The Factors of Erectile Dysfunction

As mentioned in a previous article (“The physical biology of Erections”), erections are brought about by the interplay of multiple factors and systems within the body. This co-ordination needs a highly refined and perfectly tempered system of signaling and control – a breakdown in any part of the system could potentially lead to impaired erectile function. We’ll discuss causes and availability of various male enhancement solutions on the market.

The causes of erectile dysfunction (ED) can be biological and/or psychological in origin[1] [2]; however, due to the complexity of the situation, no one is as yet 100% clear as to why ED develops. What we do have in the scientific literature is a clear description of correlations. Thus, these correlations are all good contenders (so to speak) for being contributory causes of ED. In other words, these are the factors (either alone or in some combination) that are most likely to lead to impotence. The main research findings on these correlative factors are mentioned below:[3]

Erectile dysfunction may be caused by:

  • Some underlying cardiovascular disease (CVD).
  • A study done in 2012 showed that as many as 80% of all erectile dysfunction cases are linked to some form of CVD. [4]
  • There is good evidence that links hypertension (high blood pressure) and atherosclerosis (a disease affecting arteries) to erectile dysfunction.[5] [6]
  • Age related physical decline.
  • There is a correlation between age-related hormonal changes [viz. changes in testosterone and dehyrdoepiandrosterone (DHEA)] and the incidence of erectile dysfunction.[7] [8] [9]
  • Fibrosis and age-related deterioration of the connective tissues in the penis are correlated with the incidence of erectile dysfunction.[10]
  • Diabetes.
  • Diabetic neuropathy (damage to nerves) and diabetic-linked abnormalities in blood flow are linked to erectile dysfunction.[11]

Common pharmaceutical drugs.

  • Especially those that are often used to treat various chronic lifestyle and degenerative disorders can also negatively impact on the body’s ability to induce an erection.
  • Typical examples of medications that can prevent or impair erections are tricyclic antidepressants, antihistamines (used for hay-fever etc.), benzodiazepines (tranquilizers) and many others.[12] [13]
  • Psychological factors.
  • Depression, low self-esteem, depression and anxiety are all correlated with male impotence.[14] [15]
  • Intermittent erectile dysfunction in younger men has been linked to predominantly the psychological factors mentioned above.[16]
  • In older men, erectile dysfunction is usually due to a combination of both biological and psychological factors.[17]


Psychological factors are present in almost every case of impotence. But, the question that must always be answered is whether these factors are symptoms of not being able to achieve an erection, or whether they cause the impotence in the first place? Impotence can itself lead to feelings of low self-esteem, inadequacy and emotional conflict within relationships, whilst on the other hand, depression, poor self-esteem, stress and anxiety might be able to independently impair the process of erection too.

If one does feel psychologically out of balance because of impotence then these very same induced psychological factors may further impair one’s future erections – a catch-22 cycle that can render the treatments for impotence…impotent; This situation is not uncommon in the scientific literature. [18]

Our takeaway from this brief article is to understand and come to know the factors associated with ED. Remember that the issue is complex, multi-layered and important to those who struggle with it. Both biological and psychological factors are at play and successful interventions to remedy the situation need to take account of the truth of the relevant case at hand in any arising instance of impotence. Although far too brief, I hope this short article may contribute to the enhancement of men everywhere by shedding light on the nature of the issue at hand.

[1] Heidelbaugh JJ. Management of erectile dysfunction. Am Fam Physician. 2010;81(3):305-312.

[2] Ritchie R, Sullivan M. Endothelins& erectile dysfunction. Pharmacol Res. 2011;63(6):496-501.

[3] McVary KT. Clinical practice.Erectile dysfunction.The New England journal of medicine. 2007;357(24):2472-2481

[4] Paroni R, Barassi A, Ciociola F, et al. Asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) and L-arginine in patients with arteriogenic and non-arteriogenic erectile dysfunction. Int J Androl. 2012;20(10):1365-2605.

[5] Kolodny L. (2011) Chapter 17: Men’s Health: Erectile Dysfunction (pg. 971). In: Bope E., Kellerman R. (Eds.), Conn’s Current Therapy (1st ed). Saunders, An Imprint of Elsevier.

[6] Sadeghi-Nejad H, Brison D, Dogra V. Male Erectile Dysfunction. Ultrasound Clinics. 2007;2(1):57-71

[7] MacKay D. Nutrients and botanicals for erectile dysfunction: examining the evidence. Altern Med Rev. 2004;9(1):4-16.

[8] Kolodny L. (2011) Chapter 17: Men’s Health: Erectile Dysfunction (pg. 971). In: Bope E., Kellerman R. (Eds.), Conn’s Current Therapy (1st ed). Saunders, An Imprint of Elsevier.

[9] Morales A. Androgens are fundamental in the maintenance of male sexual health. CurrUrol Rep. 2011;12(6):453-460.

[10] Sadeghi-Nejad H, Brison D, Dogra V. Male Erectile Dysfunction. Ultrasound Clinics. 2007;2(1):57-71

[11] Ginsberg TB. Male sexuality.ClinGeriatr Med. 2010;26(2):185-195.

[12] Fortney L. (2012) Chapter 60: Erectile Dysfunction (pg 560). In: Rakel D. (Ed.), Integrative Medicine (3rd ed). Saunders, An Imprint of Elsevier.

[13] Heidelbaugh JJ. Management of erectile dysfunction. Am Fam Physician. 2010;81(3):305-312.

[14] National Institutes of Health; Impotence. NIH Consens Statement. 1992;10(4):1- 33.

[15] Ginsberg TB. Male sexuality. Clin Geriatric Med. 2010;26(2):185-195.

[16] Ibid

[17] Ibid

[18] Ibid

Why Does A Dental Practice Need To Worry About Reviews?

Dental Practice Reviews

Most dental professionals prefer to focus on providing a great service… not marketing.

That’s great — from a patient service point of view. Your patients probably love you for exactly that… but the issue is that great service does not always equate to a thriving practice. Now, let me clarify, this is a key piece of running a successful practice — but unfortunately, marketing is often the driving factor behind generating growth for your practice (for better or worse).

This causes a common misunderstanding in most dental marketing strategies: A focus on patient satisfaction, without leveraging that great service for practice growth. Essentially, you need to learn how to leverage the amazing service that you are providing for effective online marketing.

Why should you bother getting reviews?

Without patient reviews, people searching for local dental practices will not be *compelled* to check out your practice. If a competing practice has more positive reviews than you, it is very likely that they will get the new patient. This comes down to social proof — essentially, people tend to make decisions that other people have made before them (because people tend to ‘follow the crowd’).

You need to take advantage of this marketing tenet — by leveraging your best patients, and getting them to post about their great experiences with your practice on online dental practice review websites, forums, and other communities. This way your practice will receive a massive boost in traffic/reputation/authority, and will have a much easier time getting new patients.

Get Started With Online Reviews, Receive Instant Gratification

If you start leveraging your great patient service today — you will see an (almost instant) increase in your online presence. Here’s how you do that:

Step 1) Talk, email, or connect with your best patients… and offer them a special deal.

Make sure that the special deal is actually valuable to them — remember they’re your best patients (whether that means the patients with the best satisfaction, or just the ones that have been coming to your practice for the longest time) — so even if you are technically losing a bit of profit by giving them a great deal… it’s worth it. You want to demonstrate that you value *their* patronage first and foremost, and then you can effectively ask for something in return.

Step 2) Ask these same patients (who want to take advantage of the special offer) to write you an *honest* review

You should make the process as easy as possible. Streamline it — whether you are executing this marketing strategy through email (send direct links to relevant review websites, this gives you control over where the reviews are placed), in person (give them a little card or paper with the same information), or some other medium.

Tip: Test whether asking for a review, or requiring a review to take advantage of the special deal, converts better. You might be surprised that sometimes taking the “soft-sell” approach will work best.

Step 3) Watch as online reviews for your practice pour in.

One of the huge benefits here is that your best patients are the ones taking advantage of this offer. So you first are offering them value, and making them happy (and reiterating why they love your practice), then asking for a small action in return. They’ll be happy to return the favor and really explain why they love your practice.

This will translate into a massive boost in online authority for your dental practice.

Now do you understand why online reviews are so important for dental practices?

What to Expect from Bunion Surgery

Bunion SurgeryBunions affect many people and are a source of pain from prolonged standing or walking. Having a bunion can limit your physical activity and can get worse over time. If you have a bunion, speak to a podiatrist or surgeon about the procedures available to help you.

Bunions are characterized by an enlarged joint below the big toe and a misaligned metatarsal in the foot. The surgery involved to correct this condition is common, but there are factors to consider. The procedure is invasive and takes a fair amount of recovery time. Generally you will need to set aside eight weeks for full recovery as the incisions and bone heals. You will be spending the first few weeks staying off of your foot and walking with the assistance of crutches, a walker or even a knee scooter. Your foot will be put in a walking shoe or boot that will help protect your foot while it heals. While the incisions are healing you will be required to use bandages and wraps to keep the wound clean and protected. You will have sutures that will need to be removed during your regular post-op checkups. You will also be required to protect your foot from water while you are wearing bandages, so have some plastic bags available to wrap around your foot while showering.

As the weeks progress you will be given more freedom of movement. Your surgeon will let you know what level of activity you should be at, so follow any instructions given to ensure a speedy recovery. If you are unsure about what you should be doing, ask your surgeon. Being at the right level of activity will protect you from injury that could prolong your healing process. Have diversions ready if you find yourself becoming restless.

You will be prescribed pain medication for your recovery. It is important to follow your doctor’s instructions on taking these drugs as there are side effects, including addiction. This is a very serious consideration since you will be taking these medications for a prolonged period. Try to limit your use if you can and stop taking them as soon as possible. If your pain does not improve over time, consult with your doctor right away as it might be a sign of complications. Be sure to attend every scheduled appointment so your doctor can recognize issues as soon as possible.

After the recovery period, your surgeon will likely refer you to a physical therapist. Even if you feel well, make sure you go to physical therapy as directed. Your physical therapist will help you fully recover and can also help identify potentially unseen difficulties. This therapy will also help you recover from lingering pain and stiffness.

What Should You Know About Taking Blood Thinners

Blood ThinnerTaking blood thinners is a serious undertaking and there are many important factors to consider if your doctor prescribes these drugs to you. They are given for a variety of circumstances from heart disease to blood clot risks.

If your doctor gives you blood thinners, be sure to thoroughly discuss their proper use. Find out any recommendations for the time of day and how to take them. Some blood thinners require you to take aspirin at the same time, so it is important to fully understand their use.

Discuss your family history at the start. Blood thinners may increase the risk of stroke and other internal bleeding, so if you or your family has a history of strokes, discuss this with your doctor before taking your blood thinners. Your risks may influence the type of drug and care you need.

While on blood thinners, you may be very prone to bruising. You will likely find bruises all over your body and you may not remember how you got them. Seemingly harmless bumps against a wall, hitting your elbows or knees and other encounters with objects can cause bruises that normally would not occur. Often these bruises will not cause lasting harm, but it is important to keep an eye on them. If you experience a bruise that is especially dark or puffy, consult your doctor right away. This could be a sign of internal bleeding, or even clotting risks that your blood thinners are supposed to protect against.

You will also experience increased or prolonged bleeding if you are cut. Have a good supply of bandages at all times for day to day cuts, since it will take longer for your cuts to close up.

It is very important that you inform all healthcare providers that you are taking blood thinners, even your dentist. Even a simple injection from your doctor could pose a problem, and any surgery is especially dangerous. If you are to undergo any procedure that cuts or pierces your skin, you will likely have to go off of your prescription for a certain amount of time beforehand. Also, ask your doctor when you should resume taking the drugs after a procedure.

Be sure to watch the dosage of your blood thinners. Taking more than your doctor prescribes could be very dangerous and greatly increases your risks of bleeding and bruising. Make sure the label matches your dosage at every refill. Mistakes can happen and could be deadly. If you have trouble remembering if you have taken your pill, get a pillbox with separate compartments and fill them with all your prescriptions for the week. This will ensure that if you forget, you can just check the pill box to see if you have taken your daily dose.

Consult often with your doctor or pharmacist if you have any questions or concerns. Blood thinners should be taken very seriously and you should be fully informed to ensure your good health.

What is Chronic Regional Pain Syndrome or CRPS

CPRS - Complex Regional Pain SyndromeChronic Regional Pain Syndrome (CRPS) is a nerve disorder that is the source of a variety of problems. Also known as RSD, CRPS is caused by physical injury, most often in the extremities. Although uncommon, CRPS is a serious problem and is not always recognized. The disorder is not widely known, so being aware of the symptoms is a great benefit to anyone at risk. If you experience an injury, being able to recognize CRPS early will greatly improve your chances of getting successful treatment.

CRPS varies in the degree to which it affects you, but there are common symptoms. Edema, or a purple coloration coupled with swelling is prevalent. Strange sensations often accompany this disorder and are usually only found in the hands and feet, especially if these are the sites of the initial injury. Chronic pain is the worst symptom and can often be mistaken for an injury that refuses to heal, although this is not the case.

While the exact causes of CRPS are not known, it is known that it is a disorder of the sympathetic nervous system. One way to explain this is that your brain constantly thinks you are being injured and makes you feel the pain and even swelling associated with an injury. Your nerves are stuck in a loop of reacting to trauma that is no longer there. Sensations vary greatly but are often difficult to describe. Skin sensations are often overactive and unexpected. Even light touch could be very painful. Temperatures can feel very extreme. Textures can cause a variety of strange sensations such as a blanket’s touch feeling like a massive sunburn or a pet’s fur feeling like a thousand needles.

Other symptoms include initial hair loss followed by rapid hair growth that often grows back thicker than it was before.  The symptoms are commonly isolated to the hand or foot that was initially injured, though in some cases, the disorder can spread and even jump to other extremities. Unfortunately, because CRPS is not widely recognized and the symptoms are varied, it is often misdiagnosed for months or years.

There is no cure for CRPS but there are treatments that can help reduce the effects. Early diagnosis greatly improves the results of treatment, so it is important to be aware that CRPS exists. Treatments include nerve blocks, physical therapy and medications, including pain medications for chronic pain. Compounded creams are available to help mitigate the effects of extreme skin sensitivity but they are often expensive and only available through mail order pharmacies. Additionally any treatments given are usually variable and unpredictable in effectiveness.

There is currently no way to predict if an injury will lead to the onset of CRPS. Being aware of the existence of CRPS and spreading that awareness can help you get an early diagnosis or even help in the diagnosis of a mysterious condition already in effect.

What are the Risk Factors for Hearing Loss

Hearing Loss RisksHearing loss affects millions of people. It is important to know the risk factors that can lead to hearing loss to determine if you are in danger. Once you know your risk level, you can determine ways to prevent hearing loss or help treat the conditions involved.

The risk factors for hearing loss can be divided into two categories: genetic and environmental. Environmental factors are the easiest to control and proactive measures can be taken at any time to help reduce your risk. High noise levels are the most common environmental factor that often leads to hearing loss. This is especially true in the workplace where you may be exposed to dangerous levels of sound for prolonged periods. Hearing loss commonly happens over time, so it is important to take measures to prevent damage as early as possible. Military personnel, construction workers, musicians and factory workers are just a few of the types of workers at high risk. Speak with your employer about your exposure to noise. In many cases, your employer is obligated to provide you with safety measures such as earplugs or earmuffs and even regular hearing tests. If you believe you are at risk on the job, take action to protect your hearing as soon as possible. Check in with your doctor or an audiologist to determine your risk and also determine if any damage has already been done. Disease or physical trauma are other environmental factors that can lead to hearing loss. High fevers, infections, head trauma and objects entering the ear canal are also common sources of hearing loss. Again, check with your doctor if you experience any of these risk factors.

Genetic factors are difficult to control and also play a major role in hearing loss. Unfortunately, there may not be any way to avoid eventual hearing loss, but it is important to be aware of your family history as early as possible. If you know that hearing loss runs in your family, seek out professional medical advice before you experience hearing loss. While you may not be able to prevent the problem, you will be able to seek out help to improve your hearing once it does affect you.

Whatever the source of your risk factors, being able to recognize them will give you an edge on dealing with the problems associated with hearing loss. It is never too early to plan for this problem and you may be able to prevent hearing loss altogether. Make hearing tests a part of your regular healthcare plan so that you can catch damage early on. Your doctor may not recommend hearing tests, so it is up to you to bring this up at your regular visits.

Is Physical Therapy Really Useful?

Physical therapyInjuries and physical medical issues are sources of great difficulty and can affect your functionality. After receiving initial medical treatment and follow-ups, your healthcare professional may suggest that you begin physical therapy. It is sometimes tempting to skip this part as you may be taking medication that reduces pain and makes you feel more able. However, physical therapy can provide you with essential help in reaching the peak of your functionality.

There is a phrase that goes, “Motion is Lotion”, and physical therapy can provide you with this much needed help. Your physical therapist will guide you in specific exercises that are proven to aid in your recovery. Your sessions will include these exercises as well as help you know your limitations and how to work on improvement over time.

Sessions with your physical therapist will improve your range of motion. Stiffness and pain will reduce your ability to move. Your physical therapist will guide you in ways to exercise that will reduce pain and help you regain as much ability as possible. By reducing your pain with these techniques you will quickly reduce your dependence upon medications.

Physical therapy will help uncover issues that your doctor may not be aware of. Injuries can affect nerves which present added difficulties in areas you normally wouldn’t notice. Simple things such as left and right orientation may be affected and you would probably never realize this without specialized physical therapy to expose and treat these issues. Your physical therapist is trained to recognize the potential for hidden issues and provide the proper care to address any unusual problems.

Surgery can present issues that may benefit from physical therapy as well. Any surgery is technically an injury in and of itself. Ask your doctor if your recovery program would benefit from post-op physical therapy. You may have to go through a healing period before starting physical therapy sessions, but following through could provide you with a faster recovery.

Even if you have not experienced any direct injury or physical trauma, you might be suffering from chronic pain that seems to have no source. A physical therapist can still help you improve your range of motion and reduce your overall pain. Additionally, you will be provided with guidelines for exercises to do on your own that will continue to maintain your functionality.

Whatever the reason you choose to start your physical therapy sessions, be sure to follow through with all of your visits. It is often tempting to end your sessions early because you are feeling better. However, it is important to see it through to the end to ensure the full benefit. Also, don’t skip out on your homework. Your will be provided with exercises to do at home and this is an integral part of your plan. Finally, most insurance plans will cover a set number of visits during a given year. Don’t be afraid to take advantage of the benefits your insurance offers.