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Penis Anatomy

The anatomy of the penis is complex. It is comprised primarily of two cylinders of sponge-like vascular tissue that fill with blood to create an erection. Blood is pumped into the penis under great pressure and a series of valves keep it in the penis to maintain the erection.

A third cylinder is the urethra, a tube that carries the urine and the ejaculate. The knobby head of the penis is called the glans. Blood flows to the penis by two very small arteries that come from the Aorta. These arteries are the same size as the arteries to your finger.

The main problem that causes impotence is that the blood vessels become blocked and the blood can not get to the penis. The other major problem is leakage of blood from the penis into the veins around the penis called a venous leak. This is very common, similar to a hole in a tire.

The larger the hole the more air that needs to be pumped into the tire to keep it hard!

The creation of an erection is an extremely complicated cascade of events that requires many different things to happen. There are numerous chemical transmitters involved in this including epinephrine, norepinephrine, acetylcholine, prostaglandins and nitric oxide. The exact mechanism by which erection occurs is still unclear but we do know that the neural input from the brain is extremely important. Reflex erections, as seen in people with cord damage such as paraplegics, are often poor erections and not sustainable for prolonged periods of intercourse.

Causes

The Effects of Disease States and Drugs

•	Diabetes is the most common cause of sexual dysfunction in men. It has been estimated that up to 50-60 percent of diabetic men have erectile dysfunction. Attention must be paid with diabetics to a diabetic neuropathy -- the loss of vibratory sensations of the lower extremities. With this disease, there is always the possibility of peripheral neuropathies. Other diseases that are associated with peripheral neuropathies include chronic renal failure, carcinomas, rheumatoid arthritis, hypothyroidism, herpes zoster, anemias, breathing problems, such as chronic obstructive pulmonary disease, as well as a long list of hereditary neuropathies.
•	It is estimated that fifty percent or more of men with Multiple Sclerosis have erectile dysfunction. Bladder dysfunction can be also be associated with the erectile dysfunction in multiple sclerosis.
•	Parkinson's disease and temporal lobe abnormalities are risk factors for impotence.
•	Stroke and alcoholism create a very high risk because of damage to the testicles and the resulting decrease of testosterone in the body.
•	Aging is a common risk for erectile dysfunction, often related to a decrease of male hormones.
•	Chronic renal insufficiency is another potential factor. Many drugs used to treat the type of high blood pressure associated chronic renal insufficiency can cause erectile dysfunction, and many drugs are, by themselves, the culprit.

Drugs That Cause Impotence

Recreational drugs are a major cause of erection problems and the number one drug is tobacco. Experiments show that even two cigarettes will markedly decrease the blood flow to the penis if smoked before sex. Marijuana and alcohol are also big causes of erection problems.

Prescription drugs are also big culprits, especially blood pressure drugs. The major problem drugs include:

1. Estrogens used in men with prostate cancer

2. Antiandrogens (flutamide) used in men with prostate cancer

3. Lupron - prostate cancer drug

4. Proscar - for men with enlarged prostates, can decrease the volume of ejaculate

5. Diuretics - used for men with heart disease and hypertension

6. Methyldopa - older treatment for blood pressure

7. Beta blockers - for heart disease and hypertension

8. Calcium Channel Blockers- newer treatments for hypertension

9. Tranquilizers

10. Decongestants

11. Seizure Medications

12. Drugs to lower Cholesterol

13. Cimetidine - a drug for ulcers

14. Digoxin - a drug for heart failure

Other causes include surgical treatments for prostate problems, bladder removal for cancer, urethral stricture, urinary surgery, carcinoma of the penis, priapism, renal transplantation, colon surgery, radiation, lumbosacral surgery, penile amputations, and penile surgery in children to correct congenital problems.