#ErectileDysfunction #ED #RutherfordVascular #VascularHealth #MensHealth #CardiovascularDisease #EDTreatment #EDCauses #HealthDeepDive
Erectile dysfunction (ED) is a very common and often unspoken issue. It’s the repeated inability to get or keep an erection firm enough for satisfying sex. Discussed using information from Rutherford’s Vascular Surgery, ED profoundly impacts well-being and relationships, and is often a sign of something bigger, including systemic health problems. Globally, cases are projected to reach 322 million by 2025.
Normal erection is a complex process involving psychology, nerves, hormones, blood vessels, and smooth muscle. Blood fills the penis’s spongy tissues (corpora cavernosa, corpus spongiosum) via penile arteries. Nitric oxide (NO), released by parasympathetic nerves, is key; it triggers smooth muscle relaxation via the NO-cGMP pathway, allowing blood inflow. The swelling then traps this blood by compressing veins (veno-occlusive mechanism).
Causes are diverse, including psychogenic (stress, anxiety), neurogenic (stroke, spinal cord injury, pelvic surgery like radical prostatectomy), endocrinologic (hormone imbalances like low testosterone), drug-induced (certain blood pressure meds, antidepressants), and importantly, vasculogenic. Vasculogenic ED, often due to atherosclerosis reducing blood flow, is extremely common and strongly linked to cardiovascular disease (CVD). ED can serve as an early warning sign for heart attacks or strokes, sometimes years in advance, potentially because smaller penile arteries show blockages first (artery size hypothesis). Endothelial dysfunction also impairs crucial NO production.
Assessment starts with thorough history and physical exam. Blood tests check glucose, lipids, and morning testosterone. Duplex ultrasonography (DDUS) is the main vascular test, evaluating blood inflow (peak systolic velocity) and venous leakage (end diastolic velocity) after induced erection.
Treatment options are tailored and involve shared decision-making. First-line approaches include lifestyle changes (quitting smoking, exercise, weight loss, managing CVD) and psychosexual therapy. Medications like oral PDE5 inhibitors (sildenafil) are common and often effective. If pills fail, intracavernosal injections (ICI) are a highly effective alternative. Vacuum erection devices (VEDs) are also an option. For men who fail other treatments, penile implant surgery is considered the gold standard surgical option. Penile revascularization is rare, mainly for young men with trauma-related blockage, while venous surgery is generally not recommended due to poor long-term results. Future research explores restorative therapies (stem cells) and shockwave therapy. ED is also common in men undergoing other vascular surgery.
The crucial takeaway is that ED isn’t just a quality of life issue; it can signal underlying vascular disease. Talking to a healthcare professional is the vital first step.
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