[Erectile dysfunction].

Erectile dysfunction, otherwise known as impotency, affects more than 30 million men each year, yet only about 200,000 seek help from a physician. Impotency remains largely unrecognized simply because most men do not discuss sexual problems with their doctors. In addition, many physicians do not ask or are uncomfortable dealing with the subject. Erectile dysfunction is defined as the inability to sustain an erection well enough to perform intercourse and ejaculation.[1] While almost all men will experience some degree of sexual difficulty at one time or another, only those who are unable to have successful intercourse 75 percent of the time are considered impotent. Contrary to popular belief, aging is not an inevitable cause of impotency. It does, however, take elderly men longer to develop erections and the force of ejaculation is diminished.[2] Conventional medicine usually addresses erectile dysfunction issues by prescribing a drug regimen or surgery. Oral medications such as Erecaid or testosterone are rarely effective unless the condition is due to low testosterone levels. Viagra, Cialis and Levitra which act to relax corpus cavernosal smooth muscle and facilitate erections, are not without their side effects. Penile injections of Papaverine or Prostaglandin E1, which affect penile blood flow, can result in prolonged erections necessitating other drug therapy to counter act its effects. Additionally, the therapy can cause burning and eventual fibrosis of the penis. Lastly, malleable or inflatable prosthesis' are used in severe cases, requiring surgical implantation. These prosthesis' often need to be surgically re implanted, are uncomfortable and subject to periodic failure. Erectile dysfunction can be broken down into primary and secondary impotency. Primary causes are rare and may be associated with low androgen levels, genetic defects and severe psycho-pathology. Secondary impotency is much more common and, as the name implies, results from something else such as diabetes, arteriosclerosis, neurological disorders, psychological issues, prolonged stress or previous surgery to the genitalia. Blood pressure medications and antidepressants may also lead to impotency, especially in the elderly. Dietary factors, largely ignored by conventional medicine, also fuel the problem as men with diets high in caffeine, sugar and alcohol experience more erectile dysfunction, as do men who smoke and use recreational drugs.[3] Psychological causes account for the majority of impotency complaints. A skilled and sensitive physician may often uncover this during an interview and suggest corrective measures.