Penile erection

Two processes result in penile erection:
The penis touched directly experiences the reflex erection. Peripheral nerve and the lower parts of the spinal cord take part in the erection.
Erotic stimuli provide the psychogenic erection using the limbic system of the brain.
But a proper functioning nervous system is necessary as it stimulated the penis. Nitric oxide is releases and smooth muscles are relaxed. Smooth muscles are a part of the main tissue of the penis responsible for the erection – corpora cavernosa. The amount of testosterone and pituitary gland in the organism are also connected to the functioning of the erectile system.

Erectile Dysfunction

The first name of the erectile dysfunction was impotence. Both these terms define the inability of the penis to erect during sexual activity. In some cases a complete inability to achieve the erection is noticed while in others slight dysfunction is the problem.
There are some typical disorders that result in erectile dysfunction (ED) of impotence. They are neural and blood system disorders, hormonal deficiency and psychological troubles. Coronary artery diseases, long time exposure to bright light or high noise are less frequent but still possible reasons of impotence.

Erectile dysfunction can arise when a man is undergoing a treatment course and takes medications. Often nervous system is damaged by some drugs. Antihypertensives can change the blood circulation and therefore contribute to the development of the erection.

Surgeries that involve operations on the nerves and anatomical structures connected with erection influence the work of the nervous system and blood supply to the penis. According to some studies male circumcision may be a cause of erectile dysfunction while other studies have proved that circumcision improves the erectile ability.

Alcohol abuse was ranked as a cause of impotence long time ago and got the name “brewer’s droop”. Shakespeare described this disease in his Macbeth.

A few years ago bicycling was added to the list of the actions that cause erectile dysfunction. The saddle pressures the penis and on condition that a man used to riding a bicycle for a long time the risk to develop impotence increases.

Most men feel confused about erectile dysfunction and try to deny the problem instead of curing it.

They try to hide they problems behind the words “I’m tired today”, “I’ve worked too much today”, “It’s occasional”, “I’m not up to it”, “My partner is doing something wrong”, “I have too much stress in my life”, “I’m too concerned about other problems”.

Nevertheless impotence mild at first can develop in a complete inability to achieve the erection if not treated properly. Impotence is often connected with diabetes, arteriosclerosis and while treating ED these diseases are also cured.

The Erection Mechanism
The erection mechanism can be described as a several stage process:
Release of nitric oxide - activation of the enzyme guanylate cyclase - rise in the amount of cyclic guanosine monophosphate (cGMP) - relaxation of the smooth muscle in the corpus cavernosum - inflow of blood.

When the male gets sexually stimulated smooth muscles of the corpora cavernosa relax and arterioles become dilated. Blood is supplied to the penis and its backflow is delayed as veins narrow under pressure. The penis elongates and thickens. Then the erector muscle moves the penis upward.

Causes of Erectile Dysfunction
80% of all cases of impotence were a result of physical diseases. Among them are vasculare and metabolic disorders, hormonal problems, smoking and alcohol abuse, sedentary lifestyle, cancer treatment and intake of other medication.
Other 20% were caused by psychological disorders (anxiety, stress, depression).

Erectile Dysfunction Diagnosis
No test defining ED is available. To identify the case and find the reason it’s necessary to undergo several tests that examine the functioning of systems connected with the erectile ability.

Blood tests provide the necessary information about the level of male hormones in the blood and identify diseases such as diabetes mellitus is present.
Nerve sensation in the penis can be examined by several physical tests.
Ultrasound helps to make sure that blood circulates properly in the penis.
Other tests measure penile rigidity and girth during nocturnal erections.
Cavernosometry is undertaken to measure vascular pressure.

Treatment and Care:

There several traditional and proven medications
Oral Medication
PDE6 inhibitors sildenafil (Viagra®), vardenafil (Levitra®) and tadalafil (Cialis®) are prescribed as drugs that stop cGMP degradation by blocking PDE5.

Oral Medication (herbal remedies)
These medications are taken orally before sexual intercourse. Herbal remedies do not have any side effects as they are usually a mixture of herbs, vitamins and minerals. For example – ProCalisX.

Vacuum pump:
Vacuum pump is and external device that makes the penis engorged. The penis ring that maintains the engorged penis should be removed in a half an hour. The erection differs from a natural one (the penis is less hard and rigid) that’s why a lot of men prefer to use drugs and injections if they work. Controversial results can’t provide a proper estimation of the vacuum pump effectiveness. 20% of men who tried a high-priced vacuum pump eventually bought it. But cheap vacuum pumps are doubtful to give a good result.

Sex counseling
There are special doctors and counselors that can help a couple to cope with difficulties that arise during the intercourse as well as a psychiatrist or psychologist can help to understand the problems in the relationships.

Injections:
Before the sexual intercourse a special injection that increases the blood inflow is made into the penis.

Intraurethral Therapy:
Pellets that contain medicine are embedded into the urethra.

Vacuum therapy
A vacuum device stimulates the blood flow into the penis and the ring maintains this state.

Penile Implant Surgery:
A special device used in the process of sexual interaction is implanted surgically into the penis.

Unapproved Treatment

hMaxi-K is a gene therapy. During the therapy hSio gene responsible for encoding of the alphs-subunit of the Maxi-K channel is expressed.

Bremelanotide was formerly called PT-141. It does not affect the vascular system but increases the sexual desire in both men and women. When bremelanotied is spayed in (it is issued as a nasal spray) melanocortin receptors activates in the brain.

Herbal and other treatments
They are highly ranked for their placebo effect and can be effective only when the patient expect a good result.

Ginseng
Ginseng is considered to be better than placebo.

Precaution or Cure?
Before undergoing medical treatment a lifestyle of the person can be changes. Simple changes made in everyday life may prevent the development of the erection.
Exercises, diet, and stress management are recommended along with cutting down on alcohol and quitting smoking.