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December 2, 2011
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Erectile Dysfunction
(Impotence, ED)

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Viagra: The Little Blue Pill That Could

Medical Author: Benjamin Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Learn how the use of Viagra has evolved.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.

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 male sexual intercourse, such as lack of sexual desire (decreased libido) and problems with ejaculation and orgasm (ejaculatory dysfunction). 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 due to embarrassment, and thus the condition is underdiagnosed. Nevertheless, experts have estimated that erectile dysfunction affects 30 million men in the United 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 50-54, and in 50% of men between ages 70-78. In 1999, the National Ambulatory Medical Care Survey counted 1,520,000 doctor-office visits for erectile dysfunction. Other studies have noted that approximately 35% of men 40-70 years of age suffer from moderate to severe ED, and an additional 15% may have milder forms.

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.

Picture of arteries and veins involved in erectile dysfunction (ED)


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Erectile Dysfunction (Impotence) - Treatments

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Erectile Dysfunction (Impotence)

What disorders affect the penis?

Some disorders that affect the penis include priapism, Peyronie's disease , balanitis, phimosis, paraphimosis, and penile cancer .

What is priapism?

Priapism is a persistent, often painful erection lasting more than 4 hours in duration. The priapism erection is not associated with sexual activity and is not relieved by orgasm. It occurs when blood flows into the penis but is not adequately drained.

What causes priapism?

Common causes of priapism include:

  • Alcohol or drug abuse (especially cocaine)
  • Certain medications, including some antidepressants and blood pressure medications
  • Spinal cord problems
  • Injury to the genitals
  • Anesthesia
  • Penile injection therapy (a treatment for erectil...

Read the Penis Disorders article »






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