Male Erectile Function

We will be talking about Male Erectile Function, or men’s erections. I’d like to start out by showing you a model of a penis, and I hope you will be able to see this. So this is a model of a penis. This is down, this is up and down. And basically the penis has two elements in here – like sponges. They are called the cavernos bodies, right here. They’re white. So in the penis this is like a sponge, that actually will be filled with blood in order to cause the erection. Up here what’s blue is the blood vessel, so the blood vessel gets into the penis here, and then down here the yellow – you might be able to see the yellow – is the urethra, where the urine comes out of the penis. All erection really is is blood filling up the penis. So blood flows into the penis, these sponges fill up, and the blood flow back out of the penis is actually cut off by a membrane that goes around the penis. So the blood is trapped in the penis, and that is all that is causing the erection – it’s blood filling up the penis and being trapped. Some men have a problem – maybe they can get an erection but they have a problem by losing it too quickly. That can be due to several reasons, but sometimes it’s because the blood vessels are almost leaking and the blood is flowing out of the penis too fast. And if that’s the case, I recommend using a penis ring, or a cock ring, they are also called. And basically what the man does, he puts this on the erect penis and he can tighten it and it will be down on the base of the penis, trapping the blood inside the penis. The one thing to remember is not to use it more than thirty minutes because we need circulation into penis after that, but its usually safe to do it for about half an hour and use this penis ring to trap the blood in the penis. But again, I only recommend this for men that have this problem, and it’s actually a really good idea, if you think you might have this veinous leakage problem, to see a urologist first.

As a man gets older, he will need, on top of this mental stimulation, he will need more and more direct stimulation of his penis. So this is really important for men to know, and for women too, that as a man gets older, as early as even in his 30’s, he can no longer just rely on his mental stimulation in order to get an erection, but he will need some direct touching of his penis as well.

Well, now let me talk a little bit about nighttime erections. Those are completely normal, and some men notice when they maybe get up in the middle of the night to have to go to the bathroom, or in the morning when they wake up that they have an erection. And many people think that its due to the bladder being full, but thats not the case. It’s due to the sleep pattern that we all go through. Each night, men and women go through the REM sleep pattern – its called Rapid Eye Movement. And scientists have found that during that pattern men get erections. And we think its simply natures way of making sure that someone gets erections even though he may not be sexually active, that he once in a while at least gets fresh blood to the penis. Its almost like exercising – its good to have an erection, its good to have blood rushing through the penis, its good to get that oxygen into the tissue. So that also reminds me to tell you that the phrase “use it or lose it” really applies here. The more you use your penis, the more you have erections, the better – its healthy! Its healthy having blood flow through the penis. So use it or lose it!

Now, one thing I do not want to forget to tell you is something that many men dont realize, that once in a while if you lose an erection, if youre unable to get an erection once in a while, thats nothing to worry about. It happens to most men, if not all. But its something that they usually dont share with each other, so Im going to tell you that its considered completely normal – Im going to use a term that I hardly ever use – to once in a while at least, not be able to get an erection. However, if it happens consistently and many times, then thats a problem, and I will be talking about that too. But some of the things that can happens is maybe someone had too much alcohol one time, and can’ get an erection. Maybe hes too tired. Maybe hes not really aroused – hes not turned on. If a woman is not turned on, its not as obvious as for the man, where if he doesnt have an erection sometimes he panics if that happens. Being nervous really can affect erections. Once in a while that happens to most men, that they might be nervous and cant get an erection, or cant keep an erection. I want to say a little more about that – its something we call performance anxiety. I see quite a few young men, not only young men, but a lot of times these are young men who get very upset when that happens. And what I tell them is that its a normal response to the stress hormone thats released by your body when you get nervous. Everyone knows if you get chased by a dog – a dog comes running after you, you need more blood in your muscles, in your legs, in order to be able to run away from the dog. So your body shuts down the digestion – certainly shuts down the blood supply to your penis – you dont need an erection as youre running away from a dog. So any kind of anxiety or nervousness will shut down that erection and make it disappear. And it can become a big problem for a lot of men when that happens. And one of the things that works very well in those cases usually is to go see your physician, or a nurse practitioner, or your prescribing health practitioner, and get a prescription for either Viagra, Levitra, or Cialis. In those cases where someone is really nervous, I really recommend using, if you can tolerate them and you are one of the people who can get this medication – and by the way we will have a separate tape on that – its almost like using a crutch – a crutch that you just need for a little while and usually what happens is that if he takes this medication and this erection stays even though he might be a little bit nervous, its still there – he will then get more confident about it and he will lose his anxiety. So this is something that happens to many men. It doesnt always work well, but usually in my experience those pills (Viagra, Levitra and Cialis) can help a man to overcome this anxiety, and he can throw the crutch away. I tell them after a while, when they feel more comfortable, just cut them in half – next time cut that one in half, cut that in half, keep cutting this little pill in half and at the end theres hardly anything left and he realizes he can do without the pill. So thats performance anxiety.

I already have said that if erectile dysfunction happens consistently, then that is not normal and it needs to be followed up – its very important that you go and have a health exam, because several things can be going on that affect your erections that maybe are not healthy. It can be high blood pressure – diabetes – in fact, some men are diagnosed with diabetes because they have erectile problems. Its something that happens after youve had diabetes usually for several years, your erections can get affected. And all of this is usually related to the blood flow. You remember I was telling you how the erections are simply blood flowing into the penis, so anything in the body that can interfere with blood flow can also interfere with your erections. Heart disease – high cholesterol – being overweight can really affect your erections. And sometimes when someone loses weight the erections become better. And the same thing is true with high blood pressure – once its controlled, a lot of times the erections get better. Surgery – especially men who have had maybe prostate surgery – can have erectile problems, although many surgeons try not to – its called nerve-sparing surgery – where they try not to cut the nerves to the penis. Various medications – including high blood pressure medication – can cause erectile problems. So whenever you notice erectile problems after youve started on a certain medication, be sure to tell your health provider, because sometimes its a matter of changing the dosage, or sometimes you can change to a different medication that might not have that side effect.

Other conditions that can affect erections are stress and depression, very much so. If someone is stressed out or depressed, that will usually affect erections. I already mentioned – drinking alcohol depresses the nervous system and that can reduce erectile function. And then another thing that can affect blood circulation in your body is smoking. It simply constricts the blood vessels and it can interfere with circulation. Im not sure whether you can see this – I usually show this slide in my talks. Its the Marlboro Man, and his cigarette is hanging down, and instead of Marlboro it says impotence. So this is an ad telling you that its not healthy to smoke – it will affect your blood circulation, and it can at the end affect your erections. Let me just very quick go over some of the methods that we have to treat erectile dysfunction. I already mentioned three drugs that currently are in the market, in 2005 – Viagra, Levitra, and Cialis – and I will talk about those in a separate video. Let me show you the next option thats available – its called the vacuum pump. Its kind of a big device but it works really well for a lot of men. And what it is – we have this device, and this is a constriction ring – its really tight. You put it on here, and then the man inserts his penis right here, at this end. The penis comes in at this end. This end is tight, so it creates a vacuum by pumping up here, the blood is sucked into the penis, so the penis fills up with blood. Once its longer and thicker because of the blood, this constriction device comes off and it keeps the blood trapped in the penis. The penile pump works really well for a lot of men who cannot tolerate Viagra. This is usually – Viagra, Levitra, Cialis or other drugs – thats usually the first option, and then the second one would maybe be the vacuum pump.

Another option that also works for a lot of men, and some men don’t like this idea at all, is injections. And it comes usually in a whole kit like this, with a drug in it – in this case, it’s a prostoglandin – and swabs, everything is in this kit. Needles, very thin, fine needles. So basically the injection – you need to go to your urologist, and they will determine exactly how much you need in order to get erect, and they will test that in the office. But basically, you just take a little bit of this medicine and you inject it into the side of the penis, right into one of these two sponges. And it will immediately, within a few minutes, it will cause a dilation. It can cause a little burning sensation, but many men actually like this option – it works well, they claim that the needle doesn’t hurt much. So this is another option for some of you that might work. Penile injections.

And then another option is called Muse. And those are small pellets that are put into the urethra, and they will kind of dissolve and also from the inside affect these cavernos bodies and again cause increased blood flow into the penis. So that’s another option thats out there, Muse.

And then finally we have the penile implants. And I don’t have a sample here to show you, but its something you would need to talk to your urologist about. It’s usually the last option that we might consider for someone or that someone might consider for himself. There are certainly many different kinds of penile implants available, and it’s something that does work for some men. So if you’re interested in penile implants be sure to ask your urologist about this option.

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