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Veterans coming back from conflict may experience unimaginable levels of stress and anxiety being in that type of environment. Even if they may be retiring from battle, PTSD is something that can linger for decades after. Could it also influence your ED?

The root causes of erectile dysfunction can come in many different shapes and sizes. Some of the more common reasons that a patient may suffer from erectile dysfunction stem from the fact that they may have chronic conditions like hypertension, cardiovascular diseases or diabetes [1]. Less likely causes come from the fact that patients may have an underlying psychological disorder or excessive stress that would make it impossible to realize an erection during sexual intercourse [2]. Standard treatment options like Viagra can be beneficial for patients suffering from organic causes of erectile dysfunction but when patients have more extensive underlying problems, it can be a treatment that fails. Various alternative options and natural treatments for erectile dysfunction can be of some help. There are some vitamins and dietary supplements for ED like Korean ginseng that can help improve your mood but when suffering from a serious condition like post-traumatic stress disorder (PTSD), its effects may be limited. In this article, we will explore the deeper link between PTSD and erectile dysfunction and how PTSD in veterans can lead to sexual challenges and erectile dysfunction. 

What is Post Traumatic Stress Disorder? 

Whether you are a pacifist or not, an unfortunate thing about human history is the propensity towards global conflicts that require military intervention. Young men and women are placed in a high-stress environment and may even be asked to do things that question their morals to the core. Because of these conditions, military personnel can suffer from a condition called post-traumatic stress disorder. PTSD is an anxiety disorder commonly seen in patients who have experienced highly stressful or life-altering events. PTSD is most commonly seem in military veterans but can also be seen in cases of victims or assault, rape or car accidents to name a few. [3] Prevalence studies estimate that 17 percent of American soldiers currently involved in the war efforts in the Middle East already show or will exhibit some form of PTSD. Even though the weapons are more modern and the need for ground troops should be fewer due to drone use, the number of veterans suffering from PTSD roughly compares to the veterans who fought in the Vietnam War[4].

PTSD should be suspected when patients start to exhibit numerous "ill-defined" or "medically-unexplained" symptoms should as tinnitus (ringing ears), dizziness or blurry vision. If gone unnoticed, this can eventually snowball into something more sinister like organ system involvement where patients exhibit respiratory, cardiac, musculoskeletal or even neurological attacks. PTDS is not just a condition of "flash-backs" as depicted in movies but something much more complex and much less understood medically. Computer tomography (CT) scans show that several alternations can be seen in the limbic pathway in the brain, the hypothalamus, and the adrenal glands. Because of these imbalances, patients will have problems with sleep, memory, and will oftentimes be in a state of "hypervigilance." This means that the victim will be only able to have "local sleep" meaning the patient will be partially awake and partially asleep. [5

Unfortunately, because of the extensive systemic involvement due to alterations in neurological activity in the brain, treatment options may not be effective. When dealing with patients suffering from PTSD, the most likely treatment to be prescribed is a combination of anti-depressants, anti-psychotics and cognitive behavioral therapy. Studies show that patients receiving this combination had a significantly better quality of lives compared to those who decided not to have treatment. Due to federal budget deficits and insufficient resources, it may be hard for families to find continued relief if they are financially limited and those who have PTSD can regress to their post-war status if therapy is not maintained. [6]

How Does it Relate to Erectile Dysfunction? 

There is an obvious link between erectile dysfunction and military veterans suffering from post-traumatic stress disorder. One investigation was able to quantify it into more comprehensible terms and showed that veterans suffering from PTSD had concomitant erectile dysfunction in 85 percent of cases compared to 22 percent in controls (veterans who did not have PTSD). Erectile dysfunction was determined to also be moderate or severe in 45 percent of cases compared to only 13 percent of controls. This study also indicated that war veterans suffering from PTSD had the same level of sexual desire as those veterans not suffering from PTSD but had difficulty with arousal and ejaculation, proving that those afflicted were not just too traumatized for sex. [7

Even if there are many factors that could be the cause of this erectile dysfunction, the prevalence of anti-depressant and antipsychotic medications can be a primary cause for this scenario. Some of the more common side effects of anti-depressants like SSRIs (serotonin -selective reuptake inhibitors) include anxiety, insomnia, and sexual dysfunction so it is quite possible that the pharmacological treatment prescribed to veterans suffering from PTSD may also be causing their ED. [8] These are also the gold-standard treatment option for patients suffering from ED. 

Another common treatment that patients may be prescribed would be clonazepam, the gold-standard anti-psychotic medication that can be used for PTSD. In one study, out of 42 patients receiving clonazepam, 18 experienced severe erectile dysfunction; over 40 percent. Due to this side effect, veterans complained of poor quality of life and compliance rates were extremely low. [9]

All in all, PTSD has an unfortunately strong link with ED and treatment options are not easy. Because of the cascade of complex problems that are occurring, it can be hard for patients to return to a normal quality of life without treatment but side effects from common medications can inherently lead to erectile dysfunction as well. Even if these are treated, anxiety and stress from war scenarios can be difficult to cope with and psychiatric consultations should be used even years after returning to a normal life. Natural supplements for erectile dysfunction may provide some benefit. In this case and numerous vitamins and dietary supplements for ED are on the market to help fight mood symptoms without having the same panel of side effects. 

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