What causes erectile dysfunction and what can be done to treat it? | Peter Attia & Mohit Khera

The paragraph discusses the criteria for diagnosing ED, focusing on two key questions from the SEP2 and SEP3 questionnaires. These questions assess whether a patient can achieve and maintain an erection sufficient for penetration until orgasm. The text explains that any instance of failure to achieve these criteria, even if infrequent, qualifies as ED. It also differentiates ED from other issues such as the ability to achieve an erection but not ejaculate. The paragraph further explores the pathophysiology of ED, distinguishing between vascular, endocrine, neurologic, and traumatic causes, as well as the role of medications and psychological factors in causing ED. It concludes with a discussion on the treatment of psychogenic ED, which is often seen in younger patients and is treated differently from organic ED, using daily Cialis as an effective treatment.

This paragraph delves into the mechanism of action of PDE5 inhibitors, such as Viagra, Cialis, and Levitra, which are used to treat ED. It explains the role of nitric oxide, cyclic GMP, and phosphodiesterase in achieving and maintaining an erection. The text highlights that these medications work by inhibiting phosphodiesterase, thereby increasing cyclic GMP levels and allowing for sustained erections. It also touches on the different types of phosphodiesterases in the body and how certain medications may have cross-reactivity, leading to side effects. The paragraph discusses the development of Viagra and its unintended discovery as an ED treatment, as well as the impact of Viagra on the field of sexual medicine.

The paragraph discusses the impact of aging on the penile tissue and the ability to achieve and maintain erections. It explains that aging can lead to muscle atrophy and fibrosis, which affects the ability to maintain blood flow within the penis and can result in a venous leak. The text explores various methods to overcome this issue, such as increasing blood inflow with medications like Viagra or using a penile band to compress veins and increase back pressure. It also discusses the role of testosterone in maintaining penile muscle health and the benefits of regular erections for oxygenating penile tissue. The paragraph concludes with a discussion on the potential preventative benefits of daily Cialis use for maintaining penile tissue health.

This paragraph addresses the cost and dosing strategies of Cialis, highlighting the transition from high costs for the brand name drug to the affordability of generic versions. It discusses the conversion between single, on-demand doses and the daily 5-milligram dose, emphasizing that the daily dose has additional benefits such as FDA approval for Benign Prostatic Hyperplasia (BPH) and pulmonary hypertension. The text also mentions the potential for endothelial dysfunction improvement and the importance of separating the intake of Cialis and certain other medications to avoid hypotensive effects. It concludes with a discussion on the perceived quality of generic medications and the importance of lifestyle modifications in managing ED.

The paragraph explores the evolutionary perspective on male sexual health and the changes that occur as men age. It discusses the difficulty in achieving erections as men get older and how this contributes to increased refractory time. The text also touches on the impact of health quality on sexual health, highlighting that older men in good health can still have good semen parameters and erectile function. It emphasizes the importance of lifestyle modifications, such as diet, exercise, sleep, and stress reduction, on improving erectile quality and overall quality of life. The paragraph also discusses the correlation between cardiovascular disease and ED, with ED often serving as a sentinel sign of cardiovascular issues.

This paragraph outlines the diagnostic methods used to assess physiological ED. It describes the use of penile ultrasound after injecting a medication to induce an erection, allowing for the measurement of peak systolic and end diastolic velocities to diagnose arterial insufficiency and venous leak. The text explains the significance of these measurements in understanding the hemodynamic problems within the penile tissue and how they can inform treatment approaches. It also discusses the importance of lifestyle modifications in improving not just ED but also overall cardiovascular health, emphasizing the impact of diet and exercise on endothelial function and ED reversal.