Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, August 15, 1995 TAG: 9508150027
SECTION: EXTRA PAGE: 6 EDITION: METRO
SOURCE: JANE BRODY
DATELINE: LENGTH: Medium
But when the choice is between performing a preliminary mechanical act and being unable to enjoy sexual intercourse, a growing number of men with erectile dysfunction are choosing to forgo spontaneity so they can maintain an active sex life.
Compared with a decade ago, many more men are seeking help, and there are a growing number of ways and specialists to help them. Interestingly, the penile implants that touched off current professional and public interest in treating erectile problems are among the least popular and, while still highly effective, are mainly being used after other approaches fail. Nowadays, when the underlying cause of erectile dysfunction permits, less risky and less costly methods that are applied externally just before sexual activity are preferred.
Experts caution men against self-treatment with over-the-counter remedies that are purported to stimulate erections. A few may be hazardous and most are ineffective.
Except for the spontaneous erections that occur during rapid-eye-movement, or dream-sleep, erections start in the conscious brain with a nervous system response to imagined or actual erotic stimulation. The penis has two compartments that are collapsed in the flaccid state but that can expand when filled with blood to widen and lengthen the penis. Nerves provide a chemical signal that relaxes the smooth muscles that line feeder arteries and these cavities. Blood then flows into the cavities, causing them to swell and temporarily squeezing shut the escape route.
When the nerves are damaged, there is no release of the chemicals that allow the smooth muscles to relax. When there are blockages in the arteries, the penis cannot fill properly. And when the escape valve malfunctions, the blood leaks out too quickly.
In the flaccid state, relatively little oxygen reaches the penile tissues, but when the penis is erect it has a rich oxygen supply. Studies at Johns Hopkins Medical Institutions have shown that the nerves that project into the penis and surround its blood vessels produce nitric oxide, which triggers an erection and maintains the health of the blood vessels and penile cavities.
A failure to have erections, even during sleep, chronically deprives penile tissues of oxygen and nitric oxide and eventually may cause permanent damage that makes it difficult for the penis to trap blood. Men with erectile dysfunction should therefore not delay seeking treatment, the costs of which are covered by most insurers.
Counseling of couples, sex therapy and psychotherapy remain the best treatment for men whose erectile dysfunction is caused by emotional factors - a minority of sufferers. For those with organically based impotence, modern treatments include methods that can help nearly every man.
One of the newest and still experimental methods involves insertion into the urethra of one or two drugs that bypass damaged nerves.
Meanwhile, highly effective drugs, including alprostadil, papaverine, phentolamine and prostaglandin E1, can be injected directly into erectile tissue.
The usually painless injections into the side of the penis use a short, fine needle and cost $5 to $15 per dose. Their main drawback is the possibility that frequent use will cause a buildup of scar tissue from the needle wounds in the penis that could eventually make an erection difficult to attain.
Another increasingly popular external method is vacuum therapy.
The two-minute procedure, using a device called Erecaid, helps about a third of the men who try it. Its main side effects are minor and infrequent, mainly a reddish pinpoint rash on the penile surface and bruising if the vacuum pressure is maintained for too long.
A third external method involves oral medications that are purported to enhance blood flow to the penis. The main drug used is yohimbine, which is extracted from the bark of the yohimbine tree and has long been used in folk medicine to raise libido. In addition, there are penile implants, used mainly when other approaches are unacceptable or ineffective. Although they are expensive to install (the device, surgeon's fee and hospital costs run well into the thousands of dollars), the procedures are not experimental and the costs are usually covered by insurance.
by CNB