Erectile Dysfunction Causes and Treatments for ED

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 Erectile dysfunction (ED) is defined as “the persistent inability to achieve and/or maintain an erection for a satisfactory sexual performance.” ED is a common health problem. Researchers estimate that 50% of men between the ages of 40 and 70 will suffer from some form of ED, with 10% of those men being severely affected.

Fortunately, several ED treatments are available, including ED oral meds, injection, shockwave therapy, penile prosthesis, vacuum pumps, and lifestyle changes. However, it is essential to accurately diagnose ED’s cause to determine which treatment option is best. Read on to learn more about erectile dysfunction, the diagnostic tests used to identify the source of the problem, and available ED treatments.

 Dr. Kambiz Tajkarimi (Dr. Taj) is a board-certified urologist and high-volume penile prosthetic surgeon. He specializes in sexual health and wellness. He is internationally renowned for his extensive knowledge and expertise in sexual medicine and his development of medical devices that restore male and female sexual and urinary health. With nearly two decades of experience, Dr. Taj is the leading Urologist for ED treatments in northern Virginia and greater Washington DC.

 To understand the causes of ED, it is helpful to understand the physiology of an erection. Within the penis, two chambers run down the shaft of the penis. These chambers are known as the Corpora cavernosa. They contain a spongy material comprised of smooth muscles, fibrous tissue, and blood vessels.

Erections begin when the brain responds to visual or mental stimuli by sending chemical messages to the nerves inside the penis. This initiates a hormonal response that relaxes the soft-tissue muscles within the corpus cavernosum, allowing arteries to dilate (open.) This allows blood to flow in and fill the spongy tissue of the chambers.

Simultaneously, veins within the chambers close, ensuring more blood flows into the penis than flows out. Increased blood pressure causes the penis to expand and become firm. After orgasm, the brain sends signals that cause the muscle tissue within the penis to constrict (tighten.) This blocks the blood flow to the arteries and opens the veins to allow the blood to flow out. This reverses the erection, and the penis becomes soft. Dr. Tajkarimi performs penile duplex ultrasound in the clinic to identify exact causes of erectile dysfuntion in your first visit.  

 According to findings published in the Journal of clinical and diagnostic research, “The most common cause of organic erectile dysfunction is vasculogenic causes.” 1 Vascular causes include abnormalities of the arteries (lack of sufficient blood flow into the penis) and/or veins (excessive drainage of blood, known as venous leakage.) Arterial problems are typically caused by the hardening of the arteries (arteriosclerosis.)

Neurological dysfunction is thought to be the second most prevalent cause of ED. Another common culprit of ED is a hormonal deficiency when the body does not produce enough testosterone. This condition is known as hypogonadism. Lastly, impotence may be a side effect of certain medications used to treat allergies, depression, or high blood pressure. 

 Dr. Taj utilizes a battery of diagnostic tests when evaluating patients for erectile dysfunction. These tests include:

Physical Examination – Dr. Taj will examine the penis and testicles for irregularities and nerve sensation. He will also take an in-depth medical history.

Blood and Urine Analysis – Lab work can identify diseases associated with ED or endocrine issues that cause low testosterone.

Ultrasound -According to a clinical study, “It is essential to differentiating between the vascular and nonvascular causes of the ED [to determine] appropriate management of the patient.” Ultrasound of the penis called Penile Doppler ultrasound testing is a helpful tool for determining vascular causes of ED. Ultrasound can also be used to diagnose Peyronie’s Disease.

 Before the penile ultrasound, a small needle will inject papaverine (prostaglandin E1) into your penis. The injections take 3 seconds. It is uncomfortable but easily bearable. The injected medicine dilates the arteries, increasing blood flow to induce erection. Once the penis is erect, Dr. Taj moves a doppler (a wand looking device) over your penis. Sound waves penetrate the penis to create a video of your blood vessel. This allows Dr. Taj to assess arterial blood flow (flow in) and venous blood flow (flow out) of the penis. It can also identify areas with scarring or tissue thickening. With this information, Dr. Taj can accurately prescribe an ED treatment best suited for your needs.

General health is strongly correlated with sexual function. Damage to the nerves or blood vessels (the top two causes of ED) is often caused by disease (such as diabetes, obesity, or high blood pressure) and lifestyle choices (such as alcoholism and cigarette smoking.) Therefore, Dr. Taj will recommend specific lifestyle changes to improve, restore, and preserve your erections by utilizing your natural pathways of erection.

A vacuum constriction device is a cylindrical pump that fits over the penis. The device pumps air out of the cylinder, creating a suction effect that draws blood into the penis, inducing an erection.

A penile prosthesis, also known as a penis implant, is a surgical solution for ED.  It is the most successful form of ED treatment with men who do not respond to oral ED medications.  Dr. Tajkarimi is one of the highest volume penile implant surgeons in the country.  He performs the minimally invasive implant with excellent cosmetic result and maximum length and girth preservation.  

ED medication is typically the first line of defense against erectile dysfunction. These meds are taken an hour before sexual activity. They consist of phosphodiesterase (PDE) inhibitors, which temporarily cure ED by enhancing nitric oxide, the chemical responsible for relaxing smooth muscles of the penis to improve blood inflow. Popular ED drugs include Viagra, Cialis, and Levitra.

Hormone replacement therapy (HRT) using bio-identical hormones is a safe, effective, and natural solution for improving sexual function caused by low testosterone (low T).

Many ED treatments offer palliative care, seeking to ease the symptoms of Erectile Dysfunction. Shockwave therapy, in comparison, is one of the few treatments that target the cause of ED. Shockwave therapy utilizes advanced acoustic wave technology to stimulate neovascularization (the creation of new blood vessels.) This improves blood flow to the penis.  Shockwave therapy can help a segment of patients suffering from ED.  Not all types of ED respond to shockwave therapy.  Since shockwave therapy is expensive and not covered by insurance, it is imperative that you see Dr. Tajkarimi for penile duplex ultrasound to assure you can benefit from this therapy or not.