Erectile Dysfunction – What is it, and How to treat it?

What is Erectile dysfunction? 

Erectile Dysfunction (ED) is a common sexual issue in men. Nearly 30 million men are impacted by it.

An erection that is too weak or difficult to maintain for sexual activity is known as Erectile dysfunction.

While occasional erection issues in men are not uncommon, ED that progresses or frequently occurs during sex is abnormal and has to be treated.

An ED could occur

• When there is a restriction in penile blood flow or damage to the nerves
• Due to anxiety or emotional factors
• As a precursor to a more severe condition such as atherosclerosis (hardening or obstruction of the arteries), heart disease, high blood sugar from Diabetes or high blood pressure. 

Erection process

Nerves release chemicals that boost blood flow to the penis during sexual arousal. Two erection chambers of the penis, composed of spongy muscular tissue, receive blood flow (the corpus cavernosum). The chambers of the corpus cavernosum are solid.

The spongy tissues loosen up and trap blood during an erection. Erection results from the penis being stiff due to the blood pressure in the chambers. 

The second set of nerve signals that reach the penis during orgasm causes the muscular tissues in the penis to contract, releasing blood back into the circulatory system and causing a weak erection or no erection.

The penis is soft and limp when there is no sexual arousal. Men may see that their penis changes in size in response to heat, cold or stress. This is typical and represents the balance of blood entering and exiting the penis.

Causes of Erectile dysfunction 

Neurological disorders 

Stroke, Diabetes and other conditions can harm the nerves that transmit impulses to the penis. ED has a variety of neurological causes. Erectile dysfunction can be brought on by long-term alcoholism, multiple sclerosis, heavy metal toxicity, spinal cord and nerve trauma, and nerve damage following pelvic surgeries.

Vascular disease 

Vascular conditions like atherosclerosis (hardening of the arteries) can limit or obstruct the blood flow to the penis.

Psychological factors 

These include anxiety related to performance, stress, depression and a lack of brain stimulation. Erectile dysfunction can also result from depression, which is closely related to erection. 

Men with depression should have a thorough medical and psychological evaluation because there is a tripartite association between depression, ED and cardiovascular disease. Erectile dysfunction is a side effect of some antidepressants.

Risk factors of Erectile dysfunction 

Erections may be harder to get and may not be as firm as they used to be as with the increase in age. Given that men’s bodies alter as we age, this is a common occurrence. 

Males aged 50 and beyond exhibit ED, compared to men aged 40 to 49, who reported a small percentage of men reporting their first ED encounter.

Risk factors include

• Diabetic or cardiovascular diseases
• Restriction of blood flow caused by smoking or using tobacco products
• Usage of drugs or alcohol continuously.
• Medications
• Obesity
• Depression and other psychological disorders
• Surgery on the prostate 
• Pelvic trauma can harm the nerves or arteries that supply blood to the penis.

Symptoms of Erectile dysfunction 

To receive timely treatment for Erectile dysfunction, it is critical to recognise the signs and symptoms as soon as possible. One or more of these important symptoms will be present in a guy with Erectile dysfunction.

• Having issues obtaining an erection
• Difficulty maintaining an erection for a sufficient amount of time
• Low self-esteem
• Low sex drive
• Embarrassment or guilt feelings
• Anxiety and depression

Erectile dysfunction diagnosis 

Physical examination 

Physical examination helps detect signs of systemic problems, like the following.

• If the penis does not react to certain contact as expected, there may be an issue with the nervous system.

• Endocrine system-related hormonal issues can be indicated by secondary sex traits like hair growth patterns.

• An aneurysm (enlargement of artery) may be an indication of circulatory issues.

• Unusual features of the penis may provide clues as to the cause of impotence.

Medical and ED history 

The doctor will inquire about the lifestyle and medical history of the patient. Sharing information about drug use, smoking, alcohol consumption, and so on is quite beneficial. 

Communicating honestly with the doctor is helpful so they can guide toward the best course of treatment.

Laboratory tests 

Blood tests can reveal potential ED triggers such as Diabetes, atherosclerosis, chronic renal disease and hormonal issues.

Dynamic infusion cavernosometry

Dynamic infusion cavernosometry (Technique for dentifying venous leakage in ED) is useful for men with ED who have a venous leak.

A preset amount of fluid is infused into the penis during this procedure. Doctors can gauge the severity of a venous leak by counting how much fluid must be injected to get a hard erection.

Imaging tests 

Duplex Ultrasound

Duplex ultrasound may be the most effective for assessing ED. An ultrasound photographs the body’s tissues using high-frequency sound waves. 

An ultrasound may be used on persons with ED to assess blood flow and look for any venous leaks, artery hardness or tissue scarring. 

This test is carried out both with the penis erect (often brought about by an injection of an erection-inducing substance) and when it is soft.

Cavernosography 

This test includes injecting a dye into the penis and is used in conjunction with dynamic infusion cavernosometry. The venous leak is then visible on an X-ray of the penis.

Nocturnal penile tumescence (NPT) 

NPT examination evaluates a man’s erection while he is asleep. A man often experiences five to six erections while sleeping. An issue with nerve function or blood flow to the penis may be the cause of the absence of these erections. 

The strain gauge and snap gauge methods are used in the test. Three plastic bands of varied tension are wrapped around the penis when using the snap gauge technique. Then, depending on which of the three bands breaks, erectile function is evaluated. 

Elastic bands are wrapped around the tip and base of the penis for the strain gauge method to function. The bands stretch if the penis becomes erect during the night, monitoring changes in penile circumference.

Injection test 

A medication will be injected into the penis to induce an erection. Drugs may occasionally be administered directly into the urethra. This will enable a doctor to monitor the size of the penis and the duration of the erection.

How to treat Erectile Dysfunction? 

Lifestyle modification 

The following points assist in improving vascular health and, in turn, erection.

• Reducing weight
• Moving around actively
• De-stressing
• Keeping an active sex life
• Adopting a balanced diet.

Medication 

Nitric oxide, a substance the body naturally produces and which relaxes muscles in the penis and causes an erection, is enhanced by ED medications. These drugs help improve blood flow to the penis, which aids in its erection.

• Sildenafil (Viagra) 
• Tadalafil (Adcirca, Cialis) 
• Vardenafil (Levitra, Staxyn), Avanafil (Stendra)

The penile nerves will produce nitric oxide in response to physical or sexual stimulation of the penis. Nitric oxide production increases, causing the penis to erect normally. 

Intraurethral therapy 

For Intraurethral therapy (IU), a small medicated Alprostadil pellet is inserted into the urethra. IU Alprostadil should be tried in the presence of a healthcare professional before being used at home.

Penis burning is one of IU Alprostadil’s most usual side effects. It will require medical care to make an erection subside if it lasts more than four hours.

Vacuum erection device 

A vacuum erection device is a plastic tube that fits over the penis and forms a seal with the body’s skin. An erection is produced when a low-pressure vacuum is created around the erectile tissue by a pump at the other end of the tube. 

The base of the penis is then covered with an elastic ring. This retains the blood in the penis and keeps it firm for up to 30 minutes. 75 out of 100 men can successfully use a vacuum erection device with the right training.

Penile injection 

A very thin needle is used in this self-injection to give medication to the base or side of the penis. Alprostadil (injection or topical cream), phentolamine, and papaverine are a few examples of the several drugs that can be injected in this area. These drugs can be taken either concurrently or separately.

Side effects of the injection include 

• Mild bleeding
• Scar tissue at the injection site
• Priapism – is a severe medical condition that causes penile pain.

Surgical treatment 

A penile implant, also called penile prostheses, is the primary surgical remedy for Erectile dysfunction. Older boys or men who have tried oral PDE5 inhibitors, ICI, or IU treatments but failed are not advised to have penile vascular surgery. Instead, implants are the best option for them.

Penile implant

Erectile dysfunction can be managed by two different implant kinds, including

Portable genital prosthesis (3-piece hydraulic pump) – Within the penis’s erection chambers are a pump and two cylinders that can be used to inflate or deflate the penis. The pump releases a saline solution to bring about an erection.

Semi-rigid genital prosthesis – It is possible to induce an erection by inserting two semi-rigid, flexible rods inside the erection chambers.

Infections are the leading reason for penile implant failure, accounting for less than 2% of the total cases. Typically, implants are not evaluated until after other treatment options show no positive results, despite the fact that they have a very high patient satisfaction rate and are a great therapeutic option for the right patient.

Supplements 

Popular dietary supplements are mostly less expensive than Erectile dysfunction prescription medications. However, it is unknown how successfully or safely these supplements treat ED. 

Patients should be aware that PDE 5 Inhibitors, which have been bootlegged, have been discovered to be the primary ingredient in numerous over-the-counter medications during drug testing. 

Since these supplements are not subject to quality control, it is possible that different pills may contain different amounts of Sildenafil, Tadalafil, Vardenafil or Avanafil.

Sex therapy 

If a guy can have a regular erection while sleeping, his physical exam and blood tests come back normal, and he’s in generally good condition, sex therapy may help cure Erectile dysfunction. 

Sex therapy may also be beneficial when Erectile dysfunction is brought on by stress from worry about money, relationships, work, or other concerns. 

Can Erectile dysfunction be prevented? 

Many of the causes of Erectile dysfunction can be avoided.

• Quit smoking
• Adhere to a healthy eating regimen
• Maintain a healthy weight
• Be physically active 
• Control medical diseases like Diabetes and heart disease
• Ensure to exercise frequently
• De-stress
• Maintain a consistent sleep routine
• Avoid drinking alcohol
• Avoid taking medications that the doctor has not prescribed.

When to see a doctor? 

Erection problems can usually occur occasionally, especially when under stress, preoccupied, or just not in the mood for sex.

However, it’s crucial to speak with a healthcare professional if a person persistently struggles or is unable to erect during foreplay or intercourse.

The optimal time to visit a doctor is as soon as one starts to feel worried about their erectile health or sexual performance.

It is possible to treat Erectile dysfunction and enhance erectile health with doctor consultation.

Conclusion 

Erectile dysfunction, formerly known as impotence, is the lack of a stiff penile erection necessary for satisfying sexual interaction. 

The majority of Erectile dysfunction treatment is provided by primary care doctors, specialised nurses, pharmacists and psychologists. 

Patients who do not improve with the first treatment should be referred to secondary providers, typically urologists, for additional evaluation and therapy. 

The emotional stress experienced by patients and their partners might be reduced by prompt diagnosis and treatment.

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