying medical conditions such as depression.

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Causes of Erectile Dysfunction

Though impotence or ED can be attributed to a number of factors, some of the most commonly observed medical and psychological factors are listed below:

  1. Drugs, smoking, substance abuse and alcoholism:

Anti-depressants like SSRIs and nicotine are the biggest causative factors under this category. In a research paper, it was shown that patients receiving duloxetine or paroxetine as a part of anti-depressant medications had a much higher incidence of emergent sexual dysfunction as compared to those treated by a placebo.

Stop SmokingSmoking causes arterial constriction, alters male sex hormones, causes a reduction in sperm quality and a reduced response to fertility treatments, all factors bringing on or further worsening symptoms of ED.

Drinking too much alcohol can also be a cause of erectile dysfunction, and this is especially true in the older male population. In the short-term, drinking before sex can bring on anxiety, making it difficult to attain and maintain an erection. Long-term alcohol consumption affects body systems and has a causative link to sexual dysfunction, including erectile dysfunction.

Substance abuse causes the body to undergo hormonal changes which makes it difficult to attain or sustain an erection. Certain drugs impair the bodies vascular and nervous systems, including those associated with attaining erections, thus directly instigating erectile dysfunction.

  1. Cardiovascular disease:

Cardiovascular disease may often lead to atherosclerosis, which is a sort of narrowing or clogging of arteries (due to thickening of the artery walls). This could occur in the penis and is a common cause of erectile dysfunction. An associated problem with cardiovascular function – hypertension or high blood pressure – can damage arteries throughout the vascular system thus restricting the needed amount of blood flow to in order to maintain an erection.

  1. Ageing:

Ageing is one of the chief culprits behind erectile dysfunction. Men of the 60s age group are four times as likely to face ED complications than their 40s demographic counterparts. Age has a direct detrimental effect on the penile tissue. Over time, the concentration of elastic fibres and smooth muscle fibres around the penis, both of which play an important role in erectile function, are reduced.

Age-related conditions like diabetes mellitus, atherosclerosis, etc. are more likely as a person gets older, thus potentially leading to ED. Body systems in general gradually degrade with age, leading to reduced sexual function and possibly erectile dysfunction.

  1. Hormonal Imbalance:

This is an important causative factor accounting to a considerable number of cases of ED. Liver and kidney diseases may lead to hormonal disorder. Testosterone deficiency (due to hypogonadism) results in loss of libido (your sex drive!) and the subsequent loss of an erection. Some other hormonal disorders associated with ED are pituitary tumours, oestrogen or anti-androgen therapy, Cushing syndrome, Addison disease, etc.

Recent research suggests that being overweight or obese can lead to the hormonal imbalances which cause ED. However, the link between ED and hormonal imbalance remains obscure and requires more research for a causative link to be established.

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Product Description

How does Viagra and Sildenafil work?

Viagra (Sildenafil) helps men to get and maintain an erection when sexually stimulated and/or excited. The medicine relaxes the blood vessels in the penis which results in more blood flowing to the penis when you are sexually excited.

How do I take it?

You should take Viagra (Sildenafil) approximately 1 hour before planning to have intercourse. Within a window of between 30 minutes and 4 hours after you take the medicine, it will be easier to keep and maintain an erection when you are sexually excited. If you take this medicine after a meal with a high fat content it may take a little longer to start working. This medicine will only work when you are sexually excited. You won’t get an erection just by taking Viagra (Sildenafil).

Dosage

The standard recommended dose for Viagra (Sildenafil) is 50mg and this will be suitable for most people.  If this dose is not effective, you can try 100mg and if 50mg gives you side effects you can also reduce the dose to 25mg tablets.

You must not take more than 100mg daily of Sildenafil/ Viagra. Clinical trials have been conducted in patients taking up to 200mg sildenafil and it was found that ‘doses of 200mg did not result in increased efficacy but did increase the incidence of adverse reactions (headache, flushing, dizziness, dyspepsia, nasal congestion, and altered vision).’

In addition, in patients taking more than 100mg daily, there have been reports of rhabdomyolysis (a breakdown in skeletal muscle tissue the byproducts of which can lead to kidney failure), visual perception changes, vertebral artery dissection (a tear in the artery supplying blood to the brain), heart attacks and aggressive behaviour.

If the 100mg strength doesn’t work for you, there may be alternatives you can try and we recommend that you call us for a free consultation with our pharmacist or doctor to discuss any underlying conditions you may have. We recommend that all men taking medicine for erectile dysfunction have regular tests for blood pressure, cholesterol, diabetes and hormone imbalances. For instance, it may be that by fixing a hormone imbalance such as testosterone, your Viagra medication will be even more effective.

In addition, drug manufacturers do not advise patients to split tablets in half to get the correct dosage as they cannot guarantee that the active ingredient will be distributed evenly throughout the tablet.  For instance, if you cut a 100mg tablet in two, you may find that you get 80mg in one half of the tablet and 20mg in the other half leading to either an overdose (increased risk of side effects) or a suboptimal dose (the medication may not work).

It is important that you choose the correct dose for you. If you wish to talk to our pharmacist or doctor about this, please contact us in the pharmacy on 01625 460621 or email [email protected]

Side Effects

Viagra (Sildenafil) is normally well tolerated, however, side effects can include:

  • Headache
  • Dizziness
  • Nausea

Side effects normally subside after a few hours, however, if you experience a prolonged or painful erection (longer than 4 hours), then you must contact your doctor immediately.

Drug interactions

There are a number of medicines which interact with Sildenafil/ Viagra. For an exhaustive list please see the patient information leaflet (see section below) or call us in the pharmacy to discuss your specific situation. The main drug interactions are listed here:

Recreational drugs such as ‘poppers’ or amyl nitrate
Alpha blockers used for urinary retention or blood pressure problems (eg Flomax or Cardura)
Anti- arrhythmic drugs such as disopyramide
Antibiotics such as erythromycin
Antifungals such as itraconazole
Antivirals such as drugs used to treat HIV
Bosentan
Cobicistat
Calcium channel blockers to treat blood pressure and angina such as amlodipine
Dapoxetine (Priligy – used to treat premature ejaculation)
Grapefruit juice**
Nicorandil
Nitrates
Riociguat
Cimetidine (to treat stomach ulcers)

Please do not take Sildenafil/Viagra if you have taken any of the above drugs within the last 60 days without first consulting with either us in the Pharmacy ([email protected] / 01625 460621) or via email with our doctor [email protected]

**We advise not to take Sildenafil/Viagra with grapefruit juice as the blood concentration of Sildenafil will possibly be increased resulting in side effects.

Patient Information Leaflets

Please click here for the patient information leaflet for Viagra.

For Actavis Sildenafil please see the following leaflets: 100mg, 50mg, 25mg.

Storing Medicines Safely

Please keep your medicine out of the reach of children and store at room temperature.  Unwanted medicine can be disposed of by returning it to any local pharmacy or indeed to us here for us to dispose of it for you.

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  1. Psychological factors:

Some of the psychological factors that may lead to impaired erectile function include the following: performance anxiety, anticipation, anger, problems in the marital relationship, depression, mental disorder, panic, personality disorder, poor self-esteem, job loss, failure, and so on. ED, in turn, can itself further contribute to these problems, thus further worsening the situation. The location you’re in while engaging in sexual intercourse, or the partner you’re with, are both known to be causes of psychological ED.

  1. Diabetes:

Although studies are incomplete regarding diabetes and its link to ED, diabetic neuropathy, which causes damage to the nerves of the body (including those around the penis), could be a major cause for ED. Studies show that 35-75% of diabetic patients encounter erectile issues, a considerably higher number than in non-diabetics.

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  1. Cavernosal disorders:

The spongy bodies of the penis responsible for the erection by filling up with blood are known as corpora cavernosa. In about 5% of men, this tissue is damaged due to a disease known as Peyronie’s disease, which involves the growth of scar tissue and of fibrous plaques. This directly prevents the penis from achieving an erection due to damaged tissue. The causes for Peyronie’s disease is not well understood, but experts suggest trauma to the penis due to sexual activity or other.

  1. Surgery and Radiation Therapy:

Accidental damage might occur to the nerves and blood vessels involved in erection during surgery related to the colon, prostate, bladder or rectum. Similarly, radiation therapies to treat certain types of prostate or bladder cancer might damage the nerves responsible for erections.

  1. Other possible factors: Bicycling, Multiple Sclerosis, and Arsenic Poisoning

Research has suggested that bicycling, due to the compression and pressure-related changes it causes, can lead to erectile dysfunction. Additionally, multiple sclerosis (and possibly other neurological disorders such as Alzheimer’s) is linked to nerve damage and blood flow impairments, which can damage erectile function.

Interestingly enough, new research suggests that arsenic exposure through water consumption can cause ED. Though this relationship has not been evaluated in depth, a research paper (based on a study in Taiwan) has established clearly the impact of arsenic exposure on ED by alteration of potassium gated voltage channels, inhibition of sex hormones and reduction of NOS (nitric oxide synthase) levels. This impairs the functions of penile smooth muscle and blood vessels leading to ED. It was shown that prevalence of ED was much greater in the arsenic-contaminated area (83.3%) than in the non–arsenic-contaminated one (66.7%). [5]

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Conclusion

ED is a common medical problem affecting a large portion of the male population. Experts suggest that ED will become even more prevalent in the foreseeable future, so more exposure on this subject is important. Evidence suggests that erectile dysfunction is both a psychological and medical problem, although it can be, at times, a marker of other underlying medical conditions such as diabetes or occult cardiovascular disease.

With the advancement in research, earlier perceptions that ED is caused mainly by psychological reasons have shifted to an increased focus on medical causes. However, these categories are not entirely mutually exclusive, and in many instances, the physiological and medical causes will overlap.

Whatever the case, it is essential for society today to confront the social stigma of ED and focus on supporting the ongoing research on this topic. Do not be shy or embarrassed to discuss your ED with your doctor – this issue is a lot more common than you probably think.

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References:

  1. Delgado PL, Brannan SK, Mallinckrodt CH, Tran PV, McNamara RK, Wang F, Watkin JG, Detke MJ (2005). “Sexual functioning assessed in 4 double-blind placebo- and paroxetine-controlled trials of duloxetine for a major depressive disorder.”

http://www.ncbi.nlm.nih.gov/pubmed/15960560

  1. Peate I. “The effects of smoking on the reproductive health of men.”

http://www.ncbi.nlm.nih.gov/pubmed/15924009

  1. Armenian Medical Network. “Male Sexual Dysfunction Epidemiology”

http://www.health.am/sex/more/male_sexual_dysfunction_epid/

  1. Medical News Today. Markus MacGill.

http://www.medicalnewstoday.com/articles/5702.php

  1. Fang-I Hsieh, Ti-Sheng Hwang, Yi-Chen Hsieh, Hsiu-Chiung Lo, Chien-Tien Su, Hui-Shing Hsu, Hung-Yi Chiou, and Chien-Jen Chen. “Risk of Erectile Dysfunction Induced by Arsenic Exposure through Well Water Consumption in Taiwan.”

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291004/

  1. Armenian Medical Network. “Male Sexual Dysfunction Epidemiology”

http://www.health.am/sex/more/causes_of_erectile_dysfunction/

  1. http://www.medicinenet.com/impotence/symptoms.html

 

Assured Pharmacy is not liable for the currency or accuracy of the information contained in this blog post. For specific information about your personal medical condition, please contact our doctors or pharmacists for advice on [email protected].