What is erectile dysfunction?

Erectile dysfunction (previously called impotence) is the inability to get or maintain an erection that is sufficient to sustain satisfactory sexual activity for both partners.

How common is erectile dysfunction and what age group is more susceptible? 

There are no current statistics available for Kenya, but in America about 10% of men are believed to be affected. While erectile dysfunction can occur at any age, it is more common among elderly men than in young men. By age 45, most men have experienced erectile dysfunction at least once. Incidence increases with age: about 5% of men at the age of 40 and between 15 and 25% of men at the age of 65 suffer from erectile dysfunction and the percentage grows to 70% as men reach 80 years of age. As men age, they typically report some loss of sexual desire as well, although neither loss of desire nor erectile dysfunction is an unavoidable feature of ageing.

What makes an erection problem occur? 
The brain is the main sex organ. An erection begins with sensory and mental stimulation. Impulses from the brain travelling down the spinal column and impulses from the nerves in the penis relax smooth muscles in two spongy cylinders that run the length of the penis, parallel to the urethra. When the impulses cause the muscles to relax, blood flows into spaces in the spongy tissue, and this pressure makes the penis swell out. A membrane surrounding the cylinders helps to trap the blood in the penis and maintain the erection. The penis returns to its flaccid state if the muscles contract, stopping the inflow of blood and opening outflow channels. An erection problem can occur if any of the events in this sequence are disrupted: the problem may involve mental processes, nerve impulses, or responses in muscles, fibrous tissue, veins and arteries in the penis.

What are some of the risk factors for erectile dysfunction? 

The common risk factors for erectile dysfunction include advanced age, cardiovascular disease, diabetes mellitus, high cholesterol, cigarette smoking, recreational drug use, anxiety, depression or other psychiatric diseases.

What are the causes of Erectile Dysfunction?

1. Physical causes of Erectile Dysfunction
Damage to blood vessels, smooth muscles and fivrous tissues of the penis are the commonest physical causes of Erectile Dysfunction. Blood vessels problems contribute 48% of erection problems while those of the nerves account for 14% and those of the structure of the penis or surrounding tissues account for 3%. Below is a list of underlying factors which lead to above problems: -

• Diseases affecting the whole body account for 70% of physical causes. These may include diabetes, kidney disease, and multiple sclerosis. Arteriosclerosis or "hardening of the arteries" can prevent adequate blood from entering the penis.
• Injury to the penis, spinal cord, prostate, bladder or pelvis: such injury can be the result of sports or car accidents, or even riding on hard bicycle seats. 
• Complications of surgery or radiation (for example, for prostate cancer): these can interfere with nerve impulses or blood flow to the penis. When the nervous system cannot transmit arousal signals, or when the blood vessels in the penis cannot fill or stay filled with blood, you cannot have an erection. 
• Side effects of common medication: these include drugs taken for high blood pressure, antidepressants, antihistamines, tranquillisers, appetite suppressants, and the ulcer drug cimetidine. • Substance abuse: chronic use of alcohol, marijuana or other drugs often causes impotence, which may be aggravated by decreased sexual drive. Excessive tobacco use can also block penile arteries. 
• Hormonal factors, such as low testosterone levels. 
• Zinc deficiency.

Erection problems in men over 50 are more likely to have physical causes.

2. Psychological causes

Psychological problems, such as anxiety, interfere with the erection process by distracting the man from things that would normally arouse him. These problems cause between 10 and 40% of erectile dysfunction. Even in cases where the underlying problem is physical, these factors can play an important secondary role, for example when a man who has had some erectile difficulty starts to anticipate and fear sexual failure. As a result, psychological factors play some causal role in at least 80% of cases of erectile dysfunction. These factors include:

• Depression: erectile dysfunction is twice as likely among men suffering from depression as it is among those without depressive symptoms.
• Relationship problems: a man who loses sexual interest in or desire for a particular partner may develop erection problems. 
• Anxiety and stress, including that caused by major life changes. 
• Grief and other reactions to major loss: recently widowed men may have erection problems. 
• Low self-esteem

It is important to note that Erection problems in men under 50 are more likely to be due to psychological causes while they are physical in men over 50.

Our final post on Erectile Dysfunction will be covering Diagnosis and Treatment. We also wish to remind all that our Men’s Health Awareness Open Day will be taking place on Saturday 24th June 2017 (7 days to go) at the Outspan Medical College. Share widely with your friends, family and contacts.