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Erectile Dysfunction (ED)

Overview

Erectile Dysfunction or impotence is the inability to keep an erection firm and long enough to have sex. It is not a life-threatening condition; however, it will result in unsatisfactory sex life, self-esteem issues in men, relationship problems, and eventually the inability to get your partner pregnant. It may also point to other diseases that may need treatment. Erectile dysfunction is linked to diabetes, heart disease, and other health conditions; it may also be drug-induced. Treating those conditions may reverse erectile dysfunction or the condition altogether.

Causes

Among several possible causes of Erectile dysfunction, some are discussed below;

  • Stress
  • Psychological issues (depression, anxiety, not being attracted to the partner) 
  • Diabetes 
  • Heart diseases 
  • Chronic kidney disease
  • Clogged blood vessels (atherosclerosis )
  • High blood pressure 
  • Overweight
  • Metabolic syndrome (a condition involving increased blood pressure, high insulin, body fat around the waist, and high cholesterol)
  • Stroke
  • Parkinson’s 
  • Multiple sclerosis
  • Medication such as beta-blockers and certain antidepressants 
  • Alcohol 
  • Surgeries or injuries that affect the pelvis and spinal cord
  • Low testosterone
  • Anabolic steroids use
  • Lead, organic solvents, and pesticides have been implicated as hazardous agents  these environmental toxicants adversely impact erectile function
  • Some cancers can cause erectile dysfunction as a sexual side effect.
  • Priapism is a penile erection that might be painful and occurs without sexual stimulation.

Types

Some of the types of erectile dysfunction based on the mechanism involved are described below;

  • Psychological erectile dysfunction: It is due to psychological causes or diseases. 
  • Venogenic impotence: in this type, the veins in the penis leak the blood, and the penis fails to maintain an erection.
  • Diabetic impotence: This type results from pathological changes that accompany Diabetes Mellitus. 
  • Arteriogenic impotence: This type is due to problems with blood pressure. It is usually found in hypertensive patients who cannot receive sufficient blood for an erection.

Neurogenic impotence: It is due to any injury to the back of the body or vertebral column, particularly affecting the spinal cord nerves that control penile erection. Similarly, any surgery of the urinary bladder, prostate, or rectum that damages the concurrent nerves may result in this type of ED.

Risk Factors

Various risk factors contribute to erectile dysfunction; some of them are as follows ;

  • Being over age 50
  • Lacking exercise, sedentary lifestyle
  • Stress, anxiety, or depression 
  • Diabetes or heart condition
  • Tobacco use
  • Obesity
  • Prostate surgery 
  • Radiation treatment for cancer 
  • Long term drug use or drinking alcohol
  • Injuries that damage nerves or arteries that control erections

Epidemiology

According to CDC, about 18 million men are affected by erectile dysfunction in the USA. 

The incidence of Erectile dysfunction rises with the advancing age from approximately 22% at age 40 to 49% by age 70. It affects only 5 to 10% of the people below the age of 40. 

Signs And Symptoms

Symptoms may include 

  • Trouble having an erection
  • Trouble keeping an erection
  • Decreased desire to have sex

Diagnosis

For diagnosing the disease, your doctor will obtain a detailed history, including the past medical and surgical history, concurrent co-morbid conditions, stressors, etc. He may perform a physical exam focussing on your genitals, penis, and testicles. You may be asked to undergo the following investigations;

  • Blood tests such as  Fasting serum glucose level, Lipids, TSH, Morning Testosterone level
  • Urine analysis 
  • Ultrasound pelvis
  • Penile Doppler Ultrasound ( this checks the blood flow in penile vessels) 
  • Pelvis X-Rays 
  • Nocturnal Penile Tumescence (NMT) test: It is used to detect the penile erections that normally occur 3-5 times during the 8 hours sleep in men. 
  • Psychological exam: Sometimes, men face performance anxiety which is a fear about one's ability to perform a specific task. A thorough psychological exam will help evaluate the triggers that cause it.

Treatment

If you are suffering from ED, the best thing to do is consult a health practitioner who will advise you on treatment depending on the cause and severity of the condition. The doctor will explain the risks and health benefits of each treatment. He may prescribe medications or advise on Psychological counseling, exercise, and alternative medicine. If these measures are not effective or appropriate, the doctor may prescribe penis pumps, surgery, or penis implants. Penis implants are usually not recommended.

Medications

The medications usually prescribed are;

  • Oral phosphodiesterase inhibitors: Sildenafil (Viagra)
  • Tadalafil (Adcirca,Cialis)
  • Vardenafil (Levitra ,Staxyn)
  • Avanafil (Stendra)
  • Nitrate drugs: Nitro-Dur Monoket and Dilatrate –SR
  • Alprostadil (self-injecting)
  • Alprostadil urethral suppository
  • Testosterone replacement

Prognosis

The prognosis is generally favorable for the men who seek medical help for the ED. Many of the factors causing ED, like hormonal, psychological, or injuries to the penis, can be effectively treated, and so does the issue of ED. For the  ED caused by medical conditions that can not be cured, various treatment options are available to restore sexual function.