What is Erectile Dysfunction and Endothelial Dysfunction?

What Is Erectile Dysfunction?
stethoscopeErectile dysfunction (ED) also knows as impotence is the inability to attain and retain an erection that is firm enough for a man to have intercourse, or the inability to maintain an erection long enough to ejaculate inside the vagina.

It can happen in one of two ways:

  • A man may be unable to get an erection.
  • A man may lose his erection at some point during intercourse, before he ejaculates.

A man is considered to have erectile dysfunction if he is unable to get or maintain an erection in at least 50 percent of his attempts at intercourse.

Erectile dysfunction is a problem for both the man and his partner. In many cases, treatment may not be necessary and the ED may resolve to some degree. In others, it may remain an issues that requires treatment.

Anything that interferes with either by reducing the blood flow to the penis or increasing the blood flow out of it – can cause erectile dysfunction. Fear, anxiety, anger, or any other strong emotion can interrupt the signal from the brain. An illness or physical condition can also impair erections if it interferes with this chain of events.

In most men, erectile dysfunction does not change their sexual desires, ejaculation or orgasms once he achieves and erection.

Is It Physical Or Mental?
It was believed for many years psychological factors were responsible for many of cases of erectile dysfunction. Due to new diagnostic methods and more sophisticated equipment, the conclusion is that physical factors are the main cause in the majority of cases. Due to the brains involvement it does play an important role in sexual activity, thus the body and mind are connected as one.

How Common Is It?
doctorsErectile dysfunction is common problem through a mana��s lifetime. Most of the men by the age of 50 years old have experiences erectile dysfunction at some point in time. According to the Massachusetts Male Aging Study complete impotence increases from 5% at the age of 40 to 15% of the males in the age group over 70 years or older. In a study conducted in the Netherlands the occurrence of some form of erectile dysfunction occurred in 20% of the males between ages50-54 and in 50% of the males between 70-78 years of age.

Although sexual activity normally continues throughout a man’s lifetime, his reactions take longer as he ages. He may need more stimulation to get an erection. He may take longer to climax, and he may need to wait longer before he can get another erection.

The chance of erectile dysfunction does increase with age. But erectile dysfunction can affect men at any age and at any time in their lives.

What Are the Options For Erectile Dysfunction?
There are many options for erectile dysfunction in the vast majority of individuals. Most men regain their ability to have intercourse using one of the following options:

  • Working with doctors to selection a medication or other option that can assist in gain back erectile function
  • Making lifestyle changes (eg. Quitting smoking, lowering alcohol intake, exercising more, improve diet intakes of vegetables and fruits, among other)
  • Counseling
  • Natural supplements and anti-oxidants
  • Taking ED medications
  • Vacuum constrictive devices
  • Injections and implants

How Does Erection Normally Happen?
An erection is a cascade of events that requires the interaction of the brain, nerves, hormones, and blood vessels. This process is separate from ejaculation and orgasm, both of which can occur without an erect penis.

The brain starts the process that will produce an erection due to psychological or physical stimulation.

  • As a result of, the brain sends messages through the nervous system to the penis.
  • These messages relax the smooth muscles in the blood vessel walls of the corpus cavernosum (spongy tissue chambers running along the shaft of the penis) by the release of nitric oxide, which causes them to open wider.
  • When this happens, nitric oxide allows this tissue to relax and fill with up to sixteen times its normal capacity of blood, filling the corpus cavernosum.
  • At the same time, pressure applied to the veins that carry blood away from the penis shut down, restricting blood flow out of the penis.
  • The blood that is trapped within the corpus cavernosum causes the penis to become hard and erect.

What Can Cause Erectile Dysfunction?
The ability to achieve and sustain erections requires

  1. a healthy nervous system that conducts nerve impulses in the brain, spinal column, and penis,
  2. healthy arteries in and near the corpora cavernosa,
  3. healthy smooth muscles and fibrous tissues within the corpora cavernosa,
  4. adequate levels of nitric oxide in the penis.

Erectile dysfunction can occur if one or more of these requirements are not met.

Some men are more likely to have erectile problems if they are put under emotional or physical strain. In general, seven “triggers” are linked with erectile dysfunction:


  • Aging
  • Illnesses
    • Diabetes
    • High blood pressure
    • Heart conditions
    • Poor circulation
    • Kidney failure
    • Thyroid deficiency
    • Multiple sclerosis
    • Chronic alcoholism
    • Spinal cord injury
    • Depression
  • Physical conditions
  • Stress related to a job, marriage, or finances is a common cause of erection problems. Ongoing stress may result in erectile dysfunction, which in turn increases stress.
  • Certain medications that may affect erections include:
    • Nicotine (as in excessive smoking)
    • Alcohol
    • Cocaine, heroine, amphetamines, and other illegal drugs
    • Tranquilizers and sleeping pills
    • Antidepressants
    • Blood pressure medication (beta-blockers)
    • Heart medications (such as digoxin)
    • Some peptic ulcer medication (such as cimetidine)
  • Misinformation
  • Poor communication
  • A “vicious circle”

Physical causes are more common in older men, while psychological causes are more common in younger men.

  • Medications are the cause in an estimated 25 percent of erectile dysfunction cases.
  • Various illnesses account for up to 75 percent of those people with ED. For example, up to 35 percent of diabetic males may experience impotence at some stage

Where To Find Help
The best person to approach is your own doctor, who might be able to help you or who can recommend someone else. You may be referred to a urologist, a medical specialist with advanced training to deal with issues surrounding erectile dysfunction.

Summary Of Important Information Related To Erectile Dysfunction

  • Erectile dysfunction is common and treatable.
  • Treatment should involve a man’s partner as well, since erectile dysfunction can have an impact on both of them and their relationship.
  • Although there is usually a mind-body connection with erectile dysfunction, the majority of cases have a physical cause.
  • Various “triggers” can cause erectile dysfunction; sometimes it is the result of two or more of these triggers working together.
  • A wide variety of options are available for erectile dysfunction, including medication, lifestyle changes, counseling, mechanical devices, and surgery.
  • Because prevention is always better than cure, men should maintain healthy habits to help prevent erectile problems.

What Is Endothelium and Function Of Endothelial Cells?
The endothelium is a thin layer of cells that lines the surface of blood vessels, forming an interface between circulating blood in the lumen and the rest of the vessel wall. These cells that line the entire circulatory system are called endothelial cells. The endothelial cells create a smooth lining which decrease turbulent flow of blood through the vessels.

The involvement of Endothelial cells and its role in the body are as follows processes:

  • Atherosclerosis
  • Blood vessel
  • Blood clotting (thrombosis & fibrinolysis)
  • Inflammation
  • Formation of new blood vessels (angiogenesis)
  • Vasoconstriction and vasodilation, thus controlling blood pressure
  • Filtration – highly differentiated unique endothelial cells are found in the renal glomerulus and the blood-brain barrier.

What Is Endothelial Dysfunction?
Endothelial dysfunction is a state in which the endothelial lining and the blood vessels do not respond well to vasodilating and vasoconstricting substances like nitric oxide, which is produced by the endothelium. Endothelial dysfunction can cause or be caused by many diseases such as: hypertension, hypercholesterolemia, diabetes, or environmental factors as alcohol intake, smoking tobacco products and exposure to pollution.

Impaired or loss of endothelial function is frequently seen in patients with coronary artery disease, diabetes mellitus, hypertension, hypercholesterolemia, as well as in smokers and may be early signs of vascular disease or development of atherosclerosis. There have been many studies that show some correlation between endothelial dysfunction and future cardiovascular events. Impaired nitric oxide production due to oxidative stress or other mechanisms which damage the endothelial cells are the main reasons for endothelial dysfunction.

Is Endothelial Dysfunction Related to Cardiovascular Disease?
Endothelial dysfunction is thought to be a key event in the development of atherosclerosis and predates clinically vascular disease sometime by many years. The reduced anticoagulant properties, oxidative stress and increased adhesion molecule expression are factors in the development of arthrosclerosis which are seen in endothelial dysfunction. Endothelial dysfunction has been shown to be of significance in predicting vascular events including stroke and heart attacks.

The Role of Nitric Oxide In Endothelial Dysfunction?
In endothelial dysfunction is the inability of arteries and arterioles to dilate fully in response to release of vasodilators from the endothelium like nitric oxide (NO). Endothelial dysfunction is commonly associated with decreased NO bioavailability, which is due to impaired NO production by the endothelium and/or increased inactivation of NO by reactive oxygen species. This can be tested flow-mediated dilation, which is the most widely used non-invasive test for assessing endothelial function. This technique measures endothelial function by inducing reactive hyperemic via temporary arterial occlusion and measuring the resultant relative increase in blood vessel diameter via ultrasound. People with endothelial dysfunction have low NO bioavailability, their blood vessels have a decreased capacity to dilate in response to certain stimuli, compared to those with normal endothelial function.

Because NO has anti-inflammatory and anti-proliferative effects and therefore helps inhibit atherosclerosis, it is easy to see how endothelial dysfunction may contribute to future adverse cardiovascular events. Due to the variability in such tests (e.g. due to time of day, food, menstrual cycle, temperature, etc.) means that no technique has yet been identified that would allow endothelial testing to attain routine clinical significance, the Endo-PAT is being utilized now which is a reproducible, user independent non-invasive diagnostic test, which would limit the variabilitya��s of the test.

What Are the Options For Improvement of Endothelial Dysfunction?
Exercise and improved diet has a significant impact on endothelial function. A study published in 2005 has determined that a positive relationship exists between the consumption of high fat diet and the development of endothelial dysfunction. Lifestyle modifications can improve endothelial function which include cessation of smoking, loss of weight and treatment of hypertension and hypercholesterolemia amongst other things. Some studies have found antioxidant and arginine supplementation independently and in combination can help to restore impaired endothelial dysfunction. Studies show that increasing nitric oxide production by the endothelial cells can have a positive impact on improving endothelial function.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

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