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admin | Category: What Causes Ed 2016 | 11.01.2014
Erectile dysfunction is a condition in which a man cannot achieve or maintain an erection rigid enough to allow sexual intercourse. Erectile dysfunction is not a life-threatening condition, but it can have a serious impact on a man’s sense of wellbeing, relationships, and quality of life.
Erectile dysfunction is also associated with many systemic health conditions (health conditions which affect the whole body or other body systems). It is increasingly understood that erectile dysfunction is underpinned by disorders of the blood vessels. Erectile dysfunction and diabetes mellitus are often comorbid (the conditions often occur at the same time), and erectile dysfunction is the first symptom of diabetes in some 20% of men who develop the condition. Erectile dysfunction is the most frequent complaint amongst diabetic men and is also common amongst men with metabolic syndrome (a condition that often leads to type 2 diabetes mellitus, in which there are several co-occuring metabolic and vascular abnormalities, such as high blood glucose levels and high blood pressure) or symptoms of the disorder. Dyslipidaemia (abnormal blood lipid concentrations) is also associated with erectile dysfunction. Thyroid disorders create imbalances in sex hormone binding globulin (SHBG) levels, which in turn affect the amount of bioavailable testosterone in the body. High levels of prolactin, characterised by hyperprolactinaemia, may reduce the production of testosterone, as it suppresses the secretion of luteinising hormone (LH), which is needed to trigger testosterone production. Depression: Some studies have shown strong associations between current erectile dysfunction and depression.
Lower urinary tract disorders: Men with lower urinary tract disorders are significantly more likely to experience erectile dysfunction than those without. Benign prostatic hyperplasia: There is little evidence to show a direct association between erectile dysfunction and benign prostatic hyperplasia, although the risk of erectile dysfunction may increase, either because of lower urinary tract symptoms related to benign prostatic hyperplasia, or as a result of surgical treatment for benign prostatic hyperplasia.
Alcohol abuse has been reported to impair erectile function, and moderate alcohol consumption is recommended because of its broad health effects.
As many men do not seek medical advice regularly, doctors may use the opportunity that a visit for erectile dysfunction offers to assess and, if necessary, treat comorbid health conditions associated with erectile dysfunction.
As erectile dysfunction is associated with (and may be a symptom of) many systemic health conditions, men who go to a doctor with erectile dysfunction of unexplained origin (e.g. Men who have previously experienced cardiovascular disease may be monitored by their doctor for erectile dysfunction, as it may indicate a recurrence. Men with newly diagnosed hypertension may also be screened for erectile dysfunction, as its presence or absence will influence the choice of medication. Many modifiable lifestyle factors affect erectile function and the effectiveness of its treatments, or are associated with conditions that cause erectile function. Poor nutrition, being overweight or obese, and inadequate exercise are associated with most of the conditions that increase the risk of erectile dysfunction. Maintain a healthy BMI (body mass index): Obesity is associated with an increased risk of erectile dysfunction. Consume a healthy balanced diet and particularly a diet low in fat and cholesterol: Reducing cholesterol intake has been shown to improve erectile function in as little as three months, and is also thought to improve the effectiveness of PDE-5 inhibitor therapy.
Be physically active: Physical activity protects against erectile dysfunction, even in men who start in mid-life. All men presenting with erectile dysfunction are likely to have their use of alcohol, tobacco and other recreational drugs assessed.
For more information on erectile dysfunction, types, causes and treatments of erectile dysfunction, and tips for dealing with it, see Erectile Dysfunction.
International statistical classification of diseases and related health problems: 10th revision [online]. Mondul AM, Rimm EB, Giovannucci E, et al. A prospective study of lower urinary tract symptoms and erectile dysfunction.
Bacon CG, Mittleman MA, Kawachi I, et al. A prospective study of risk factors for erectile dysfunction. Rubella (German measles, Three Day Measles) is a contagious viral infection with mild symptoms associated with a rash. The Rubella virus is spread via droplets and is most infective before and during the time the rash is present. In older patients, they may develop malaise, fever and mild conjunctivitis, rash and lymphadenopathy may also be present.
Rubella Complications are rare but may include post-infectious (immune) encephalitis, thrombocytopaenic purpura (skin lesions), and arthralgia (painful joints). Congenital infection include cataracts, nerve deafness, and cardiac abnormalities, as well as the generalised rubella syndrome – enlarged liver and spleen, mental retardation, low birth weight, jaundice, anaemia. About 25% or more infants born to mothers infected with rubella during early pregnancy will develop congenital rubella syndrome associated with a poor outcome. Rubella Treatment is supportive – there is no specific antiviral agent that can be used against rubella. Rubella can be prevent by use of the MMR vaccine which also confers resistance against measles and mumps. Prophylaxis with immunoglobulin (antibodies) may be considered in pregnant women who are exposed and termination is unacceptable. For more information on the vaccines available to protect against Measles, Mumps and Rubella, as well as the administration, side effects and components of each vaccine, see Measles, Mumps and Rubella (MMR) Vaccine.
About myVMCVirtual Medical Centre is Australia’s leading source for trustworthy medical information written by health professionals based on Australian guidelines.
Please be aware that we do not give advice on your individual medical condition, if you want advice please see your treating physician.
Polypill helps people stick to heart disease prevention regimensPrint PDFTaking aspirin, cholesterol-lowering and blood pressure-lowering drugs long-term more than halves heart attack and stroke recurrence. After an average of 15 months’ follow-up, the proportion of participants in the polypill group who were taking medications regularly was a third higher than in the group receiving usual care. Most of the patients in the study had already had a heart attack or stroke; the rest were at high risk on the basis of risk factors such as blood pressure, cholesterol and smoking.
Myelodysplastic syndrome (MDS) describes a group of bone marrow disorders that are characterised by a defect in stem cells.
The true incidence of Myelodysplastic syndrome (MDS) is difficult to estimate as it has only recently been regarded as a distinct class of disorders and controversies exist regarding its classification. The risk of MDS increases with age where patients usually older than 50 years get the primary form (no known exposure) of the disorder.
The signs and symptoms of this disorder are quite non-specific and a significant proportion of patients may have no symptoms at all. Your doctor will carefully examine you and may identify several particular signs that suggest the diagnosis of MDS. The most common test performed is a full blood count that shows low haemoglobin (oxygen carrying protein), low red cell count, low white cell count, high monocytes, and low platelets. The median survivial in primary (non-therapy related) MDS varies from 9 to 29 months, although some individuals in good prognostic groups live for 5 years or more. Treatment of MDS largely aims to control the symptoms of the underlying cellular deficiencies and reduce progression of disease without causing severe side effects.
Erectile dysfunction is associated with increasing age – the chances of a man experiencing erectile dysfunction doubles (and may even triple) between 40 and 70 years of age.
Sexual dysfunction (including erectile dysfunction) is a major cause of relationship breakdown and stress, and can negatively affect a man’s self-esteem.

Systemic health conditions affect a man’s physical health, can impact negatively on the treatment of erectile dysfunction and, in some cases, are life-threatening. These diseases affect the way blood is transported through the body (including through the penis), and include hypertension (high blood pressure) and ischaemic heart disease (insufficient blood flow into the heart); both of which are often associated with the development of type 2 diabetes mellitus.
Men with erectile dysfunction are about one and a half times more likely to develop cardiovascular (heart) disease in the future than those who are able to achieve erections. Between 20% and 85% of diabetic men experience erectile dysfunction, and the prevalence increases depending on the severity of their diabetes and their age.
An American study found that high proportions of men with erectile dysfunction exhibited at least one metabolic abnormality characteristic of metabolic syndrome (e.g. Moderate cases of dyslipidaemia, which might not typically warrant treatment, may be the primary cause of erectile dysfunction in some men.
Some 40% of men with erectile dysfunction are hypertensive, while 35% of hypertensive men experience erectile dysfunction.
As testosterone deficiency and erectile dysfunction are associated, conditions which affect testosterone production may also affect erectile function.
It is associated with many of the same risk factors as erectile dysfunction, including obesity, diabetes, metabolic syndrome and depression. However, a large study from the United States reported that being depressed did not increase the risk of experiencing erectile dysfunction. Studies have reported a 2–9 times increased likelihood of erectile dysfunction in men with lower urinary tract disorders, depending on the characteristics of the man (e.g. While evidence suggests that erectile dysfunction improves for more men following benign prostatic hyperplasia surgery, a significant proportion of men (~20%) experience more severe erectile dysfunction following surgery. However, current evidence does not suggest that alcohol consumption impairs erectile function. The widespread approval of PDE-5 inhibitors for the treatment of erectile dysfunction has changed management of the condition considerably. Because of this, many men are unaware of the associations between erectile dysfunction and other chronic health conditions, or that the existence of such conditions can considerably reduce the effectiveness of PDE-5 inhibitor treatment, and may not mention other health problems to their doctor.
Where no other causes can be identified, a doctor will consider the possibility of this condition in men with erectile dysfunction, even in the absence of cardiovascular disease symptoms. Men with previously diagnosed hypertension or dyslipidaemia may also be monitored for the development of erectile dysfunction.
Angiotensin II receptor blockers have been shown to improve erectile function in hypertensive patients and may therefore be an appropriate choice for men with both conditions. For example, diet and smoking are associated with cardiovascular disease, of which erectile dysfunction can be a symptom.
Thus, good nutrition and physical activity should reduce the risk of these conditions and improve erectile function. One study reported that obese men (BMI > 30) were almost twice as likely to experience erectile dysfunction compared to non-obese men. High-fat foods may interact with PDE-5 inhibitors and limit their effectiveness, so eating a low-fat diet during PDE-5 inhibitor therapy is also important for optimising treatment response. One study reported a 30% reduced risk of erectile dysfunction amongst men with high levels of physical activity compared to men with low levels. One study reported a 50% increased risk of erectile dysfunction amongst men who smoked compared to those who did not.
The international index of erectile function (IIEF): A multidimensional scale for assessment of erectile dysfunction. British Society for Sexual Medicine guidelines on the management of erectile dysfunction [online]. Erectile dysfunction and cardiovascular disease: Efficacy and safety of phosphodiesterase type 5 inhibitors in men with both conditions.
The association between obesity and the diagnosis of androgen deficiency in symptomatic ageing men.
Relation between psychosocial risk factors and incident erectile dysfunction: prospective results from the Massachusetts Male Aging Study.
Men with both premature ejaculation (PE) and erectile dysfunction (ED) experience lower quality of life than men with either PE or ED alone. Correlations between lower urinary tract symptoms, erectile dysfunction, and cardiovascular diseases: Are there differences between male populations from primary healthcare and urology clinics? Correlation between lower urinary tract symptoms and erectile dysfunction in men presenting for prostate cancer screening. Association between erectile dysfunction and lower urinary tract symptoms due to benign prostatic hyperplasia in Nigerian men. Beneficial impact of exercise and obesity interventions on erectile function and its risk factors. Rubella can also be transmitted to a fetus by a mother with an active infection, causing severe disease in the fetus. Due to fear of teratogenicity (defects in the fetus due to the vaccine), use of the vaccine during pregnancy or where there is a likelihood of pregnancy within 3 months is contraindicated. However, only about 50 per cent of people with cardiovascular disease in high-income countries take all recommended preventive medications. This is most relevant to the large number of high-risk individuals globally who currently don’t take recommended medications long-term.
The late Dr Anji Reddy gave the green light to the development, seeing an opportunity to provide an affordable, convenient treatment package to patients in India and elsewhere.
The bone marrow is the tissue located in the centre of long bones in the body and is responsible for producing most of the cells in the body.
However, MDS is now considered as common as Acute Myeloid Leukaemia (AML) and more cases are beginning to be recognised.
The second type of MDS is acquired following drug treatments or radiotherapy that damage the bone marrow. The course of the disease is variable, but serious complications of bone marrow failure, and transformation into acute myeloblastic leukaemia commonly occur. These patients are sometimes diagnosed by routine blood tests for other disorders, that happen to identify abnormal or reduced numbers of certain cells in the peripheral blood. Often you will appear pale due to anaemia of the doctor may detect a rapid heart rate or signs of heart failure. These abnormalities may occur alone or in combination but later stages of disease are characterised by deficiencies in all cell types. Patients with mild disease and less than 5% blasts cells (abnormal precursors) in the bone marrow, will usually be managed conservatively with red cell and platelet transfusions and antibiotics for infections, as they are needed. These diseases, similar to erectile dysfunction, are all caused by dysfunction of the endothelium, which controls the opening and closing of blood vessels and therefore regulates blood flow through the body. As the arteries of the penis are much smaller than other arteries in the body, they may be amongst the first to be affected by endothelial dysfunction.
Having erectile dysfunction increases the risk of cardiovascular disease to a similar degree as smoking or a family history of heart attack or dyslipidaemia (abnormalities of blood lipids such as cholesterol), which are considered major risk factors for cardiovascular disorders.
As such, treating these conditions may improve erectile function in the absence of other treatments. By definition, men with low libido often do not feel like having sex; therefore, they do not need to achieve an erection, and thus many testosterone-deficient men do not experience erectile dysfunction.

This may mean that the association between erectile dysfunction and depression found in other studies arises because erectile dysfunction causes depression, rather than vice versa.
A study of erectile dysfunction in Nigerian men with benign prostatic hyperplasia-related lower urinary tract disorders reported that more severe prostate symptoms of the lower urinary tract were associated with an increased likelihood of erectile dysfunction. Marketing of PDE-5 inhibitor-containing drugs directly to the public (as opposed to marketing to health professionals) has increased the demand for this form of treatment and resulted in more men seeking medical advice about erectile dysfunction. Doctors may therefore need to investigate the possibility of comorbid chronic conditions in men complaining of erectile dysfunction. Screening for comorbid conditions can enhance the early detection and treatment of these conditions, and improve their treatment outcomes. Health conditions such as diabetes mellitus and hypertension may also be suspected in cases of unexplained erectile dysfunction, as they have common causes and men with these conditions often visit a doctor because of erectile dysfunction.
On the other hand, thiazides and non-selective beta blockers are associated with erectile dysfunction and may be inappropriate for men who have difficulty achieving erections.
Thus doctors are likely to assess the lifestyle of men with erectile dysfunction, with the aim of identifying and modifying lifestyle factors which may be exacerbating the condition.
Low-fat and Mediterranean-style diets have proven effective in reducing the risk of erectile dysfunction in men with metabolic syndrome and obesity. Exercise programs have also been demonstrated effective in improving sexual response in men with erectile dysfunction. A person can transmit the disease from 1 week before the onset of the Rubella rash, until 1-2 weeks after the rash disappears. Stem cells are the precursor cells that divide and grow to produce each of the particular cell lineages. MDS is most common in elderly patients as they are more prone to bone marrow damge but it can occur in any ae group.
This type accounts for most cases under fifty years of age and arises 2-8 years following the damaging treatment. Patients may also get infections (due to reduced neutrophils that normally fight diseases) and bleeding problems (due to reduced platelets).
If symptoms do occur, the most common are fatigue, weakness, reduced exercise tolerance and dizziness which is caused by the underlying anaemia (reduction in oxygen carrying red blood ceels in the blood). The cells also have abnormal shapes and appearances that help the doctor make the diagnosis.
Other causes of death include bleeding and infection due to the reduction in platelets and neutrophils respectively.
Patients with more severe disease and more than 5% blast cells in the bone marrow, will require more aggressive treatment. In one Australian study, almost 10% of men aged 20–39 reported experiencing erectile dysfunction. Erectile dysfunction may therefore occur before other symptoms of vascular disease become apparent. An Italian study reported that a significantly higher proportion of men with metabolic syndrome also experienced erectile dysfunction, compared to healthy men. However, in some cases of hypogonadism, men with reduced libido may still want to have sex on some occasions; in these cases, testosterone deficiency may negatively influence erectile function and its response to treatment with PDE-5 inhibitors. A significant proportion (30%) may be unaware they have hypertension, and thus screening men with erectile dysfunction for this condition may help detect unidentified cases of hypertension. However, take note that cycling for more than 3 hours per week is a risk factor for erectile dysfunction, and cycling may therefore not be an appropriate form of exercise for men who are unable to achieve erections.
After the introduction of the live MMR vaccine in 1988 there has been a marked reduction in the number of cases.
Haemopoetic stem cells produce cells in the blood of three classes- white blood cells (leukocytes), red blood cells (erythrocytes), and platelets (thrombocytes).
Certain genetic defects (such as Down syndrome), cigarette smoking, benzene exposure and DNA repair disorders can also increase your risk of this condition.
The therapy-related form of the disease is normally much worse and rapidly progresses to cause a fall in red blood cells, neutrophils and platelets within the bloodstream. You may also notice symptoms of infection such as fever, cough or discomfort urinating as your body is more prone to bacterial and other infections due reduced neutrophils. In addition, a bone marrow biopsy (sample of bone marrow) is often taken to confirm the diagnosis as this can visualise the actual abnormal precursor cells. Patients with therapy-related MDS have a much worse outlook and most only survive for 4-8 months following the diagnosis. A number of options are available, including: supportive care only, low-dose chemotherapy, intensive chemotherapy, and bone marrow transplantation.
Vascular disease is the most common cause of erectile dysfunction, and the two conditions often occur together. Different studies have reported that 40–70% of men with erectile dysfunction also experience dyslipidaemia, and men with dyslipidemia have an increased risk of developing erectile dysfunction. There is evidence that for some men, combined testosterone and PDE-5 inhibitor therapy is more effective than either treatment alone. Similarly, erectile dysfunction may be a presenting complaint in cases of undiagnosed diabetes or dyslipidaemia. Cycling should be considered a potential contributor to erectile dysfunction by men who undertake this form of exercise. In Myelodysplastic syndrome (MDS) the stem cells become mutant and are no longer able to divide effectively into each of the blood cells. The choice of treatment will depend on your age, risk of disease and current performance status. As such, men with erectile dysfunction that has no identifiable cause will probably have their blood lipid concentrations, fasting blood glucose levels, blood pressure and other cardiovascular parameters assessed by the doctor. The normal bone marrow gradually becomes replaced with the mutant cells and there is a fall in each of the different cells within the bloodstream.
In addition, they will gently feel your stomach and may identify a big spleen which is associated with a particula, advanced type of the disease. Men with reduced libido or other symptoms of testosterone deficiency will likely have their blood testosterone levels assessed to screen for hypogonadism. Patients with this disorder therefore typically have anaemia, neutropenia and thrombocytopenia (low platelets). They will ask you a more detailed history about your symptoms and any possible predisposing factors to the disorder (such as certain chemotherapy drugs). The mainstay of treatment for all patients is therefore to focus on prompt treatment of infection, bleeding complications and anaemia. The abnormal cells in the bone marrow can also transform and cause syndromes also pose a risk of transformation to Acute Myeloid Leukaemia (AML).

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