Erectile Dysfunction
(Impotence, ED)
Medical Author: Dennis Lee, MD
Medical Editors: Jay W. Marks, MD,
and Jacob Rajfer, MD
Viagra: The Little Blue Pill That Could
Medical Author: Benjamin Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
Once upon a time, there was a little blue pill. Its inventors were trying to
treat heart disease and prevent heart attacks and found that the little blue
pill could dilate blood vessels. The theory was that angina or chest pain could
be decreased when more red blood cells carrying oxygen were delivered to heart
muscle cells through the dilated coronary vessels. Though good in theory, since it
works for nitroglycerin, clinically, the little blue pill wasn't very
effective.
The little blue pill wasn't very specific as to where it dilated blood
vessels. Not only were heart vessels dilated, but so were blood vessels in other
places, and this side effect became its claim to fame. Viagra hit the market as
the first treatment for erectile dysfunction and was a superstar.
It was also becoming a superstar in the athletic world. Studies with cyclists
and mountain climbers found that at high altitude, the little blue pill dilated
blood vessels in the lung and allowed more oxygen to be extracted from the air,
increasing the oxygen concentration in the bloodstream. This translated into
faster and stronger training. All of a sudden, the little blue pill moved from
the bedroom to the playing field...please insert your own performance-enhancing
joke here.
And so we have the latest revelation that baseball players are loading up on
Viagra. No big surprise, since Viagra has been a hit on the pro cycling tour for
a while, and baseball usually lags behind by a couple of years. History reminds us of anabolic steroids and growth hormone.
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What is erectile dysfunction?
Erectile
dysfunction (ED), also known as impotence, is the inability to achieve or
sustain an erection for satisfactory sexual activity. Erectile dysfunction is
different from other conditions that interfere with sexual intercourse, such as
lack of sexual desire and problems with ejaculation and orgasm. This article
focuses on the evaluation and treatment of erectile dysfunction.
How common is erectile dysfunction?
Erectile dysfunction (ED, impotence) varies in severity; some men have a
total inability to achieve an erection, others have an inconsistent ability to
achieve an erection, and still others can sustain only brief erections. The
variations in severity of erectile dysfunction make estimating its frequency
difficult. Many men also are reluctant to discuss erectile dysfunction with
their doctors, and thus the condition is under-diagnosed. Nevertheless, experts
have estimated that erectile dysfunction affects 30 million men in the Untied
States.
While erectile dysfunction can occur at any age, it is uncommon among young
men and more common in the elderly. By age 45, most men have experienced
erectile dysfunction at least some of the time. According to the Massachusetts
Male Aging Study, complete impotence increases from 5% among men 40 years of age
to 15% among men 70 years and older. Population studies conducted in the
Netherlands found that some degree of erectile dysfunction occurred in 20% of
men between ages 50 to 54, and in 50% of men between ages 70 to 78. In 1999, the
National Ambulatory Medical Care Survey counted 1,520,000 doctor-office visits for
erectile dysfunction.
What is normal penis anatomy?
The penis contains two chambers, called the corpora cavernosa, which run the
length of the upper side of the penis (see figure 1 below). The urethra, which is the
channel for urine and ejaculate, runs along the underside of the corpora
cavernosa. Filling the corpora cavernosa is a spongy tissue consisting of smooth muscles, fibrous tissues,
spaces, veins, and arteries. A
membrane, called the tunica albuginea, surrounds the corpora cavernosa. Veins
located in the tunica albuginea drain blood out of the penis.
Next: How does erection occur? »
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