Erectile Dysfunction (ED) is defined as inability to attain or sustain an erection satisfactory for sexual intercourse. It affects over 50% of men between the ages of 40 and 70, and gets more prevalent with advancing years. Causes may be vascular, neurogenic, hormonal and psychological as well as drug use and abuse.
The four basic requirements for a satisfactory erection are psychological drive (libido), neurological signals via the spinal cord (to and from the genitalia), an uninterrupted blood supply to the penis and functional target tissue in the penis. Any significant pathophysiology of any of these systems may result in ED.
Primary ED is where the man has never had an erection. It is rare and the cause may be anatomical (congenital or traumatic) or psychological (a sense of guilt, fear, or depression).
Secondary ED is much more common and 80% of the causes are organic. The majority of these are either vascular or neurological. However, although atherosclerosis, often with diabetes, heads the list, psychological negativity creeps in with time to complicate matters. Various arterial diseases can affect various sites along the supply-route of blood from the heart to the penis, causing blockages that range from partial to total occlusions of the aorta and its major branches (by atheroma, dysphasia or dissection) to small vessel disease, pathognomonic of diabetes. Diabetes Mellitus (sugar diabetes) may also contribute to ED by effecting a "neuropathy" of the autonomic nervous system supplying the genitalia. Further, most men with spinal cord damage (disease or trauma) suffer from ED; which can also arise as a complication of prostate surgery and structural penile disease (Peyronie's).
Endocrine and hormonal changes as well as intake of various drugs may cause ED. The commonest two groups of culprit drugs are those for the central nervous system (especially amphetamines) and anti-hypertensives.
Having dual expertise in both vascular medicine and stem cell technology, we at the Mississippi Stem Cell Treatment Center (MSCTC) in Ocean Springs, see and treat patients with ED. We follow a methodical approach to diagnosis; and we carry out basic screening to rule out possible causes, including measuring testosterone levels.
Phosphodiesterase inhibitors (Viagra and others) are very popular and work, so long as there are no serious arterial blockages or nerve damage. They work through the mediation of nitric oxide in the small vessel walls, dilating them and increasing the blood supply to the penis, causing tumescence. They can cause significant hypotension, and are not recommended for men with ischemic heart disease. Arterio-occlusive disease of the larger vessels carrying blood from the heart to the genitalia is often amenable to treatment by balloon angioplasty (with or without stenting) or by surgical bypass or replacement of the culprit vessel. Mechanical pump devices and surgical implants are used as a last resort. They carry the common risks of all foreign bodies- primarily infection.