Vascular disease is probably the most common cause of ED, and of all the vascular causes, the commonest is atherosclerosis.
In addition to atherosclerosis, other disorders of both the arterial supply and the venous drainage of the penis can result in ED, and examples of both. When there is failure of the veno-occlusive mechanism, the phenomenon of venous leakage occurs. Two types of cavernosal cells are central to penile erection; namely smooth muscle cells and endothelial cells. The structural changes in the endothelium that are produced by diabetes are accompanied by functional changes that result in impaired smooth muscle relaxation. The diseases of smooth muscle that can result in erectile dysfunction have already been alluded to above. Extracorporeal shock wave therapy (ESWT) is currently used in the treatment of urinary stones and in Orthopaedics, Cardiology, Wound Healing, Plastic Surgery and Neurology.
The same modality is used for treatment of vascularbased (poor blood flow) Erectile Dysfunction problems.
There are so many physical causes that these can be further broken down into four types of health conditions.
Hormonal conditions, or disorders that disrupt hormone levels in the body, can also contribute to impotence. Finally, anatomical conditions that modify the penis’ physical structure like Peyronie’s disease that affects the tissue of the penis.
Psychological causes like depression and anxiety are also qualified as reasons for erectile dysfunction.
Chronic heavy drinking can damage your liver and nerves, aside from causing a disruption in the normal balance of male sex hormones all of which can lead to erectile dysfunction. Stress caused by different circumstances like death in the family, legal woes, job loss, financial difficulties, parenting, and divorce can make you less interested in sex and experience decreased semen count. About the AuthorTyler Goyvo is AMC's Clinical Manager and has over 5 years experience in the areas of Mens Sexual Health. TALK TO A DOCTOR 02 9929 6268Call our toll free advice line and our friendly clinical assistants will organise a time suitable to you to speak to a male medical doctor for FREE. Erectile impotence may be due to psychological problems, neurogenic dysfunction, hormonal alterations or compromised penile blood flow. JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. In our clinic, results indicate that treatment improves the quality of erections in over 80% patients with vasculogenic ED or diabetes. Men with early ED who respond to medication such as Viagra (Sildenafil), Cialis (Tadalafil), or Levitra (Vardenafil) -- {the so called 5-Phosphodiesterase inhibitors} -- In one research study, 77% of men in this group were cured, achieving spontaneous erections and intercourse without medication.
Men with severe ED, not responding to 5-phosphodiesterase inhibitors: 70% of these men with severe ED started to respond to medication after Soundwave Therapy, returning to a sex life with the help of 5-phosphodiesterase inhibitor tablets. In the case of impotence due to other causes, such as Prostate Surgery, Trauma, Peyronie’s Disease, Parkinson’s Disease or other similar causes, some men may have a combination of poor penile blood flow along with another cause for their ED and it is possible they may still benefit from the treatment. Poor penile blood flow is reportedly the commonest reason for ED and is present in 70% of men with Organic or Non-psychological ED. Many others may have risk factors for vascular disease that make vasculogenic ED more likely such as high Blood Pressure, high Cholesterol and a history of smoking.
The history obtained from the patient in a large percentage of cases would suggest or rule out ED due to vascular insufficiency. Soundwave Therapy is given as an out-patient treatment in a series of 12 short treatment sessions spread over nine weeks.

Soundwave Therapy is a non-invasive and entirely pain-free treatment that does not require any additional medication.
Early evidence shows that results have been maintained for up to two years after treatment.
The usual ED treatments involve medication which carry the risk of side effects, work only during a set time window, often require a degree of planning of sexual activity and incur ongoing drug costs. However, not only is atherosclerosis associated with ED, but its risk factors, namely smoking, hypertension, hyperlipidaemia and diabetes, are also associated with the development of ED. This is a purely radiological phenomenon seen during specialised radiological imaging of the penis (cavernosography).
The vascular endothelial cells line the trabecular spaces of the cavernosal sinusoids and release a variety of vasoactive chemicals which control smooth muscle tone within the penis. Aging results in reduced penile smooth muscle, as does atherosclerosis, while renal failure results in smooth muscle dysfunction. Shockwaves are being successfully used around the world since 2005 to treat reversible ischemic tissues in the heart, thus inducing neovascularization and developing new collaterals which improves the blood supply to tissues. According to experts, there are five main reasons for erectile dysfunction which you may want to learn more about in order to avoid misery brought about by this condition.
Vasculogenic conditions is one of the reasons for erectile dysfunction and pertain to disorders affecting blood flow to the penis. Neurogenic conditions that cover the parts of the nervous system such as the brain, nerves and spinal cord can also cause impotence.
If you suffer from hypogonadism, hyperthyroidism and hypothyroidism then there’s a risk that you will have problems sustaining an erection. These medicines include diuretics given to treat high blood pressure and kidney ailments; antihypertensive which are used for curing high blood pressure, and fibrates that are prescribed to people with high cholesterol levels. If you have been extremely sad for a long time, don’t be surprised that you find it difficult to have and sustain an erection.
Problems with your wife and partner can be a contributor to your depression and anxiety as well as past sexual problems. Stress can cause depression and will affect the neurotransmitters in helping you achieve a firm and hard erection.
He speaks to our male patients on a daily basis and is one of our most valued representatives.
With a better understanding of the erectile mechanism and with the development of new investigative techniques, recognition of the origin of impotence has dramatically improved in recent years, indicating that the majority of these patients are impotent due to vascular abnormalities.
A common cause of erectile dysfunction is reduced blood flow or vascular supply in the penis, called vasculogenic ED.
The impulses generated by the Soundwave Therapy machine are focused onto the treatment area, stimulating the treated tissues to grow new micro blood vessels.
They were able to discontinue more cumbersome or invasive treatments such as vacuum pumps or injection therapy.
Some patients may already have a diagnosis of vascular problems, such as previous heart attack or stroke. However, the doctor might advise certain tests including a Penile Doppler to make a firm diagnosis of ED due to vascular insufficiency to find out who is likely to benefit from this treatment. The treatment is given twice weekly during weeks 1-3, followed by a break of three weeks (weeks 4-6) and then a further three weeks with twice weekly treatments (weeks 7-9). This is the longest follow-up currently available, as Soundwave Therapy is a new treatment.
The Massachusetts Male Aging study described an association between ED and hypertension, diabetes and hypercholesterolaemia.

When originally described, it was thought that the abnormal veins represented the primary pathological pathological abnormality, and for some years surgical ligation of these veins was undertaken as a means of treating ED. When the smooth muscle malfunctions, arterial dilatation is incomplete, cavernosal relaxation fails to occur and the veno-occlusive mechanism fails. Erectile dysfunction, or impotence, simply pertains to a man’s inability to have or maintain an erection during intercourse. If you regularly use antidepressants, corticosteroids, antihistamines, anticonvulsants and anti-androgens, then you are at risk of having erection problems. If you are uneasy, worried, or fearful about certain things in your life including your performance in bed, then you will have problems having an erection. Rather than discussing the physiology of erection and its problems, we wish to propose a rational approach to the diagnosis and treatment of vasculogenic impotence. Research suggests that the improved micro-vessel network increases the blood supply to the penis, resulting in improved erection quality. To date, there are no reported side-effects during or after the treatment and the treatment is considered to be extremely safe. Surgical options like Microsurgery and Penile Implants are available but they carry their own risks for complications. The Cologne study of men with ED also confirmed an association between ED and diabetes and hypertension, while several studies have demonstrated an association between smoking and ED. However, with the understanding that the venous leak was almost always secondary to abnormalities of the tunica albuginea or to disease of the cavernosal smooth muscle (and with the realisation that the results of venous surgery were poor), surgical treatment has almost completely disappeared. Diseases which damage the endothelium impair the vascular response of the penis to neural stimuli. At PGS Hospital we examined the applicability of this new concept on the penis and assessed its effect on erectile function.
If you are in a new relationship and you feel insecure about your ability to satisfy your partner in bed, then you could be setting yourself up for erection dilemmas. Patients are able to return to their daily routines immediately following each treatment session. Soundwave Therapy is a non-invasive, non - pharmacological, non - surgical therapy which aims to trigger a natural mechanism that improves penile blood flow and may allow restoration of penile function and sexual spontaneity without need for ongoing treatment. At a cellular level, it has been suggested that a reduced arterial inflow leads to relative hypoxia within the penis with subsequent cellular effects.
A number of diseases damage the endothelium, including hypercholesterolaemia, but the most important is diabetes mellitus.
Br J Pharmac 87:4955.Buvat J, Buvat-Herbaut M, Dehaene JL, Lemaire A (1986) Is in-tracavernous injection of papaverine a reliable screening test for vascular impotence?
The crucial cellular mediator appears to be Transforming Growth Factor Beta 1 (TGF?1), which is increased in hypoxia and induces trophic changes in the cavernosal smooth muscle. With EDSWT, it has been possible for the first time to establish a rapid, standard and cost effective outpatient therapy, that can be used as often as required without any side-effects.
J Urol (in press)44.Zorgniotti AW, Padula G, Shaw WW (1983) Selective arteriography for vascular impotence.

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