New York Urologic


Erectile Dysfunction

About Erectile Dysfunction (ED)

What is erectile dysfunction? Erectile dysfunction is defined as the persistent inability to attain or maintain penile erection sufficient for sexual intercourse. Other terms once used for this disorder are impotent or impotence. It falls under the broader term “sexual dysfunction.” Erectile dysfunction is only considered a disorder if it occurs consistently enough to become an ongoing problem.

Erectile dysfunction is more common as men age. Regardless of the primary cause, erectile dysfunction can have a negative impact on self-esteem, quality of life and interpersonal relationships. Approximately 25 to 30% of men older than 65 years of age are suffering from this common condition and about 10-20 million American men are thought to have some degree of Erectile dysfunction.

What is The mechanism of Normal Erection?

The penis consists of two parallel cylinders of erectile tissue, the corpora cavernosa, and a smaller, single ventrally placed cylinder, the corpus spongiosum, which surrounds the urethra, a tubular structure that allows the urine to exit the body.(Figure 1). The corpora cavernosa are composed of soft elastic sinusoidal vascular smooth muscle tissues that allow the blood to enter and cause expansion of these spaces, therefore expansion and engorgement of the cylinders. Both cylinders share an incomplete septum that allows them to function as a single unit. Blood flow to these corpora bodies is provided primarily by branches of the main blood vessel called the internal pudendal artery. The blood that has entered then leave the corpora bodies via small venules that coalesce to form large veins that pierce through the wall of cylinders, finally draining into the deep dorsal vein.

In a flaccid state, the amount of blood that enters the cylinders are minimal and equal to the blood that leaves. In the erected state, the sinusoidal spaces in the cylinders expand by relaxation of those smooth muscles, therefore allowing more blood to flow in. At the same time, the venues drainage system shut closed and would not allow the blood to exit. This results in very high blood pressure in the cylinders allowing a rigid erection. This is a complex process and controlled by coordinated neural networks and nervous system in the body.

What are Causes of Erectile Dysfunction?

Erectile dysfunction is divided into two groups. Organic, that means there is an actual medical condition that has resulted in ED. Organic causes are subdivided into vasculogenic, neurogenic and hormonal etiologies.

Then there is psychogenic ED, which means psychological factors such as depression and/or anxiety has let to ED. Aesthetic ED is a new subdivision of psychogenic ED and is usually a result of a person being dissatisfied with his sexual self image, especially of his genitalia, including such aspects as penile length, girth, or shape, therefore affecting one’s self steam to an extent that inhibits him to engage in a intimate relation.

Evaluation for Erectile Dysfunction

Erectile dysfunction is not an illness rather, it is a sign of some serious underlying medical or psychological condition which has led the patient to this condition. Based on this philosophy, We at New York Urologic, believe that each and every patient should receive comprehensive medical, psychological evaluations to identify the cause, not only to achieve the best success in treating ED but also treat the medical or psychological conditions let to ED. If a cause is known such as prostate surgery, then evaluation is simple and a patient will be enrolled in a treatment protocol immediately. On the other hand, the cause may not well know. In that case, certain diagnostic evaluations will take place. In general, once a comprehensive medical examination completed, the patient will undergo a complete and detailed bleed examination. At times, patients undergo some specific tests such as two or three nights Nocturnal Penile tumescent Study or RigiScan®. Penile Doppler study will be followed if there is an abnormal RigiScan® study or, a vascular etiology is suspected.

  • RigiScan®: This is the study which is performed at patient’s home. The purpose of this test is to measure the number of penile erectile activities and penile rigidity at sleep. Patient takes a suitcase home for two or three nights based on the doctor’s order which contains a small device. Patient is required to wears this device with its attachments when he goes to sleep. While patient is asleep, this RigiScan device collects a series of data that will be downloaded into a computer in the doctor’s office once the device has been brought back.
  • Penile Doppler: Is an in-office procedure that the urologist used a Doppler ultrasound system to measure penile blood flow before and after administration of medication and normally induces an erection. Patients with the arterial disorder will have minimal to no increase in their penile blood flow, but patients with the normal function will have very good increase.