Erectile Dysfunction (ED) is one of those conditions that will effect all men as they age, but sexual performance is so deeply ingrained in the male psyche, that ED is often hidden, denied or just not spoken about.
LADIES: Please don't shut off here thinking this is a male topic. This affects couples, and men suffering this need the support, love and encouragement of their partners to work through it. You will probably have to learn together to modify your intimate relationships to allow for these changes.
I see I have covered this subject 10 times over the last 10 years, so I'll try not to cover too much old ground. Follow links for further reading.
I was in my late 50's when it first hit me, losing my erection mid-coitus. A quick visit to my doctor, and a Viagra prescription got me up and going again, but there are side effects. Over time, I started to realise there are multiple facets to this condition. First there is the lack of or loss of erection itself, then there is the decreased sensation/feeling, this in turn leads to inability to orgasm or ejaculate.
But in this last year, post prostate cancer radiotherapy treatment, I hit rock bottom. Everything was gone, and I wrote "Paradise Lost, Vale Sir Lust".
In researching my ED, I discovered that erection comes in two stages, the initial achievement of erection and secondly maintaining an erection. These stages are driven by different bio-chemical processes, which is why in early cases, erection can be attained but not maintained. Further I found that orgasm and ejaculation are not necessarily correlated. Did you know there is a medical journal, the "International Journal of Impotence Research", dedicated to understanding the underlying processes, the pathologies that leads to dysfunction and the search for medications and methods to counteract such dysfunction?
As I started to read learned research articles (not easy since my doctorate is in computer science and data analysis, not biochemical processes, but my university organic chemistry studies 50 years ago have helped), I started to get a new perspective of the problem and some promising hints into how I might regain some function.
Let me try and describe the erection process in lay terms, stripped of too much biochemical detail. Medical thinking about the causes/processes of ED flipped back and forth over 20 years or more. The thinking was that there were psychological and physiological causes separately. In younger men, psychological causes were considered principle and treatment was around relationships. In older men, physiological causes were prominent, namely ageing of blood vessels causing thickening and decreased flexibility of blood vessels.
From around 2005, understanding of the biochemical processes improved and the inter-relationship of psychological and physiological aspects were better understood. Working backward, the actual erection is caused by inflow of blood into the two 'corpus cavernosum'. This process is triggered by Nitric Oxide (NO), a signalling chemical sent from the nerve endings enwrapping the cavernosum. (NO is synthesized from L-arginine by NO synthase (NOS)). The NO causes the blood vessel walls to relax encouraging blood inflow. PDe5 inhibitor drugs like Sildenafil (Viagra) work by increasing bio-availability of NO. It is the signalling from the brain, initiated by a range of all sorts of erotic stimuli, touch, sight, smell, sound, that trigger this process. Conversely, inhibitory brain processes like depression, can disable this triggering process.
The cavernosum run down either side of the penis. The corpus spongiosum runs down the under-side of the penis and is responsible for holding the urethra open and restricting the outflow veins so blood is retained, holding the erection. A different Nitric Oxide process (eNO) is involved in retaining an erection. This is also a signalling chemical from nerve endings, but these are triggered by physiological conditions of the erection, specifically 'hematologial shear', which is a function of the actual blood flow affected by the flexibility and smoothness of the blood vessel walls and the viscosity of the blood. So a good psychologically aroused state can initiate a good erection, but aging or damaged blood vessels can limit retention.
Nerves are involved in both stages and sensory nerves provide feeling/touch sensations back to the brain, so nerve damage (surgical or radiotherapy) or peripheral neuropathy (eg. from diabetes), can also affect various aspects of ED.
Finally, there is the issue of treatment. It is best to take a holistic view, psychologically as well as physiologically. Physiological conditions can be permanent or temporary (eg.alcohol) and the best you can hope for is to moderate underlying conditions eg. diabetes, arteriosclerosis, hypertension etc. As has been mentioned, PDe5 inhibitors have proved generally beneficial in the absence of any other underlying pathology. To improve 'hematologial shear', keep well hydrated. Low testosterone has been linked to lower libido (psychological), but there is no evidence that testosterone supplements improve ED. Similarly, L-arginine supplements are promoted in men's 'health supplements', but a placebo-controlled, crossover comparison found no difference in ED improvement between oral L-arginine and placebo.
In the specific case of ED due to radiotherapy, some general healing of damaged tissue, both cavernosum and nerves, has been achieved with daily low doses of PDe5 inhibitors. Extra high doses of PDe5 inhibitors can also improve erection response and retention, if side effects can be tolerated. EG. Viagra is normally only recommended up to 100mg, but controlled experiments with 150mg and 200mg doses have had some success. The author seems to be having success with 150mg and plans to go for another 'test drive' once his Lady Of Pleasure is out of COVID19 self isolation. The other factor in ED 'recovery' noted in some studies, is frequency of use, even if it is DIY ('Use It Or Lose It' will be addressed in a coming post).
Click to see who else is taking the challenge.
LADIES: Please don't shut off here thinking this is a male topic. This affects couples, and men suffering this need the support, love and encouragement of their partners to work through it. You will probably have to learn together to modify your intimate relationships to allow for these changes.
I see I have covered this subject 10 times over the last 10 years, so I'll try not to cover too much old ground. Follow links for further reading.
I was in my late 50's when it first hit me, losing my erection mid-coitus. A quick visit to my doctor, and a Viagra prescription got me up and going again, but there are side effects. Over time, I started to realise there are multiple facets to this condition. First there is the lack of or loss of erection itself, then there is the decreased sensation/feeling, this in turn leads to inability to orgasm or ejaculate.
But in this last year, post prostate cancer radiotherapy treatment, I hit rock bottom. Everything was gone, and I wrote "Paradise Lost, Vale Sir Lust".
In researching my ED, I discovered that erection comes in two stages, the initial achievement of erection and secondly maintaining an erection. These stages are driven by different bio-chemical processes, which is why in early cases, erection can be attained but not maintained. Further I found that orgasm and ejaculation are not necessarily correlated. Did you know there is a medical journal, the "International Journal of Impotence Research", dedicated to understanding the underlying processes, the pathologies that leads to dysfunction and the search for medications and methods to counteract such dysfunction?
As I started to read learned research articles (not easy since my doctorate is in computer science and data analysis, not biochemical processes, but my university organic chemistry studies 50 years ago have helped), I started to get a new perspective of the problem and some promising hints into how I might regain some function.
Let me try and describe the erection process in lay terms, stripped of too much biochemical detail. Medical thinking about the causes/processes of ED flipped back and forth over 20 years or more. The thinking was that there were psychological and physiological causes separately. In younger men, psychological causes were considered principle and treatment was around relationships. In older men, physiological causes were prominent, namely ageing of blood vessels causing thickening and decreased flexibility of blood vessels.
From around 2005, understanding of the biochemical processes improved and the inter-relationship of psychological and physiological aspects were better understood. Working backward, the actual erection is caused by inflow of blood into the two 'corpus cavernosum'. This process is triggered by Nitric Oxide (NO), a signalling chemical sent from the nerve endings enwrapping the cavernosum. (NO is synthesized from L-arginine by NO synthase (NOS)). The NO causes the blood vessel walls to relax encouraging blood inflow. PDe5 inhibitor drugs like Sildenafil (Viagra) work by increasing bio-availability of NO. It is the signalling from the brain, initiated by a range of all sorts of erotic stimuli, touch, sight, smell, sound, that trigger this process. Conversely, inhibitory brain processes like depression, can disable this triggering process.
The cavernosum run down either side of the penis. The corpus spongiosum runs down the under-side of the penis and is responsible for holding the urethra open and restricting the outflow veins so blood is retained, holding the erection. A different Nitric Oxide process (eNO) is involved in retaining an erection. This is also a signalling chemical from nerve endings, but these are triggered by physiological conditions of the erection, specifically 'hematologial shear', which is a function of the actual blood flow affected by the flexibility and smoothness of the blood vessel walls and the viscosity of the blood. So a good psychologically aroused state can initiate a good erection, but aging or damaged blood vessels can limit retention.
Nerves are involved in both stages and sensory nerves provide feeling/touch sensations back to the brain, so nerve damage (surgical or radiotherapy) or peripheral neuropathy (eg. from diabetes), can also affect various aspects of ED.
Finally, there is the issue of treatment. It is best to take a holistic view, psychologically as well as physiologically. Physiological conditions can be permanent or temporary (eg.alcohol) and the best you can hope for is to moderate underlying conditions eg. diabetes, arteriosclerosis, hypertension etc. As has been mentioned, PDe5 inhibitors have proved generally beneficial in the absence of any other underlying pathology. To improve 'hematologial shear', keep well hydrated. Low testosterone has been linked to lower libido (psychological), but there is no evidence that testosterone supplements improve ED. Similarly, L-arginine supplements are promoted in men's 'health supplements', but a placebo-controlled, crossover comparison found no difference in ED improvement between oral L-arginine and placebo.
In the specific case of ED due to radiotherapy, some general healing of damaged tissue, both cavernosum and nerves, has been achieved with daily low doses of PDe5 inhibitors. Extra high doses of PDe5 inhibitors can also improve erection response and retention, if side effects can be tolerated. EG. Viagra is normally only recommended up to 100mg, but controlled experiments with 150mg and 200mg doses have had some success. The author seems to be having success with 150mg and plans to go for another 'test drive' once his Lady Of Pleasure is out of COVID19 self isolation. The other factor in ED 'recovery' noted in some studies, is frequency of use, even if it is DIY ('Use It Or Lose It' will be addressed in a coming post).
Click to see who else is taking the challenge.
I think overall health (or issues therewith, such as diabetes or heart problems, etc.) and diet have an effect as well. My husband jokes about his "man diet" (which perhaps I will write about at a later date), but there's definitely a difference in his energy levels - including his sexual energy level- when he eats certain foods.
ReplyDeleteI find this an interesting subject, because my husband seems to suffer from 'mild' ED, as he sometimes loses the stiffness during sex, and even though he wants to continue, he can't. We never make a problem of this. It happens. One question: with your experience with ED, did it also affect your libido?
ReplyDeleteRebel xox