Erectile dysfunction, also called impotence, is defined as a man’s inability to get an erection or maintain it long enough to have sex with a partner. For some men, impotence means they are unable to ejaculate during sex.

Erectile dysfunction or impotence happens to most men at one time or another, but studies indicate that erectile dysfunction is more common in older men, so it is often associated with the aging process in men.

Occasional impotence is often not seen as a problem, but when impotence continues for awhile, it can bring on great emotional distress for both the man and his partner.

Common Causes of Impotence or Erectile Dysfunction

Erectile dysfunction can be caused by emotional problems:

• Worry
• Fear
• Stress
• Anger
• Depression
• Lack of interest in sex, or in the sexual partner

Erectile dysfunction can also have physical causes:

• Reduced testosterone level, which can be treated with hormone therapy
• A side-effect from some medications, including meds for depression, heart disease, high blood pressure and epilepsy
• An injury to the groin, or nerve damage
• Illnesses including kidney or heart disease, or diabetes, can cause erectile dysfunction
• A reduction in blood flow to the penis, common in men who have hardening of the arteries
• Overuse or abuse of drugs including alcohol, tobacco and recreational drugs
• A possible side-effect of some medical procedures, including prostate or urinary tract surgery

Source: About.com

Men with type 2 diabetes who have difficulty achieving an erection could have heart disease and not realize it, according to a report in today's rapid access issue of Circulation: Journal of the American Heart Association.

Men who had silent, or symptomless, coronary artery disease (CAD) and type 2 diabetes were nine times as likely to have erectile dysfunction (ED) as were diabetic men who did not have silent heart disease.

"If our findings are confirmed, erectile dysfunction may become a potential marker to identify diabetic patients to screen for silent CAD," said lead researcher Carmine Gazzaruso, M.D., an internal medicine specialist at Maugeri Foundation Hospital in Pavia, Italy.

Erectile dysfunction and coronary atherosclerosis (narrowing of the coronary arteries) are frequent complications of diabetes, and the association between erectile dysfunction and overt or symptomatic CAD is well documented. However, many diabetic patients have asymptomatic (silent) CAD and are unaware of their heart disease risk. This is the first study to evaluate the prevalence of erectile dysfunction among men with type 2 diabetes and silent heart disease, researchers said.

"Silent CAD is a strong predictor of coronary events and early death, especially in diabetic patients," the investigators noted. "So, it is of interest to know clinical conditions associated with silent CAD to identify subjects who should be screened for CAD."

To evaluate potential associations between ED and silent coronary artery disease, the Italian group studied 133 men who had uncomplicated diabetes and silent coronary artery disease documented by coronary angiography, a test that produces images inside the heart's blood vessels. They were compared with 127 diabetic men who did not have silent heart disease, as verified by a series of tests.

Men in the two groups were evaluated for ED by means of the International Index of Erectile Function (IIEF), a widely used questionnaire to determine a man's ability to achieve erections. The IIEF was administered to all of the men as part of routine ED screening in the year prior to diagnosis or exclusion of silent CAD.

Diabetic men with and without silent CAD did not differ with respect to current forms of treatment. They also had similar rates of diabetic retinopathy, a diabetes complication that correlates with the severity of the disease.

Among the diabetic men with silent CAD, 33.8 percent had ED, compared to 4.7 percent of diabetic men who did not have silent CAD. A statistical analysis that evaluated potential risk factors for silent CAD showed that ED was a better predictor than more traditional risk factors for CAD. Risk factors for silent CAD were apolipoprotein(a) polymorphism (genetic alteration affecting cholesterol), smoking, microalbuminuria (protein loss related to kidney function), and levels of HDL (good) and LDL (bad) cholesterol.

The findings have several potential implications for the evaluation and management of diabetic patients, Gazzaruso said. First, erectile dysfunction warrants consideration with other CAD risk factors, such as high blood pressure and cholesterol abnormalities, in deciding whether a diabetic man requires more extensive evaluation for coronary artery disease.

A second implication relates to treatment of erectile dysfunction in diabetic men. The availability of oral medications for ED has raised questions about their use in men with cardiovascular disease, not only because the drugs can affect blood pressure, but also because they permit formerly impotent men with heart disease to resume sexual activity. Gazzaruso and his associates suggest that diabetic men with erectile dysfunction might require an exercise test or other evaluation for silent CAD before starting erectile dysfunction medication.

As for the possible biologic or physiologic mechanisms that link ED and silent CAD, the investigators cite microalbuminuria and neurologic disorders as possible explanations. However, they emphasize that more studies are needed to determine the precise nature of the association.

Source: Science Daily

Mayo Clinic researchers report in the latest issue of Mayo Clinic Proceedings that there may be an association between lower urinary tract symptoms and sexual dysfunction among older men. As the population ages, this finding will help further research that could help millions of men.

Lower urinary tract symptoms become common as men age and their prostates enlarge, restricting urine flow or altering their bladder habits. At this same age (age 65 and older) an estimated 100 million men worldwide experience erectile dysfunction. The Mayo Clinic researchers set out to determine whether the urinary tract symptoms and sexual dysfunction are related or not.

"This observation suggests there may be a common cause that someday may prove amenable to medical treatments that could be effective for treating both conditions," says Steven Jacobsen, M.D., Ph.D., a Mayo Clinic researcher and the senior author of the study in the June 2004 issue of Mayo Clinic Proceedings.

The researchers studied 2,115 male patients in The Olmsted County Study of Urinary Symptoms and Health Status Among Men. The men, ages 40 to 79, completed questionnaires in 1990 and were followed up every two years. Dr. Jacobsen says the study in Mayo Clinic Proceedings is one of the few community-based studies to assess the relationship between the symptoms of sexual dysfunction and lower urinary tract symptoms. In contrast, other studies examined only the association between individual urinary symptoms and sexual life dysfunction and lower urinary tract symptoms in selected patients who underwent medical or surgical treatments.

The symptoms that were most strongly associated with sexual dysfunction included a feeling of urgency, having to get up multiple times at night, a weak urine stream and straining to start urinating. These symptoms were all associated with difficulties with getting or maintaining erections, feeling of problems with sexual function and satisfaction. However, they were not strongly associated with sex drive after taking age differences into account.

Source: Science Daily

Men with high blood pressure who smoke are 26 times more likely to have erectile dysfunction --impotence -- than nonsmokers, John Spangler, M.D., M.P.H., of Wake Forest University Baptist Medical Center told the American Society of Hypertension May 19 in San Francisco.

Erectile dysfunction, or impotence, is the inability of a man to achieve an erection or to complete intercourse, he said, and affects an estimated 30 million Americans.

"These data are the first to quantify a 26-fold increase in erectile dysfunction among primary care men with hypertension who also currently smoke, a rate that is also twice that of former smokers," said Spangler, associate professor of family and community medicine.

He said the study showed that former smokers among patients with high blood pressure are 11 times more likely to be impotent than non-smokers.

"Cigarette smoking, hypertension and erectile dysfunction are common disorders in primary care, and informing men who smoke of the exceptionally high possibility of developing erectile dysfunction may motivate many to quit their tobacco habit."

Spangler said that cigarette smoking and impotence had been linked previously by other investigators, including finding what doctors call a dose response relationship: the more cigarettes smoked per day the greater the chance of impotence.

But most of these earlier studies looked at a highly selective group of patients going to urology or cardiology clinics, he said. "This is the first study that looked at a primary care population and is more reflective of the general population."

Spangler said smoking has "both acute and chronic effects on erectile physiology." In both human and animal studies, smoking inhibits the ability to achieve a full erection.

Smoking also is known to accelerate atherosclerosis -- hardening of the arteries-- and when the blood vessels in the pelvis area are narrowed, that contributes to reduced penile blood flow.

"A smoking history should be obtained from all patients, especially those who report erectile dysfunction," Spangler recommended, "Informing men who smoke about the exceptionally high likelihood of developing erectile dysfunction should become a standard part of care of these patients." Spangler said the research team was surprised that there was no relationship between stress and impotence, but noted that the small size of the study -- 59 patients -- may have limited the chance to detect differences. The smoker versus nonsmoker difference, however, was dramatic.

"It may be that cigarette smoking and high blood pressure are such powerful risk factors for impotence that it just overshadows stress," he said.

The study was supported in part by a cooperative agreement from the Centers for Disease Control and Prevention. The team, in addition to Spangler, include John H. Summerson, M.S., Joseph C. Konen, M.D., M.S.P.H., and Ronny A. Bell, Ph.D. Konen is now at the Department of Family Medicine at Carolinas Medical Center in Charlotte.

Source: Science Daily

Researchers at the University of Pennsylvania and other institutions have identified an enzyme that appears to play a key role in bringing on sexual dysfunction in both men and women – and a second molecule that can just as easily yank the offending enzyme out of commission. The findings, which carry the possibility of new treatments for sexual disorders, are scheduled to appear in two papers in the March 13 issue of Biochemistry, a peer-reviewed journal of the American Chemical Society, the world’s largest scientific society.

Led by Penn chemist David W. Christianson, the team found that the enzyme arginase can effectively short-circuit a biochemical pathway critical to male sexual arousal. But unlike remedies developed expressly for erectile dysfunction, which have proven disappointing in clinical trials with women, treatments that home in on arginase may offer hope for both sexes.

"There is intense interest in new targets for sexual dysfunction therapy," said Christianson, the Edmund and Louise Kahn Professor in the Natural Sciences. "Arginase should be a target in men and women alike, insofar as sexual dysfunction arises in both from circulation defects in the genitalia."

Offering the means to strike that target, Christianson and his co-authors pinpoint the amino acid derivative S-(2-boronoethyl)-L-cysteine, also known as BEC, as one of the tightest-binding arginase inhibitors ever identified. BEC joins another powerful arginase-blocking compound, (S)-2-amino-6-boronohexanoic acid, which was identified by Christianson in 1999.

In the chemical pathway that leads to sexual arousal in both sexes, arginase comes into play somewhat before phosphodiesterase V, the target molecule of Viagra – which could present a new solution for the roughly 3 in 10 men for whom that medication is ineffective. Viagra has shown even less success in preliminary studies of female sexual dysfunction.

Healthy sexual function in both genders relies on a biochemical cascade as carefully orchestrated as any courtship ritual. At one critical step in that pathway, nitric oxide synthase converts arginine, one of the 20 human amino acids, into citrulline and nitric oxide. The latter product is said to be the principal mediator of penile erection; it facilitates neurotransmission and causes rapid relaxation of smooth muscle in the penis’ spongy tissue, allowing the thousands of tiny vessels there to swell with blood.

Arginase can derail this reaction by sequestering arginine and breaking it down into compounds unrelated to those physiologically responsible for arousal, depriving the genitalia of the nitric oxide needed for sexual function.

"Both Viagra and BEC function by blocking enzymes that can degrade key chemical players in this pathway," Christianson said. "The difference is that Viagra works several steps later than arginase-inhibiting compounds."

Erectile dysfunction, which afflicts half of men older than 40 to some extent, occurs when this enzyme-mediated pathway goes awry, impeding blood flow in and out of the penis. Female sexual dysfunction can also result from impaired blood flow to the genitalia. Sexual difficulties in both genders often manifest themselves as side effects of heart disease, hypertension, diabetes and the use of certain medications such as antidepressants.

Working with tissue taken from men undergoing penile prosthetic implantation, Christianson and his colleagues verified for the first time that arginase is present in the human penis. The group also found that administering BEC enhanced smooth muscle relaxation in human penile tissue, which triggers erection by allowing the penis’ spongy tissue to fill with blood.

Christianson is corresponding author of the two Biochemistry papers. He was joined by J. David Cox, Ricky F. Baggio and Evis Cama of Penn and authors at Boston University, Temple University, the University of Pittsburgh, the Wistar Institute in Philadelphia and Université Paris. The work was supported by the National Institutes of Health.

Source: Science Daily

The same basic process used by the popular pharmaceutical Viagra may someday help people suffering from a variety of conditions, from allergies to diabetes. Viagra’s success has raised interest in the growing study of phosphodiesterase (PDE) inhibitors, says Joseph Beavo, Ph.D., a professor of pharmacology at the University of Washington School of Medicine.

Viagra works by inhibiting one specific type of enzyme called a cyclic GMP phosphodiesterase. "There is not just one, but many phosphodiesterases. Different PDEs are expressed in different tissues and in different parts of the cell, and have different physiological functions. The challenge has been for the drug companies to find agents that are selective for specific phosphodiesterases so that they can treat the disease without causing toxic side effects," Beavo says.

Beavo discussed PDEs and their inhibitors during the "Signal Transduction" panel at the American Association for the Advancement of Science annual meeting here today.

The different PDEs make up a large class of enzymes. Beavo and his colleagues discovered many of the 11 families that are recognized so far. These enzymes are found throughout the body, where they modulate many important functions. For example, they play a key role in many sensory processes including vision and smell. They may even play a role in learning and memory. On the one hand, this means that drugs regulating PDEs may someday provide a treatment for people with vision or memory problems. But at the same time, any researcher wanting to use PDE inhibitors to treat one specific part of the body must make sure that the therapy does not interfere with other PDEs – such as the ones involved in vision or memory.

Most PDE inhibitors currently available as medication affect PDEs in multiple organs, and so their use is often limited by their toxic side effects. Viagra, introduced in 1999, became a poster child for PDE research in part because of its selectivity.

"Viagra was the first really successful PDE inhibitor, both mechanistically and commercially," Beavo says. Viagra has generated more than $1 billion in sales. It is among the most widely prescribed drugs.

Viagra is a very selective drug. It acts on one specific PDE found in the penis. In the presence of nitric oxide, a signaling molecule released from the nerves in the penis, inhibition of this PDE helps cause an erection.

Here is why inhibition of the PDE has that effect: nitric oxide causes the production of a secondary signaling chemical, cyclic GMP, which leads to erection. During sexual stimulation, men with erectile dysfunction may have trouble producing enough cGMP. Normally, the PDE breaks down the cGMP into molecules that cannot cause erection. By inhibiting the breakdown of cGMP, Viagra leads to more cGMP. In other words, PDEs cause reductions in the needed chemical in the penis, and Viagra blocks the PDE to prevent this from happening. Viagra generally does not have side effects caused by inhibition of other PDEs.

"We use Viagra's mechanism of action as a beautiful example of drug and physiological selectivity when we talk to students," Beavo says. Researchers are now seeking other PDE inhibitors that will also act selectively, without toxic side effects throughout the body. Since many PDEs have been discovered only within the past year, the search is just beginning.

Beavo’s lab recently characterized PDE7 and PDE8, which can be induced in certain kinds of immune cells -- particularly T-cells. These two families of PDE do not break down cGMP; instead, they reduce cAMP, a similar signaling molecule, found in those immune cells. Since these PDEs appear to be very important for immune system activity, researchers are studying whether inhibitors of these enzymes might have an effect on anti-immune and hyper-inflammatory diseases such as rheumatoid arthritis and allergies. Other PDEs are thought to mediate other processes. PDE3 affects insulin secretion (with potential involvement in diabetes) and leptin signaling (with dietary and fat implications). Researchers at drug companies and other universities are examining how PDE inhibitors may be used to improve memory, treat chronic obstructive pulmonary disease and blood clotting disorders. In all of these examples, considerable work and testing will be needed before there are clinical benefits, Beavo said.

Source: Science Daily

A limited study conducted at Cedars-Sinai Medical Center in Los Angeles, and utilizing post-marketing adverse event reports made to the FDA, shows that there appears to be a high number of deaths and serious cardiovascular events associated with the use of Viagra, the most commonly prescribed therapy for erectile dysfunction in men. These findings will be presented March 14 at the meeting of the American College of Cardiologists in Anaheim, CA. Presenters will be Sanjay Kaul, M.D., and Babak Azarbal, M.D.

In an analysis of 1,473 major adverse events, 522 people died, the majority due to cardiovascular causes. According to the study's senior author, Dr. Kaul, the majority of deaths were associated with standard Viagra dosages (70 percent of the deaths were associated with the 50 mg dose), were due to cardiovascular causes and appeared to be clustered around the time of dosing (two thirds of deaths in which the time from ingestion to death was reported, occurred within 4-5 hours of taking Viagra). The majority of deaths occurred in patients who were less than 65 years of age, and who had no reported cardiac risk factors.

The study confirmed the well-documented increased risk with combined use of nitrates and Viagra. Of the 90 patients who were on nitrates and taking Viagra, death occurred in about 68 percent, and death or myocardial infarction occurred in 88 percent. However, the study showed that most deaths (88 percent) actually occurred in patients who were not taking nitrates, leading investigators to speculate whether there are some susceptible individuals who don't need nitrates to unmask the harmful effects of Viagra.

Source: Science Daily

Having intercourse more often may help prevent the development of erectile dysfunction (ED). A new study reports that researchers have found that men who had intercourse more often were less likely to develop ED.

Analyzing a five-year study of 989 men aged 55 to 75 years from Pirkanmaa, Finland, the investigators observed that men reporting intercourse less than once per week at baseline had twice the incidence of erectile dysfunction compared with those reporting intercourse once per week. Further, the risk of erectile dysfunction was inversely related to the frequency of intercourse.

Other factors that may affect the incidence of ED, such as age, chronic medical conditions (diabetes, heart disease, hypertension, cerebrovascular disease and depression), body mass index and smoking were included in the analysis of the data.

Erectile dysfunction incidence was 79 cases per 1000 in men who had reported sexual intercourse less than once per week, dropping to 32 cases per 1000 in men reporting intercourse once per week and falling further to 16 per 1000 in those reporting intercourse 3 or more times per week.

In addition, the frequency of morning erections predicted the development of complete erectile dysfunction, with an approximate 2.5-fold risk among those with less than 1 morning erection per week compared with 2 to 3 morning erections per week

Writing in the article, Juha Koskimäki, MD, PhD, Tampere University Hospital, Department of Urology, Tampere, Finland, states; "Regular intercourse has an important role in preserving erectile function among elderly men, whereas morning erection does not exert a similar effect. Continued sexual activity decreases the incidence of erectile dysfunction in direct proportion to coital frequency."

The study clearly indicates that regular intercourse protects men from the development of erectile dysfunction, which may, in turn, impact general health and quality of life. The investigators advise clinicians to support the sexual activity of their patients.

Source: Science Daily

Men who smoke are more likely to suffer from erectile dysfunction than nonsmokers, reports an international group of impotency experts in the November issue of the Journal of Urology.

Erectile dysfunction is the inability to achieve or maintain an erection suitable for sexual intercourse. It is estimated that over 30 million American men have some form of erectile dysfunction.

The research consortium, headed by Kevin T. McVary, associate professor of urology at Northwestern University Medical School, found strong parallels and shared risks among smoking, coronary artery disease, atherosclerosis and erectile dysfunction. Results of the group’s review showed that smoking exacerbates the well-known negative effects of coronary artery disease and hypertension on a man’s ability to achieve and maintain an erection.

In addition, prevalence of erectile dysfunction in former smokers was no different from that in men who had never smoked. McVary said that the vascular system in the penis is subject to the same degenerative diseases of blood vessels of the heart, kidneys, brain and major vascular systems. Smoking alters the ability of blood to coagulate and accelerates hypertension by promoting vasoconstriction and atherosclerosis. In turn, hypertension increases the need for drugs that induce or worsen erectile dysfunction.

The underlying cause of erectile dysfunction in smoking is poorly understood, but there is evidence that smoking may impair production of nitric oxide, the principal "chemical messenger" involved in penile erection, in the cells that line blood vessels. Nitric oxide also plays an important role in cardiovascular health and inhibition of apoptosis, or programmed cell death.

While the results of the group’s study indicated that erectile dysfunction is linked to smoking and its related health risks, additional basic and clinical science studies will be required to determine the exact mechanism of the smoking effect and establish clinical practice guidelines for men with erectile dysfunction.

Scientists from the University of Washington School of Medicine, Seattle, McGill University Medical School, Montreal, and other members of the Sexual Medicine Society of North America also contributed to this study.

Source: Science Daily

Preliminary findings from clinicians at the Research Institute of the McGill University Health Centre (MUHC), show that men with erectile dysfunction are more likely to have cardiovascular disease. Cardiovascular disease affects approximately 40 000 Canadian men annually.

"Our study suggests, that erectile dysfunction, particularly in young men, may be an early warning sign of heart disease and stroke," says MUHC Director of Clinical Epidemiology and lead investigator, Dr. Steven Grover.

Dr. Grover, who is also a professor in the Faculty of Medicine at McGill University, and his colleagues evaluated more than 4 000 men. They compared the risk of erectile dysfunction among patients with and without cardiovascular disease. "We found that the presence of cardiovascular disease was strongly associated with erectile dysfunction," says Dr. Grover."

Among men without diagnosed cardiovascular disease, cardiovascular risk factors such as diabetes, smoking, high blood pressure and low HDL cholesterol were more common among those who had erectile dysfunction. This suggests that the men who have erectile dysfunction and have no other symptoms of cardiovascular disease may be at increased risk for developing the disease.

Accordingly, a complete diagnostic evaluation of erectile dysfunction should include screening for cardiovascular risk factors."

This study was selected as the winner of the Yamanouchi Impotence Best Abstract Series Award by the American Urological Association (AUA) and the findings will be presented today, at the Annual Meeting of the AUA.

This study was funded by Pfizer Canada Inc.

Source: Science Daily

Erectile dysfunction gives a two to three year early warning of a heart attack, warns an expert on the British Medical Journal website.

But the link between erectile dysfunction and the risk of heart disease is being ignored by doctors, writes Dr Geoffrey Hackett from the Good Hope Hospital in Birmingham.

Over many years Hackett reports regularly seeing patients referred with erectile dysfunction after a heart attack, only to hear that they had developed erectile dysfunction two to three years before—a warning sign ignored by their general practitioners.

It is well known that erectile dysfunction (a symptom of vascular disease in the smaller arteries) doubles the risk of heart disease, a risk equivalent to being a moderate smoker or having an immediate family history of heart disease. Erectile dysfunction in type 2 diabetes has been shown to be a better predictor of the risk of heart disease than high blood pressure or high cholesterol.

But despite this considerable evidence erectile dysfunction is still treated as a recreational or "lifestyle issue" rather than a predictor of a serious health problem, says Hackett.

The UK government has pledged to reduce the death rate from coronary heart disease and stroke and related diseases in people under 75 by at least 40% by 2010, yet there is no screening for erectile dysfunction in patients with diabetes or heart disease, he says.

"Continuing to ignore these issues on the basis that cardiologists feel uncomfortable mentioning the word 'erection' to their patients or that they may have to deal with the management of a positive response, is no longer acceptable and possibly, based on current evidence, clinically negligent", he concludes.

Source: Science Daily

Sexual dysfunction in men with high blood pressure may be aided by the newest type of hypertension drug, reported Carlos Ferrario, M.D., of Wake Forest University Baptist Medical Center (WFUBMC), today at the American Heart Association's annual conference.

After 12 weeks of treatment with the new drug losartan, 88 percent of hypertensive males with sexual dysfunction reported improvement in at least one area of sexuality. The number of men reporting impotence dropped from 75.3 percent to 11.8 percent.

"These results suggest a possible solution for people who've stopped taking blood pressure medicines because they interfere with sexual function," said Ferrario director of WFUBMC's Hypertension and Vascular Disease Center. "In addition to controlling blood pressure as well or better than other medications, losartan seems to have a positive effect on sexuality."

The study was conducted in Spain by Ferrario and colleagues at the University of Valencia School of Medicine and Hospital Marina Alta. It used a self-administered questionnaire to screen 323 men and women with hypertension for sexual dysfunction, which includes decreased libido, impotence, and poor sexual satisfaction. Sexual dysfunction was diagnosed in 82 men, a prevalence of 42 percent.

These 82 men were compared to an equal number of men without sexual dysfunction. Both groups took 50 to 100 milligrams of losartan (sold under the brand name of Cozaar) daily for 12 weeks. They completed the questionnaire at both the beginning and end of the treatment period.

In the men with sexual dysfunction, 88 percent reported improvement in at least one area of sexual function after treatment with losartan. The number reporting overall sexual satisfaction increased from 7.3 percent to 58.5 percent. The number reporting a high frequency (at least once a week) of sexual activity improved from 40.5 percent to 62.3 percent. An improved quality of life was reported by 73.7 percent of the men with sexual dysfunction.

Similar results were reported in a small group of women treated with losartan. The sample size, however, was too small for the results to be statistically validated.

In the group of men without sexual dysfunction, the drug treatment produced no changes in sexual function or satisfaction.

Ferrario said the results are promising and point to the need for additional research.

"This study was performed in a non-random sample, so we must be careful in extrapolating the findings to the general hypertensive population," said Ferrario. "However, the consistent nature of the findings points out the need for larger clinical trials on this subject."

In the study, losartan was equal to or better than other drugs at controlling blood pressure. Losartan works by blocking angiotensin, a hormone that causes high blood pressure, and keeping it from binding to body tissues.

"Our finding that impotence improved in men taking losartan supports the theory that angiotensin contributes to sexual dysfunction," said Ferrario. "This helps debunk the myth that impotence is caused by hypertension drugs. In fact, it appears that sexual dysfunction is part of the hypertension disease process. Certain drugs, such as beta blockers and diuretics, can aggravate sexual dysfunction, but we don't believe they cause it."

Ferrario said losartan may improve sexual function and satisfaction in two ways: by acting on blood vessels in the penis that have been damaged by high blood pressure and by acting in the brain to improve well-being.

"Aside from its vascular effects, losartan may affect the central nervous system," said Ferrario. "This suggestion comes from findings that sexual satisfaction improved even in men who had reported having sex once a day."

The research was funded by an unrestricted educational grant from Merck Sharp & Dohme Spain to the Spanish investigators.

Source: Science Daily

Priapism refers to an erection, usually painful, that lasts for more than four hours and is not necessarily the result of sexual arousal. This condition develops when blood in the penis becomes trapped and unable to drain. The condition is most common between the ages of 5 to 10 years and 20 to 50 years.

Priapism needs to be treated immediately to avoid the likely outcome of permanent erectile dysfunction. Priapism does not usually resolve itself so medical attention is definitely required.

Causes of Priapism

Although up to one third of cases have no specific cause, other conditions causing priapism include:

Sickle cell anemia. Up to 42% of men with sickle cell will develop priapism.

Alcohol and cocaine abuse

Spinal cord trauma or conditions

Trauma to the genital area

Medications such as Desyrel used to treat depression, Thorazine used to treat certain mental illnesses

Medications to prevent blood clotting and drugs used to treat blood pressure can all cause priapism

Anesthesia

In rare cases some types of penile cancer can cause priapism
Penile injections designed to treat impotence can also cause priapism

Penis changes that cause priapism

In a normal erection the veins narrow and that’s what makes the penis get bigger and hard. In priapism the veins do not relax after an orgasm so the penis remains erect and usually becomes very painful.

Diagnosis of Priapism

The doctor will ask about your medical history and examine you. He may do some tests, possibly an ultrasound or angiogram and blood tests.

Treatment of Priapism

Treatment is aimed at making the erection go, then treating the underlying cause, if one can be discovered. Treatment is usually in the form of injecting a decongestant medication, often following the draining of a small amount of blood from the penis to relieve pressure. A local anesthetic to numb the penis is usually given prior to this procedure.

Surgery will be required to restore normal blood flow if the cause is a ruptured artery. A surgical shunt for low flow priapism may be required. This is inserted into the penis to divert the blood flow and restore normal blood flow and function.

People with sickle-cell disease usually receive intravenous fluids and a transfusion of blood. If that fails to have the desired effect surgery may be required.

Some men experience semi-erect and painless erections. This is usually a result of trauma where too much blood flowing into the penis, rather than narrowed veins, is the cause. This can be treated via surgery or with a catheter threaded through blood vessels in the groin.

Importance of medical intervention for Priapism

Always seek treatment as quickly as possible to avoid any future problems of permanent erectile dysfunction.

Source: About.com

Impotence is a very common problem. Remember one in ten men have a problem achieving and or sustaining an erection at some point in their lives. The important thing is if you have a problem that does not seem to be improving, you get help. You have read what impotence is, you have looked at the possible causes of it. Now lets look at the many treatments available for impotence.

There have been big advances in the treatments for impotence.

Psychosexual Therapy for Impotence

It is estimated that up to 90% of the cause of erectile problems have a psychological cause. This can range from relationships difficulties, performance anxiety or deeper more complex causes. An experienced counselor or therapist can help. They look at and work through these difficulties with you offering possible solutions.

Vacuum Pump Treatments for Impotence

A vacuum pump is a plastic cylinder. Vacuum pumps work by placing the device over the penis. Sucking out the air from the tube creates pressure and blood is forced rapidly into the penis (simulating what happens in an erection). A ring is then applied temporarily to the base of the penis to stop the blood draining away too quickly. This sustains the erection.

Medication Treatments for Impotence

Viagra is one of the best known medications for erectile dysfunction. You need to be sexually stimulated for viagra to be effective. Viagra works within an hour and usually lasts for three to four hours.

Transurethral therapy (Muse). A small pellet of a medication is put directly into the urethra. The urethra is the tube that runs through the penis and carries urine from the bladder and out through the tips of the penis. The drug is absorbed into the erectile tissue of the penis. It gives an erection within five to ten minutes.

Cialis. Cialis is taken 30 minutes before sexual activity. Cialis is effective only with sexual stimulation. Cialis is not an aphrodisiac and does not increase sexual desire.

Levitra. Taken 10 minutes to one hour prior to sexual activity, Levitra can be effective for up to 12 hours. Levitra is not an aphrodisiac. It does not increase sexual desire.

Uprima. This medication is a pill taken under the tongue. Uprima dissolves within about 15 minutes and is effective for up to two hours. Uprima will not work without sexual stimulation.

Injection Treatments for Impotence

A drug is injected directly into the shaft of the penis when you want to have sex. Although it sounds a bit worrying it is easy to learn. The medication usually works within about 15 minutes.

Hormone Treatments for Impotence

Hormonal problems are rarely the cause of impotence. The most common hormone abnormality is reduced levels of the male sex hormone testosterone. Testosterone can be restored to a therapeutic level with hormone replacement therapy. Testosterone replacement therapy should only be taken if you are tested and these tests confirm a deficiency.

Penile Prosthesis Treatments for Impotence

You should not consider a penile prosthesis (implant) until other forms of treatment have been tried. There are two types of penile implant,
The semi-rigid type penis implant: This penis implant keeps the penis rigid all the time. The penis can be bend it downwards when you're not having sex.
The hydraulic type penis implant: The penis to stiffens when a pump that is implanted in the scrotum is activated.

Surgical Treatments for Impotence

There are a number of surgical procedures that can be carried out if there is a treatable cause of your impotence such as abnormalities in the blood flow in and out of the penis.

Remember the causes of erectile dysfunction may be organic or psychological cause or a combination of the two. A specialist in the field of impotence are the best people to investigate and treat the cause. A starting point should be your family doctor or genitourinary specialist.

Source: About.com