Erectile Dysfunction
What is Erectile Dysfunction?
An erection starts in the brain. Nerves release chemicals that increase blood flow into the penis during any type of sexual arousal (erection). During erection, blood flows into two cylinder-shaped erection chambers (the corpus cavernosum) made of blood vessels and spongy muscle tissue in the penis. Once blood is in the penis, it expands and keeps the erection. When a man has an orgasm, nerves send signals again that cause the muscular tissues in the penis to contract and blood is released back and the erection comes down.
Erectile dysfunction (ED), sometimes referred to as ‘impotence’ is the inability to get and keep an erection firm enough for sexual intercourse. Erectile dysfunction isn’t inevitable. Occasional erectile dysfunction is common. Many men experience it from time to time due to stress or emotional reasons, extreme tiredness, some medications and lifestyle changes. However, frequent erectile dysfunction can be a symptom of physical problems related to the blood supply of the penis. It can be an early warning of a more serious illness such as blocked arteries, heart disease, high blood pressure or high blood sugar. It can also be due to psychological reasons such as emotional or relationship difficulties. As per researchers, excessive alcohol or smoking or drug use can also lead to erectile dysfunction at any age.
Erectile dysfunction is the most common sexual problem all around the world. According to reports, around 30 million men in the U.S. have erectile dysfunction. This situation can lead to embarrassment, stress, lack of self-confidence and relationship problems. Men with healthier fitness and better lifestyle choices have better sexual function. Even if a man is embarrassed, he should consult a family doctor or professionals for treatment. Proper diagnosis on the basis of symptoms and then proper medications and treatments help him to get rid of this sexual problem. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. Although the risk of erectile dysfunction increases with age and some older men may need more stimulation, erectile dysfunction does not have to be a part of getting older. Old men should still be able to achieve an erection and enjoy sexual intercourse.
Causes of Erectile Dysfunction
Male sexual erection is a complex process and thus erectile dysfunction is too. It involves physical factors like the brain, hormones, nerves, heart, muscles and blood vessels as well as emotional factors like emotions, stress, relationship, moods, sleeping issues and tiredness. Lifestyle factors like alcohol, smoking and substance use also play a crucial role. Erectile dysfunction can result from one or more of these factors. Anyone from young men to old men can develop symptoms and the most common causes and factors regarding this condition are listed below:
Possible physical causes include:
Age over 60.
Enough blood does not flow into the penis due to other medical conditions such as blocked blood vessels, high blood pressure, heart disease, high blood sugar (diabetes).
Nerve signals from the brain or spinal cord do not reach the penis due to surgery or injury at the pelvic area or spinal cord.
Having peyronie's disease where scar tissue developed inside the penis.
Having high blood sugar (diabetes) may damage the nerves of the penis.
Went through prostate cancer or enlarged prostate treatments.
Having heart related disease.
Having high cholesterol.
Having high blood pressure or hypertension.
Having blocked blood vessels.
Having obesity or being overweight.
Having parkinson's disease.
Having low testosterone or hormonal imbalance.
Taking certain prescription medications.
Consuming excessive tobacco or smoking.
Consuming excessive alcohol.
Taking any forms of substance excessively.
Having sleep related issues.
Possible physical causes include:
Pressure about sexual performance.
Pressure about previous erectile dysfunction that may worsen the situation.
Stress from home, work, social, or religious conflicts.
Depression
Anxiety
Relationship problems
Symptoms of Erectile Dysfunction
Some of common symptoms are listed below:
Trouble getting an erection
Trouble keeping an erection
Reduced sexual desire
It is advisable to consult a family doctor or professional if a man is having any of these symptoms frequently for 3 or more months. They can help determine whether symptoms are caused by emotional factors or by an underlying condition. Sometimes erectile dysfunction may be a warning sign of blockage in blood vessels that may lead to heart attack or stroke.
Complications of Erectile Dysfunction
Some of complications resulted from this condition are listed below:
An unsatisfactory and unpleasant sex life
Depression or stress or anxiety
Embarrassment or low self-esteem
Relationship problems with partner
Inability to get partner pregnant
How is Erectile Dysfunction diagnosed?
Doctors may diagnose this condition by gathering more information about a person's medical condition by examining and knowing the following things:
By knowing about the person's symptoms & possible triggers.
By knowing about the medical history of the person.
By knowing about the sexual history of the person.
By knowing about the lifestyle of the person.
For many men, the above information is enough for a doctor to diagnose erectile dysfunction and recommend a treatment. But if a doctor suspects any underlying medical condition might be involved, further medical tests or a specialized consultation can be recommended. Medical tests for underlying conditions might include:
Physical exam: This might include careful examination of a man's penis and testicles, checking nerves for sensation, checking nerve function and blood flow in the pelvic region, checking hair pattern for hormonal issues.
Psychological exam: Doctors might gather useful information related to a man's sexual activities by interviewing a man alone or with his sexual partner. Doctors can also request to fill out a questionnaire about symptoms, triggers, medical history, relationship problems and sexual history. Doctors might also need to know about stress from home, work, social or religious conflicts. All information gathered either by interview or questionnaire can help doctors evaluate the severity of erectile dysfunction.
Ultrasound: This test uses high-frequency sound waves to take pictures of the body's tissues. This test is used to evaluate blood supply to the penis. This test is performed both while the penis is soft and while penis is erected using medicational injection to stimulate blood flow.
Injection test: Doctor inserts a medicated injection into the penis to stimulate an erection and to evaluate the firmness of the erection and how long it lasts. Sometimes this type of test can also be combined with ultrasound to further assess the erection.
Laboratory tests: These tests may include complete blood counts, urinalysis, lipid profile, measurements of creatinine, measurements of liver enzymes, measurements of testosterone levels etc. These tests are helpful to diagnose underlying health conditions such as heart disease, anemia, diabetes, thyroid issues, kidney issues, testosterone deficiency and other health conditions that may affect men’s erection directly or indirectly.
Treatment of Erectile Dysfunction
There are a number of options available for treating and managing the disease after diagnosis. Medications, non-surgical and surgical treatments as well as diet and lifestyle management help to manage symptoms and to treat disease. Treatment and specialists who do treatment are dependent on underlying medical conditions and their causes. Some of the treatments available for erectile dysfunction include:
Medications:
Oral medicines: These prescribed PDE5 inhibitors medications may help improve sexual function in men by increasing blood flow to the penis. Men with erectile dysfunction should take these medications about an hour before sexual intercourse for best results. Women or children should not take these medications. It is highly recommended that men follow precautions before taking medication for erectile dysfunction. Men who are on medicines that contain nitrates such as nitroglycerine should not take these oral medications. The combination of nitrates and these medications may cause low blood pressure (hypotension). Men who take tadalafil or vardenfil should use alpha blockers as per physician’s instruction to prevent too low blood pressure (hypotension). Men who have other heart or kidney related conditions as well as have diabetes or cancer should take these medications with only doctor’s advice and as per prescribed dosage. The common side effects of these medications are headache, stuffy nose, flushing, indigestion, muscle aches and a temporary visual disturbance.
Sildenafil ( Viagra )
Vardenafil ( Levitra )
Self-injection medications: Alprostadil is injected into the base or side of the man penis using a fine needle by a medical expert initially and then the man himself. Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve and psychological conditions. Generally man gets erection for an hour or till climax by each injection dose. Men who do not respond to oral PDE5 inhibitors medications can be treated with this injection medication. In some cases, medications are used with a combination of other medications such as bimix (if two medications are included) or trimix (if three are included). The amount of each drug used can be changed based on the severity of ED by an experienced health professional. The common side effects are mild bleeding due to injection, penile scarring (fibrosis), prolonged erection (priapism - erection for minimum 4 hours).
Urethral suppository: A tiny alprostadil suppository is placed inside the urethra (tube that carries urine and sperm out of penis) using a special applicator by a medical expert initially and then the man himself. This method is used instead of injection therapy and has been little less effective than injection therapy. Generally man gets an erection within 10 minutes for an hour or till climax by each dose. The common side effects are burning feeling in the penis, penile scarring (fibrosis), prolonged erection (priapism - erection for minimum 4 hours).
Urethral suppository: A tiny alprostadil suppository is placed inside the urethra (tube that carries urine and sperm out of penis) using a special applicator by a medical expert initially and then the man himself. This method is used instead of injection therapy and has been little less effective than injection therapy. Generally man gets an erection within 10 minutes for an hour or till climax by each dose. The common side effects are burning feeling in the penis, penile scarring (fibrosis), prolonged erection (priapism - erection for minimum 4 hours).
Testosterone replacement therapy (TRT): Some people may have erectile dysfunction due to low levels of the testosterone hormone. In this case, testosterone replacement therapy alone might be recommended or in combination with other oral medications. This therapy may fix normal erections issues and increase sexual interests in older men with low levels of testosterone hormone. If the man has normal testosterone levels and takes this therapy, there is a risk of prostate enlargement and other side effects. This therapy is available as a cream or gel, topical solution, skin patch, injectable form and pellet form placed under the skin.
Non-Surgical treatments: These are few non-surgical treatments that can be used along with or without prescribed medications. If medications aren't effective or appropriate, doctors might recommend a different treatment as mentioned below:
Vacuum Pumps: This vacuum erection device consists of a plastic tube, a hand-powered or battery-powered pump and an elastic ring. The plastic tube is placed over the penis and then the pump is used to suck off the air inside the plastic tube. This creates a vacuum that pulls blood into the penis. Once the penis gets an erection, an elastic ring slipped around the base of the penis to hold in the blood and keep it firm for around 30 minutes. Where the plastic tube and pump are removed from around the penis. An elastic ring is removed after sexual intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch. Use of this device with proper training is a good treatment that can be safely used to treat erectile dysfunction. The common side effects are bruising of the penis.
Psychological Therapy:
This vacuum erection device consists of a plastic tube, a hand-powered or battery-powered pump and an elastic ring. The plastic tube is placed over the penis and then the pump is used to suck off the air inside the plastic tube. This creates a vacuum that pulls blood into the penis. Once the penis gets an erection, an elastic ring slipped around the base of the penis to hold in the blood and keep it firm for around 30 minutes. Where the plastic tube and pump are removed from around the penis. An elastic ring is removed after sexual intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch. Use of this device with proper training is a good treatment that can be safely used to treat erectile dysfunction. The common side effects are bruising of the penis.
When erectile dysfunction is caused by stress, depression, anxiety, relationship problems or sexual performance tension then talk therapy or sex therapy for a man and his partner by a trained psychologist or counselor might be useful.
Surgical treatments: When oral PDE5 inhibitors, ICI or IU therapies are not responding well, then men can go with these implant surgical treatment options. Penile implants are devices that are placed fully inside the body. Penile implants are having risks such as infections but having the highest rates of success and satisfaction among other ED treatment options. There are two types of penile implants that are listed below:
Semi-rigid bendable prosthesis implant: This is a simple implant treatment. Two semi-rigid and easy-to-bend silicone rods are placed within the erection chambers of the penis. These two rods give the man's penis the firmness needed for sexual penetration. The malleable implant allows man to adjust the position of the penis manually so it can be bent downward for peeing or upward for sexual intercourse.
Inflatable prosthesis implant:
A pump and two inflatable cylinders are surgically implanted within the erection chambers of the penis. Tubing joins these cylinders to a pump placed inside the scrotum (between the testicles). The man compresses the pump to transfer fluid from the reservoir to the cylinders. This causes the penis to become erect, which is very similar to a natural erection. An inflatable implant allows man to use a pump to make his penis erected whenever he desires and for how long he desires. The use of a prosthesis preserves penile sensation, orgasm and ejaculation for most men.
Lifestyle management: Follow these lifestyle related changes during or after medication or treatment to make sexual function smoother.
Take or apply prescribed medications regularly.
Eat a healthy diet so the body gets required protein, vitamins and minerals.
Reduce or avoid high cholesterol foods.
Do exercise and yoga to keep your body and mind fit.
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