
Erectile Dysfunction is the inability to obtain or sustain an erection suitable for satisfying sex. This can be a very alarming to a man and very psychologically disturbing. Many men feel embarrassed or alone in this struggle however it is extremely common. About half of middle aged men struggle with this to some degree.
Obtaining and sustaining an erection is actually a very complicated process involving many systems. A difficulty in any part can cause problems. This is a limited discussion of some of the more common causes. Often no one specific cause is to blame but a combination of many.
Anatomic: In some rare circumstances trauma or other causes could lead to damage to the penile arteries. In these instances there may be some surgical options to reroute blood flow to restore erections.
Psychological: Stress and anxiety have a strong effect on erections. Often this can be relational, personal or actually medical. Unfortunately the more one worries about the ability to perform the more stress involved and this can lead to a self-fulfilling prophecy.
Hormonal: Although not always a primary cause, change in testosterone levels can affect erections. Decreased libido and energy can lead to psychological stress and decreased sexual health and anxiety. Additionally there can be some direct effect on erection.
Medications: Not only do the diseases above lead to ED but often the medications used to treat these have side effects increasing erectile dysfunction.
Physiological:
Evaluation
Medications
Intermediate Options
Surgical Options
I believe that sexual health is an important part of overall health and needs to be addressed. Improving overall health will address the causative issues above. By addressing the root causes and not simply the downstream effect there is a better chance of RESTORING (not just placating) your natural sexual health and ensuring that you need the least amount of medications and interventions possible while achieving the best outcomes.
Peyronie’s disease is a curvature of the penis caused by a plaque or scar which causes contracture of that area and bending the penis.
There is currently no clearly defined mechanism or cause. It is often associated with trauma and our bodies reaction to this, whether one significant event or many small traumatic events. There have also been associations with connective tissue disorders such as Dupuytren’s contracture and even some medications.
As with many ill defined disorders there is no magic bullet yet for treating Peyronie’s. Several oral medications are used with some success in milder cases. For more bothersome cases injectible medications are often used to try and break up the plaque. Verapamil has been used with some good success but still lacks strong evidence in studies. There is one new medication which looks to be promising called Xiaflex and is now FDA approved specifically for treatment of Peyronie’s.