Erectile dysfunction (ED) is defined as the inability to develop and/or maintain an erection sufficient for a satisfactory sexual experience. There is no accepted definition of how often this has to happen or for how long it has to persist before a person can be diagnosed with ED. One common definition of complete ED is a consistent inability to develop and/or maintain an erection over a period of six months.
Erectile dysfunction was only recognized as a widespread problem in the 1990s. Since then, a number of studies have been conducted to estimate its prevalence. One large study found that overall, 53% of the male population has some degree of ED. The prevalence has a marked association with age, with 40% affected at age 40, increasing to 70% by age 70. The prevalence of complete ED increases from 5% at age 40 to 15% by age 70.
Although the chance of developing ED increases with age, aging does not cause ED. The link between ED and age is complex. Most men experience a progressive decline in libido and testosterone production starting in their mid-20s, and this may contribute to ED as the man ages. However, as noted in the next section, the main causes of ED are health conditions that become increasingly common as men age.
Erectile dysfunction is strongly associated with cardiovascular disease, including arterial disease, hypertension, and arteriosclerosis. The underlying link between ED and cardiovascular disease seems to be endothelial dysfunction, which plays a pivotal role in both conditions. Endothelial cells form a layer in the wall of every blood vessel, where it plays key roles in vascular tone and fluid homeostasis.
Endothelial dysfunction causes blood vessels to become rigid and inflamed. The blood vessels develop fatty plaques in their walls and become unable to undergo vasorelaxation. Vasorelaxation of blood vessels in the penis is a key step in achieving an erection. ED is also associated with metabolic syndrome, obesity, diabetes, smoking, alcohol abuse, and depression. Medications used to treat depression can cause or contribute to ED.
Twin studies indicate ED has a genetic component. About one-third of the risk is inherited. Some variants in certain genes have been linked to ED. The strongest association is with variants in the genetic elements that control the expression of the gene SIM1.
SIM1 encodes a transcription factor. Excessive levels of SIM1 produced during fetal development in fetuses carrying Down's syndrome (trisomy 21) are thought to play major roles in the formation of the characteristic skull and facial features of children with Down's syndrome and in their cognitive impairment. Genetic mutations that eliminate the production of SIM1 during fetal development cause a condition called Obesity Due to SIM1. Affected children suffer from hyperphagia, cognitive impairment, autistic-like behaviors, and early-onset obesity.
Exactly how genetic variants in the genetic components that control the expression of SIM1 increase the risk of ED is currently unclear. SIM1 plays a role in the leptin-melanocortin system, which regulates appetite and body weight, and also has a role in sexual function. The genetic variants in SIM1 are not linked to obesity or changes in BMI, and therefore they must affect some sex-specific function that increases the risk of developing ED in association with other risk factors.
In more severe cases, erection devices, penile implants, or testosterone therapy may be considered. More recently, plastic and reconstructive surgeons have achieved excellent results by performing a nerve transfer for erectile dysfunction.
At The Institute for Advanced Reconstruction, plastic and reconstructive surgeons Dr. Tushar Patel, Dr. Michael Rose, and Dr. Eric Wimmers offer advanced surgical treatment for erectile dysfunction caused by nerve damage or interruption, including conditions such as prostatectomy, prostate radiation, pelvic surgery, pelvic trauma, or diabetes. We also address idiopathic erectile dysfunction (which has an unknown cause).
Nerve Transfer for Erectile Dysfunction
A genitofemoral to cavernous nerve transfer is a minimally invasive procedure usually done on an outpatient basis. Patients typically return to work within one week and achieve full recovery in approximately six weeks. Nerve regeneration after surgery is expected within a year, restoring erectile function.
Prostate Reconstruction to Preserve Erectile Function
Our revolutionary prostate reconstruction procedure offers hope to patients undergoing radical prostatectomy surgery for prostate cancer. This 20 to 30-minute procedure allows men to retain normal erectile function. During the procedure, about four inches of nerve tissue is removed from the patient's calf and used to restore the vital nerves severed during the prostatectomy. This significantly increases the likelihood of achieving normal erectile function after the surgery, with no additional risks involved.
Do not let ED hold you back any longer. The Institute for Advanced Reconstruction is home to leading erectile dysfunction specialists. Our esteemed team, led by Dr. Patel, Dr. Rose, and Dr. Wimmers, offers cutting-edge treatments for erectile dysfunction caused by various factors, including nerve damage and prostate-related issues. With our revolutionary procedures and expertise in nerve transfers, we aim to provide long-term solutions for our patients. Take the first step toward restoring your quality of life by scheduling a consultation with our advanced NJ reconstructive surgeons today.