Impotence

What is impotence (erectile dysfunction)?

Impotence is the inability to achieve or maintain an erection sufficiently rigid for sexual intercourse, ejaculation, or both. Sexual drive and the ability to have an orgasm are not necessarily affected. Because all men experience erection problems from time to time, doctors consider impotence to be present if attempts at intercourse fail on at least 25% of attempts.

Impotence is not new in medicine or human experience, but it is not easily or openly discussed. Cultural expectations of male sexuality inhibit many men from seeking help for a disorder that can, in most cases, benefit from medical treatment. The term "impotence" comes from Latin and means loss of power; a more accurate term is "erectile dysfunction." The condition is normal and usually temporary, so it is highly unfortunate that the common term for it implies a sweeping diminution in a man's overall capabilities.

The Penis and Erectile Function
The Structure of the Penis. The penis is composed of the following structures:

  • Two parallel columns of spongy tissue called the corpus cavernosa, or erectile bodies.

  • A central spongy chamber called the corpus spongiosum, which contains the urethra, the tube that carries urine from the bladder through the penis.

These structures are made up of erectile tissue. Erectile tissue is rich in tiny pools of blood vessels called cavernous sinuses. Each of these vessels are surrounded by smooth muscles and supported by elastic fibrous tissue composed of a protein called collagen.

Erectile Function and Nitric Oxide. The penis is either flaccid or erect depending on the state of arousal. In the flaccid, or unerect, penis, the following normally occurs:

  • Small arteries leading to the cavernous sinuses contract, reducing the inflow of blood.

  • The smooth muscles regulating the many tiny blood vessels also stay contracted, limiting the amount of blood that can collect in the penis.

During arousal the following occurs:

  • The man's central nervous system stimulates the release of a number of chemicals, including nitric oxide, which is now considered the main contributor for eliciting and maintaining erection.

  • Nitric oxide stimulates production of cyclic GMP, a chemical that relaxes the smooth muscles in the penis. This allows blood to flow into the tiny pool-like cavernous sinuses, flooding the penis.

  • This increased blood flow nearly doubles the diameter of the spongy chambers.

  • The veins surrounding the chambers are squeezed almost completely shut by this pressure.

  • The veins are unable to drain blood out of the penis and so the penis becomes rigid and erect.

  • After ejaculation or arousal, cyclic GMP is broken down by an enzyme called phosphodiesterase-5 (PDE5), and other compounds are released that cause the penis to become flaccid (unerect) again.

Important Substances for Erectile Health
A proper balance of certain chemicals, gases, and other substances is critical for erectile health:

Collagen. The protein collagen is the major component in structural tissue in the body, including in the penis. Excessive amounts, however, form scar tissue, which can impair erectile function.

Oxygen. Oxygen-rich blood is one of the most important components for erectile health. Oxygen affects two substances that are important in achieving erection:

  • Oxygen suppresses transforming growth factor beta 1 (TGF-B1). TGF-B1 is a component of the immune system called a cytokine and is produced by smooth muscle cells. It appears to stimulate collagen production in the corpus cavernosum, which can lead to erectile dysfunction.

  • Oxygen enhances the activity of prostaglandin E1. Prostaglandin E1 is produced during erection by the muscle cells in the penis. It activates an enzyme that initiates calcium release by the smooth muscle cells, which relaxes them and allows blood flow. Prostaglandin E1 also suppresses production of collagen.

Oxygen levels vary widely from reduced levels in the flaccid state to very high in the erect state. During sleep, oxygen levels are high and a man can normally have three to five erections per night, each one lasting from 20 to 40 minutes.

Testosterone and Other Hormones. Normal levels of hormones, especially testosterone, are essential for erectile function, though their exact role is not clear.

Testosterone and Other Hormones. Normal levels of hormones, especially testosterone, are essential for erectile function, though their exact role is not clear.

Testosterone and Other Hormones. Normal levels of hormones, especially testosterone, are essential for erectile function, though their exact role is not clear.

Erectile Dysfunction and Oxygen Deprivation

Erectile dysfunction most commonly occurs when the penis is deprived of oxygen-rich blood. When oxygen levels to the penis are low, an imbalance occurs in two important substances, TGF-B1 and prostaglandin E1:

  • TGF-B1 levels increase, which trigger production of collagen, a tough protein that forms all types of connective tissue, including scar tissue.

  • In addition, there is a reduction in prostaglandin E1, a chemical that suppresses collagen production and relaxes the smooth muscles to allow blood flow resulting in an erection.

When TGF-B1 levels increase and prostaglandin E1 levels decrease, smooth muscles waste away and collagen is overproduced, causing scarring, loss of elasticity, and reduced blood flow to the penis. A number of conditions can deprive the penis of oxygen-rich blood.

Blockage of Blood Vessels (Ischemia). The primary cause of oxygen deprivation is ischemia--the blockage of blood vessels. The same conditions that cause blockage in the blood vessels leading to heart problems may also contribute to erectile dysfunction. For example, when cholesterol and other factors are imbalanced, a fatty substance called plaque forms on artery walls. As the plaque builds up, the arterial walls gradually narrow, reducing blood flow. This process, known as atherosclerosis, is the major contributor to the development of coronary heart disease. It may also play a role in the development of erectile dysfunction.
Blockage of Blood Vessels (Ischemia). The primary cause of oxygen deprivation is ischemia--the blockage of blood vessels. The same conditions that cause blockage in the blood vessels leading to heart problems may also contribute to erectile dysfunction. For example, when cholesterol and other factors are imbalanced, a fatty substance called plaque forms on artery walls. As the plaque builds up, the arterial walls gradually narrow, reducing blood flow. This process, known as atherosclerosis, is the major contributor to the development of coronary heart disease. It may also play a role in the development of erectile dysfunction.
Blockage of Blood Vessels (Ischemia). The primary cause of oxygen deprivation is ischemia--the blockage of blood vessels. The same conditions that cause blockage in the blood vessels leading to heart problems may also contribute to erectile dysfunction. For example, when cholesterol and other factors are imbalanced, a fatty substance called plaque forms on artery walls. As the plaque builds up, the arterial walls gradually narrow, reducing blood flow. This process, known as atherosclerosis, is the major contributor to the development of coronary heart disease. It may also play a role in the development of erectile dysfunction.

Impotency and Cholesterol

In a totally unrelated development (unrelated to aging, that is), National Institute of Aging supported scientists from the University of South Carolina have found yet another compelling reason to avoid cholesterol. Men with lower blood cholesterol or higher amounts of the beneficial high-density lipoprotein (HDL) cholesterol may be less likely to develop erectile dysfunction or impotence. According to the researchers, atherosclerosis (hardening of the arteries), which may impede blood flow to and from the penis, is one primary cause of impotence. While a positive link between blood cholesterol and atherosclerosis, the association between cholesterol and impotence has only been suggested until now.

The South Carolina scientists conducted a study of more than 3,200 generally healthy men between the ages of 25 and 83. Data indicated that the men with total cholesterol over 240 milligrams per deciliter (mg/dl) of blood had nearly double the risk of penile dysfunction as men with readings of 180 mg/dl. A similar pattern held true in patients with significant amounts of HDL cholesterol. Those with HDL readings of 60 mg/dl or greater were one-third less likely to develop dysfunction than were men with less than 30 mg/dl HDL.

 

 

 

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