Erectile Dysfunction

Overview

Erectile dysfunction is a common penile disorder in men aged 40 or older, where one's ability to get or maintain an erection during intimacy decreases. This may result from an injury or trauma to the penis, prescription drugs, psychological conditions or underlying health problems such as heart disease or obesity. Diagnosis usually involves a physical examination where the doctor asks the patient about their medical history, symptoms and intimacy-related questions.

Treatment plans may involve reaching out for professional help from a sex therapist, indulging in cardio exercises and testosterone replacement therapy. The more holistic way of preventing the disorder is to maintain a healthy lifestyle while including changes such as quitting smoking and drinking, eating vegetables and fruits, and exercising.

What is Erectile Dysfunction?

Erectile dysfunction, also named impotency or impotence, is a penile disorder that affects an individual’s ability to get or hold an erection during sexual intercourse. During intimate moments, one's feelings share a pivotal role in getting and keeping an erection firm.

For this, one may feel confident, relaxed and aroused. While problems with erection are normal sometimes, they can occur due to causes such as psychological conditions, prescription drugs, and underlying health conditions. Excessive smoking or drinking can also trigger the condition.

Types of Erectile Dysfunction

The following are different types of erectile dysfunction:

Vascular Erectile Dysfunction: This common type of ED impacts the blood vessels that are responsible for sending blood to the tissues surrounding the penis and allowing it to keep an erection. It also affects the penis’ valves that hold blood inside.

Hormonal Erectile Dysfunction: The deficiency of testosterone hormone in the body causes hormonal ED. This type of erectile dysfunction may also result due to thyroid issues.

Neurogenic Erectile Dysfunction: It occurs due to nerve problems, preventing electric impulses from passing to the penis from the brain, eventually restricting an erection. It may result from radiation therapy, trauma, pelvic surgery or neurological problems such as multiple sclerosis (MS), spinal stenosis and stroke.

Psychogenic Erectile Dysfunction: Psychological conditions such as overthinking habits, anxiety, stress and behavioural syndromes can cause erectile dysfunction in many people.

Symptoms of Erectile Dysfunction

The symptoms of erectile dysfunction (ED) include getting an erection before sexual intercourse only occasionally, the ability to get an erection before penetration but facing difficulty in maintaining it during the process, the inability to get an erection completely, and the dire requirement of an external stimulation all the time to maintain the erection. Reduced sexual desire is also another symptom that some individuals with ED experience.

Causes of Erectile Dysfunction

Many underlying conditions can contribute to the cause of erectile dysfunction. Some of the conditions affecting one's nervous system, circulatory system and endocrine system can be a major cause of ED. The penis relies on some of the heart valves to close when it is abundant in blood, hence when these valves are dysfunctional, it leads to an ED.
The nerves, spinal cord and the brain also function together to pass electrical impulses across the body, helping it feel and move, including the penis. When testosterone fails to open up one's blood vessels, blood stops flowing towards the penis, causing an ED.

Other conditions and diseases that lead to erectile dysfunction include epilepsy, stroke, atherosclerosis, testosterone deficiency, vascular disease, hyperlipidemia, hypertension, chronic kidney disease, Peyronie’s disease, diabetes and diabetes-related neuropathy.

An erectile dysfunction can also be caused by experiencing trauma to the penis or surrounding areas. This includes injuries to the bladder, pelvis bones, spinal cord and prostate; pelvic, prostate, colon or bladder cancer surgery; penile fracture and radiation therapy. Erectile dysfunction can also be a common side effect of taking certain prescription drugs, which include antidepressants, chemotherapy drugs, anxiolytics, diuretics, Parkinson's drug disease, sedatives, anti-seizure medications, antiarrhythmics, antihistamines, blood pressure medications, prostate cancer drugs, and muscle relaxers.

Being involved in substance addiction including alcohol, opioids, nicotine, marijuana, methadone, cocaine, amphetamines, and barbiturates can also lead to ED as they suppress the central nervous system, damaging the blood vessels severely.

Emotional and psychological conditions such as low self-esteem, stress anxiety, depression and genophobia or the fear of intimacy or sexual intercourse also increase the risk of erectile dysfunction. Hence individuals who are 40 or older, are physically inactive, have diabetes, depression, a body mass index of over 25, and smoke are at a greater risk of developing ED.

Diagnosis of Erectile Dysfunction

The diagnosis of editor dysfunction starts with a physical examination where a healthcare provider asks the patient about the medical history and the symptoms they have been experiencing. While the questions may make the patient feel uncomfortable or awkward, it is essential to be open about them and honest with the medical expert to help them determine the cause promptly.

Examples of these questions may include asking the patient if they feel stressed frequently if they are currently taking any prescription drugs, how hard the erections are, how often they get erections, if they are facing any issues in their relationship, and the first time they started noticing the symptoms. The doctor may also request to talk with the sexual partner to determine the severity of the condition.

The healthcare provider may order certain tests to confirm the diagnosis based on the answers. These include blood tests complete blood count (CBC), thyroid tests testosterone tests, urinalysis, lipid panel liver function tests kidney function tests penile Doppler ultrasound, penile biothesiometry, vasoactive injection and magnetic resonance angiogram (MRA).

Treatment for Erectile Dysfunction

Identifying the underlying cause can help treat erectile dysfunction. Treatment options that a Healthcare provider may recommend to a patient can include talking to a sex therapist, quitting smoking completely, engaging in cardiovascular exercises such as swimming or bicycling, testosterone replacement therapy, taking the help of a penis pump (vacuum constriction device), penile implant procedure and penile low-intensity focused shockwave therapy (LiSWT).

A doctor may also recommend injecting medications right into the penis to create an erection within 10 minutes, this includes phentolamine (Regitine®), papaverine (Papacon®), and alprostadil (Caverject®).

Prevention of Erectile Dysfunction

Adopting a healthy lifestyle can help to prevent erectile dysfunction. Changes such as quitting smoking, limiting alcohol intake, engaging in cardiovascular exercises (jogging, running, swimming or bicycling), consuming a low saturated fat diet (fruits, whole grains and vegetables), maintaining a healthy weight and getting quality sleep can be immensely beneficial in the prevention journey.

Myths and Facts Related to Erectile Dysfunction

Following are the common myths and facts surrounding erectile dysfunction:

Myth 1: Erectile Dysfunction is a Normal Thing in Ageing People
Fact: While erectile dysfunction affects older people more commonly, it is not a normal part of ageing. An elderly individual may not experience ED and have satisfying sexual lives in their later years.

Myth 2: Erectile Dysfunction is All in One’s Head
Fact: While erectile dysfunction can be triggered by psychological factors, underlying physical health conditions such as heart disease, high blood pressure, high cholesterol, obesity and smoking can also cause the condition.

Myth 3: Only Taking Viagra Can Treat Erectile Dysfunction
Fact: Viagra may be recommended by a healthcare provider as a treatment option for erectile dysfunction. However, this condition can also be treated by a more holistic approach such as implementing lifestyle changes, taking medicines and opting for psychological counselling.

Myth 4: Erectile Dysfunction Only Affects the Elderly
Fact: This condition can affect males of any age, implying that even young men in their 20s and 30s develop erectile dysfunction.