Erectile Dysfunction

What is Erectile Dysfunction?

“The inability to attain and/or maintain a penile erection sufficient for satisfactory performance.”

Erectile Dysfunction(ED) is becoming a bigger topic in the medical sense. But what is it? Strictly defined, ED or erectile dysfunction, is the inability to attain and/or maintain a penile erection sufficient for satisfactory sexual performance. This could mean a frank inability to get an erection or, more likely, the erection is not the same quality it once was. In general, this tends to affect men more as they age, but this issue does not have an age limit.

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Signs and Symptoms of Erectile Dysfunction

Not attaining erection required for satisfactory sex is the main symptom of Erectile Dysfunction. But, there are several other psychogenic and organic symptoms as well.

Psychogenic Symptoms of Erectile Dysfunction

  1. Sudden onset
  2. Intermittent function (variability, situational)
  3. Loss of sustaining capability
  4. Excellent nocturnal erection
  5. Response to phosphodiesterase type 5 inhibitors is likely to be excellent

Organic Symptoms of Erectile Dysfunction

  1. Gradual onset
  2. Often progressive
  3. Consistently poor response
  4. Erection better in standing position than lying down (in the presence of venous leak)
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Causes of Erectile Dysfunction

Many factors like psychogenic, Nonendocrine, Medications, Lifestyle, and endocrine can cause erectile dysfunction. Let’s discuss each factor in detail

Psychogenic causes of Erectile Dysfunction

  1. Stress
  2. Performance Anxiety
  3. Depression
  4. Low self-esteem

Nonendocrine causes of Erectile Dysfunction

There are several Nonendocrine causes of Erectile Dysfunction like Neurogenic, Vasculogenic, and Iatrogenic.

Neurogenic causes of Erectile Dysfunction
  1. Spinal Cord injury
  2. Multiple Sclerosis
  3. Parkinson disease
  4.  Lumbar disc disease
  5.  Traumatic brain injury
  6.  Radical pelvic surgery (radical prostatectomy, radical cystectomy, abdominoperineal resection)
  7.  Diabetes
Vasculogenic causes of Erectile Dysfunction
  1. Reduced blood inflow to the penis
  2. Arterial insufficiency or arterial stenosis
  3. Hypertension
  4. Dyslipidemia
  5. High Blood Pressure
  6. Hypoxia

Endocrine Causes of Erectile Dysfunction

  1. Low testosterone or Hypogonadism
  2. Lowering of androgen levels

Medications that can cause erectile dysfunction

  1. Thiazide diuretics, β-blockers, and spironolactone used to treat hypertension
  2. Digoxin used to treat atrial fibrillation
  3. 5α-reductase inhibitors used to treat benign prostatic hyperplasia
  4. Anti-androgens used to treat prostate cancer
  5. Luteinizing hormone-releasing agonists and antagonists used to treat prostate cancer
  6. Tricyclic antidepressants, selective serotonin reuptake inhibitors, benzodiazepines, antipsychotics and phenytoin used to treat depression and other psychiatric conditions
  7. H2 blockers used to treat ulcers
  8. Opiates used to treat pain

Lifestyle causes of erectile dysfunction

  1. Smoking
  2. Drinking
  3. Overweight or obesity
  4. Cannabis
  5. No physical activity
  6. Less exercise
  7. Sleep

Risk Factors of Erectile Dysfunction

The identification of the pathogenetic factors involved in erectile dysfunction is the cornerstone of an accurate diagnosis and successful treatment.

Lifestyle factors and diabetes

Alcohol and smoking habits have consistently been shown to affect erectile function. Evidence from observational studies suggests a positive dose-response association between quantity and duration of smoking and the risk of erectile dysfunction. Similar results have been documented for alcohol abuse.

Diets that are low in whole-grain foods, legumes, vegetables and fruits, and high in red meat, full-fat dairy products, and sugary foods and beverages are all associated with an increased risk of erectile dysfunction.

Obesity and metabolic syndrome are associated with an increased risk of erectile dysfunction. It is conceivable that obesity-associated hypogonadism and increased cardiovascular risk are correlated with the higher prevalence of erectile dysfunction in overweight and obese men. More frequent physical activity is associated with reduced risk of erectile dysfunction.

Peripheral neuropathy, atherosclerosis of large blood vessels, endothelial dysfunction of arterioles, and the associated hypogonadism all contribute to diabetes-related sexual dysfunction.

Cardiovascular disease

Arteriogenic erectile dysfunction and cardiovascular disease are considered different manifestations of a common underlying vascular disorder. Erectile dysfunction needs to be considered the harbinger of coronary heart disease and as a predictor of future silent cardiac events. This association is particularly important in younger men (<55 years of age) and those with erectile dysfunction and no other comorbidities, emphasizing the importance of early diagnosis and correct management of erectile dysfunction-associated morbidities.

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BPH and LUTS

The presence of LUTS alongside BPH represents another important issue in men with erectile dysfunction. The presence of LUTS is an independent risk factor for erectile dysfunction, although the pathological reason for this association is unclear.

Psychogenic factors

Aside from organic factors, psychogenic and relationship domains need to be evaluated in men with symptoms of erectile dysfunction. All sexual dysfunctions, even the most documented organic types (such as diabetes-associated erectile dysfunction), are stressful and can lead to psychological disturbances. Performance anxiety is a common issue in men with sexual dysfunction, often leading to avoidance of sex, loss of self-esteem, and depression. Psychiatric symptoms are often comorbid in patients with erectile dysfunction. In addition, many psychotropic drugs can induce erectile and other sexual problems.

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Relationship factors

Although considered less often, the quality of a relationship represents an essential determinant of successful sexual activity. In fact, any sexual dysfunction in one member of the couple will affect the couple as a whole, causing distress, partner issues, and further exacerbation of the original sexual problem. Interestingly, a patient’s perception of reduced partner interest represents an independent predictor of incident cardiovascular events. Hence, the physical relationship between partners should be considered not only as enjoyable but also as a strategy for improving overall health and life expectancy.

Available treatments for Erectile Dysfunction

Yeah, it’s true! There are a wide range of treatments available to treat Erectile Dysfunction, Let’s talk about them.

1. Oral Drugs

Most of you are familiar with many of the available oral medications as this is the most common treatment for Erectile Dysfunction. There are a number of oral medications and most work by helping to relax the blood vessels in the penis, allowing blood to flow in. There are a number of oral treatments available including Sildenafil, Tadalafil, Vardenafil, Dextromethorphan, and Apomorphine which you see in more detail at “The ED Clinic”.

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2. Injection Therapy

As the name suggests it’s an Injectible Dose that will be taken directly by sticking needle to the penis every time they have the sex. This is an effective and reliable way of producing an erection with drugs. When injected, the drug (most commonly alprostadil, commonly known as Caverject and Viridal), relaxes the blood vessels and muscles, allowing increased blood flow and producing an erection within 15 minutes.

3. MUSE (medicated urethral system for erection)

 This method also uses alprostadil, but this time it’s administered by means of a small pellet inserted into the urethra, the opening to their penis, via a single-dose, disposable plastic applicator.

4. Vacuum Pumps

In this therapy, the penis is directly inserted into a cylinder-like device that pumps out creating a vacuum making the penis fill with blood. Once the erection is hard enough a plastic constricting ring is placed around the base of the penis to trap the blood. Many men find the process too unnatural and intrusive, however, and prefer to try other methods of tackling ED.

5. Hormonal Supplements

In the case of men with Erectile Dysfunction caused by low levels of testosterone, they will be treated by giving testosterone. This works better for men with less sexual desire.

6. Penile Implants

Although oral and vacuum erection therapies are effective first-line and second-line management options for most men with erectile dysfunction, surgical interventions remain an important modality in certain situations. Indeed, surgery might be suited for patients who have contraindications, experience adverse effects or are refractory to medical therapy; patients with erectile dysfunction and penile fibrosis secondary to Peyronie disease, prolonged priapism or severe infections; and patients with structural and/or vascular penile defects from genital or pelvic trauma. The current surgical armamentarium includes the insertion of a penile prosthesis and vascular reconstructive surgery.

7.Penile revascularization

Building on the same principles as bypass surgery for coronary artery disease, penile revascularization surgery techniques were developed to anastomose the inferior epigastric artery to either the dorsal artery or deep dorsal vein (arterialization), with or without venous ligation, to improve penile vascular inflow while reducing venous outflow. However, multicentre studies have revealed that arteriogenic erectile dysfunction is not common, and is more often associated with the systemic multifactorial disease, possibly caused by a combination of endothelial and corporal smooth muscle dysfunction, leading to a drop in penile revascularization procedures performed clinically

8. Sex Therapy or Counselling

This involves counseling for men who are suffering from Erectile Dysfunction caused by mental pressures and emotional distress. This Therapy could also benefit the men who have lost their self-esteem due to Erectile Dysfunction.

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DIAGNOSIS OF ERECTILE DYSFUNCTION(ED)

A doctor, such as a urologist, diagnose erectile dysfunction (ED) with a medical and sexual history, and a mental health and physical exam. You may find it difficult to talk with a healthcare professional about ED. However, remember that a healthy sex life is part of a healthy life. The more your doctor knows about you, the more likely he or she can help treat your condition. Here are some steps to diagnose Erectile Dysfunction.

Medical and Sexual History

Medical and Sexual history is the primary step that helps in diagnosing Erectile Dysfunction (ED). He or she will ask you to provide information, such as

  1. How you would rate your confidence that you can get and keep an erection
  2. How often your penis is firm enough for intercourse when you have erections from sexual stimulation
  3. How often you are able to maintain an erection during sexual intercourse
  4. How often you find sexual intercourse satisfying
  5. If you have an erection when you wake up in the morning
  6. How you would rate your level of sexual desire
  7. How often you’re able to climax, or orgasm, and ejaculate
  8. Any surgeries or treatments that may have damaged your nerves or blood vessels near the penis
  9. Any prescription or over-the-counter medicines you take
  10. If you use illegal drugs, drink alcohol, or smoke

This information will help your doctor understand your ED problem. The medical history can reveal diseases and treatments that lead to ED. Reviewing your sexual activity can help your doctor diagnose problems with sexual desire, erection, climax, or ejaculation. Before consulting a doctor asking these questions yourself will help you to face these questions and answer properly.

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Mental and Physical Examination

There are many causes for Erectile Dysfunction but mental or psychological issues are primary among them. The physician or doctor might ask you some questions about your personal life to know about your mental status.

The health care professional may also ask your sexual partner questions about your relationship and how it may affect your ED.

He or she also will perform a physical exam to help diagnose the causes of ED. During the physical exam, a healthcare professional most often checks your

  1. penis to find out if it’s sensitive to touch. If the penis lacks sensitivity, a problem in the nervous system may be the cause.
  2. penis’s appearance for the source of the problem. For example, Peyronie’s disease causes the penis to bend or curve when erect.
  3. body for extra hair or breast enlargement, which can point to hormonal problems.
  4. blood pressure.
  5. pulse in your wrist and ankles to see if you have a problem with circulation.

Lab Tests

Blood tests can uncover the medical reasons which can cause erectile dysfunction like diabetes and hormonal diseases.

Imaging tests

A technician most often performs a Doppler ultrasound in a doctor’s office or an outpatient center. The ultrasound can detect poor blood flow through your penis. The technician passes a handheld device lightly over your penis to measure blood flow. Color images on a computer screen show the speed and direction blood is flowing through a blood vessel. A radiologist or urologist interprets the images. During this exam, a health care professional may inject medicine into your penis to create an erection.

Other tests

Nocturnal erection test. During a nocturnal, or nighttime, erection test, you wear a plastic, ring-like device around your penis to test whether you have erections during the night while you sleep. This test usually takes place at home or in a special sleep lab. A more involved version of this test uses an electronic monitoring device that will record how firm the erections are, the number of erections, and how long they last.

Each night during deep sleep, a man normally has three to five erections. If you have erections during either type of test, it shows that you are physically able to have an erection and that the cause of your ED is more likely a psychological or emotional issue. If you do not have an erection during either test, your ED is more likely due to a physical cause.

Injection test. During an injection test, also called intracavernosal injection, a health care professional will inject a medicine into your penis to cause an erection. In some cases, a healthcare professional may insert the medicine into your urethra instead. The health care professional will evaluate how full your penis becomes and how long your erection lasts. Either test helps the health care professional find the cause for your ED. The tests most often take place in a health care professional’s office.

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