07 Mar Understanding Erectile Dysfunction Part I: A Guest Post from Dr "C"
Note: Dr “C” is a We Gotta Thing listener, a medical doctor AND in the lifestyle. This blog post is the first in a series on this topic and a new content feature we intend to expand upon in the future.- Mr & Mrs Jones
It happens at least a couple of times every week. I’m about to leave the exam room after a visit with a man, typically in his 50s or 60s. The visit may have been for preventive care, or for management of a chronic illness such as diabetes or hypertension, or possibly just to discuss a cold or sprained ankle. Just as I shake his hand and reach for the door, he takes in a deep breath and spits out something like, “Doc, there’s one more thing I need to talk about…” I put down my clipboard and turn around and ask about his problem. But the truth is, I already know what he wants to talk about: erectile dysfunction.
Erectile dysfunction (ED) is extremely common, and not just for men in their 50s and 60s. I have had the same conversation with men anywhere from their 20s to their 80s. Fortunately, today there are very good treatments for ED, and most men can get significant improvement in function. But expectations should be managed as well. A 40 or 50-year-old man cannot expect to have the same function as he did when he was 15 or 20. (And is that such a bad thing? Did you really enjoy having those unfulfillable erections in first period English class?) Rather than trying to repeat young adulthood, the important part of managing ED is to help men and their partners enjoy a fulfilling sex life, with or without a “raging hard-on”.
In the swinging lifestyle, where men are frequently faced with new partners and new situations, ED is even more of a concern. I approach this problem not just as a primary care physician, but also as a 47-year-old man who also finds that my own erectile function can be…well…inconsistent. One of my worst episodes of ED was in my very first experience in the lifestyle. So my interest in this subject is not only professional, but also personal. Nevertheless, I am firmly (ha ha) convinced that most men and their partners can find significant improvement in erectile dysfunction with patience and through consideration of the possible causes.
Now let’s put this in medical context for a moment. ED should be considered as a subcategory of the broader category of male sexual dysfunction, which also includes ejaculatory problems (i.e. too quick or too long) and lack of libido. While these problems can overlap with ED, they do tend to have very different causes and treatment. And, of course, we don’t want to leave the ladies out; female sexual dysfunction is also very common, although usually with a different spectrum of causes and treatments. While these other facets of sexual dysfunction are very important, here I will focus on ED.
In order to understand erectile dysfunction, first we must understand erections. The penis is not a muscle, as some people believe; rather the bulk of the penis is occupied by three enclosed spaces of erectile tissue that travel its whole length: two corpus cavernosa on the top (or dorsal) side, and a corpus spongiosum on the bottom. Imagine a tube sock with three elongated balloons in it; when the balloons are empty then the whole structure is limp; when the balloons are inflated then the sock will become erect. Of course, in the penis it is not air that fills the corpus cavernosa and corpus spongiosum “balloons”, but rather blood. When the brain sends out the signal that it is time to get erect (“Look, boobies!”) then the arteries leading to the penis open up, and the veins leading out of the penis constrict, causing pressure to build up in the erectile tissue, resulting in an erection. Importantly, the blood never stops flowing, as pooled blood may clot, which can cause a dangerous condition of sustained and painful erection called priapism. Instead the higher arterial pressure and venous back pressure maintain the erection while the blood moves slowly through the erectile tissue. Once the brain gives the signal that the erection can cease (“Have a tissue, dear”), then the arteries close back down, the veins open up, and blood flows out of the penis.
In the next post, we will examine the possible causes of erectile dysfunction. In many cases, once the cause of ED is established, then the treatment becomes self-evident.
May your genital blood flow freely,