Erectile Dysfunction

Secondary vaginismus is when the woman once was able to achieve penetration but now cannot. Trauma from childbirth or a yeast infection can be causative. Menopause and vaginal dryness can play a role in vaginismus. There are many psychological factors involved, including a fear of losing control, sexual assault, denial of sexuality, or lack of trust in one’s partner.

The treatment is more successful with secondary vaginismus than it is with primary vaginismus. Desensitization may or may not help. Because of the high risk of childhood sexual trauma in the disorder, psychological treatment related to that can be helpful. Vaginal dilators and Kegel exercises along with lubricants can sometimes help. Botox is being investigated and has been shown to be successful in some cases. Antidepressants and anti-anxiety drugs can help the anxiety.

ERECTILE DYSFUNCTION

Erectile dysfunction or ED was once known as impotence. It is seen when a man cannot attain an erection or cannot maintain an erection during sex. Men who have it can develop low self-esteem and relationship problems. About 80 percent of the time, the disorder is found to be physical, with the rest being purely psychological or a combination of physical and psychological causes. The problem must be present for three months to be called erectile dysfunction.

There are numerous physical causes of erectile dysfunction, including many types of prescription drugs, such as beta blockers, SSRIs, diuretics, and certain hormonal treatments. Neurological causes include diabetes, Parkinson’s disease, multiple sclerosis, temporal lobe epilepsy, and multiple system atrophy. There can be anatomic problems with the penis, high prolactin levels, surgery to the pelvis, cardiovascular disease, kidney failure, smoking, and general aging that can contribute to the problem. Nerve damage from cycling can cause erectile dysfunction.

Purely psychological causes of erectile dysfunction happen in 10 percent of cases. Any type of psychological or psychiatric problem can contribute to the problem, and both stress and performance anxiety can be causative.

It is helpful to understand the mechanisms that need to be in place in order to have an erection. There must be a reflex erection that happens when touching the penis and a psychogenic factor, which involves reacting to erotic stimuli. There needs to be intact peripheral nerves, an intact lower spinal cord, and normal activity of the limbic system. As mentioned in the first chapter, nitric oxide is released after penile stimulation that relax the muscles of the erectile tissues of the penis to get an erection. The pituitary gland and testosterone levels need to be normal. A lack of blood flow to the penis can impact the attainment of an erection, which is seen in coronary artery disease.

The diagnosis of erectile dysfunction can usually be made by listening to the patient’s symptoms. If this is not helpful, an exam should be done to look for hypogonadism or immature genitalia in the male. Labs for diabetes, testosterone level, and prolactin level can be done. Less commonly, nocturnal penile tumescence can be done, which assesses the presence of erections during the man’s sleep. This can tell if there might be a psychological cause for the erectile dysfunction.

An ultrasound of the penis is done with a Doppler ultrasound of the erect penis in order to evaluate the blood flow in the corpora cavernosa. Prostaglandin E1 is injected to create an erection and then blood flow is checked every five minutes for a half an hour. Sildenafil or stimulation can be used to induce an erection. The test checks to see what happens to the penile blood flow after an erection. It can tell the difference between erectile dysfunction from atherosclerosis versus other causes of erectile dysfunction.

Less common tests for erectile dysfunction include assessing the bulbocavernosus reflex, which involves stimulating the glans of the penis and checking for tightening of the anal sphincter, penile biothesiometry, which checks for penile sensation, and corpus cavernosometry, which measures pressures in the penis. An angiogram can be done using magnetic resonance imaging or MRI scanning to look at the blood vessels to the penis.

The treatment of ED depends on the cause. Aerobic exercise and counseling can treat mild disease or psychogenic erectile dysfunction. The mainstays of more severe ED include medications and penile vacuum devices. Penile implants and medications injected into the penis are less commonly used.