The ancient Druids thought a sprig of mistletoe held the cure to impotence. Standing beneath the herb, or ingesting the berries, was believed to boost blood circulation and amorous feelings among would-be lovers.
But unlike the ancient Celts, we have a variety of medically respected treatment options available to help modern men recapture their sexual vitality.
Determining the best treatment begins with understanding what causes this consistent inability to reach or sustain an erection.
Anatomy And Physiology
An erection is the result of a complicated series of mechanisms involving blood flow.
“Blood needs to flow into the penis, and it needs to get trapped there,” explains Michael P. O’Leary, M.D., M.P.H., a urologist and associate professor of surgery at Harvard Medical School. Physical or psychological stimulation triggers impulses from the brain and local nerves, causing the muscles of the penis to relax so the blood can enter two cylinders on either side of the penis. A membrane called the tunica albuginea surrounds the cylinders, trapping the blood to sustain the erection through orgasm.
When that flow is prevented or interrupted, erectile dysfunction — or the more familiar term, impotence — occurs.
Certain illnesses, stress, medications, and drugs contribute to erectile dysfunction, as do poor lifestyle choices, such as smoking, excessive alcohol consumption and inadequate physical activity.
Risk factors include:
- Certain diseases and conditions interfering with blood flow. Eighty percent of erectile-dysfunction cases are linked to vascular disease, diabetes, kidney disease, and chronic alcoholism. Vascular disease is recognized as a leading cause, with 60 percent of men who have had a heart attack or open-heart surgery expected to become impotent. “Probably 80 percent of patients who have erection problems have a real, physically identifiable problem,” Dr. O’Leary says.
- Drugs and medications, including illegal ones like cocaine. One out of four cases are related to side effects from medication. High blood pressure, heart disease and depression medications are the most common prescription drugs to interfere with the ability to achieve erection.
- Damage to nerves from stroke, spinal-cord injury, or prostate and other types of surgery. Diabetes, multiple sclerosis and long-term heavy alcohol use also can damage the nerves’ ability to send signals.
- Stress, anxiety, guilt, depression, low self-esteem and fear of performance failure are some of the psychological factors, resulting in 10 percent to 20 percent of cases of impotence. Psychological factors also can worsen impotence caused by a physical condition.
- Smoking, because it accelerates atherosclerosis, or “hardening of the arteries,” including the blood vessels of the penis.
The Effects Of Aging
Starting at midlife, the vessels of the penis begin to stiffen and become less pliable, making it difficult for the blood to easily flow through them. Current estimates suggest that more than half of all men in the United States over age 40 experience some erectile problems, according to the Massachusetts Male Aging Study, published in the journal Urology.
As men live longer, healthier lives they desire sexually fulfilling lives long past 40. Urologists like Dr. O’Leary are seeing patients of a wide age range.
“I still have plenty of men in their 60s and their 70s who are starting to deteriorate a little bit and want some help,” he says.