Characterized by the inability to achieve and maintain an erection of sufficient rigidity of penis for enough duration to perform sexual intercourse.
Sexual arousal is a very complex process involving nerves, blood vessels, muscles, hormones, brain signals, and emotions. Any problem within the process may affect directly or indirectly and cause erectile dysfunction.
Common causes include:
Clogged blood vessels (atherosclerosis)
High sugar or blood pressure (BP)
Low male hormones (testosterone)
Enlarged prostate (male organ which forms sperms)
Treatment for prostate cancer
Injuries and surgeries which may affect lower abdomen/back (pelvic region) and spinal cord
Psychological causes of erectile dysfunction:
– Brain plays a major role in an initial (arousal), an event that causes erection and it starts from sexual excitement.
– There are multiple factors which may affect the arousal and includes:
Depression, anxiety or mental health condition
Relationship problems with the partner/ inhibitions and limitations of the surroundings
The patients present with a complaint of:
Trouble getting an erection
Keeping an erection with sufficient rigidity to perform sexual intercourse
Reduced sexual desire to start with
Investigations and Treatment:
Diagnosis with erectile dysfunction (ED) is considered if an individual cannot achieve or maintain an erection repeatedly for sexual performance for at least three months.
Detailed history is required to exclude other causes of dysfunction such as loss of libido or premature ejaculation. History should also include inquiry about a person’s mental health any form of stress or anxiety or if the dysfunction is due to physical or psychological factors
Physical examination includes:
Assessment of BP, pulse, temp with local area examination of penis, testicles, and nerves by stimulating surrounding sensitive areas. The detailed examination helps to identify between the physical/structural factors or neurological (nerve) involvement
Blood samples are collected and sent to check for common causes of ED i.e. blood sugar, cholesterol, and male hormone (testosterone) levels
To check the blood flow through the penis. A wand-like a device (transducer) held over the vessel supplying the penis, a video image is created to see if there is any problem in the blood flow
Overnight erection test:
Most men have an erection during sleep without knowing it. A special tape is wrapped around your penis and if in the morning the tape is removed that means you had an erection unknowingly during your sleep, indicating the dysfunction is psychological and not physical
1) General principles:
Improve capacity to acquire and sustain an erection
Treatment varies according to the underlying condition.
Treat suspected underlying cause (if possible)
Avoid risk factors for ED
Use of ED specific medications
Stress reduction, counseling, psychotherapy
Lifestyle modification including avoidance of risk factors, e.g. encourage the reduction in the use of recreational drugs including alcohol and tobacco, lose weight
When treating the underlying cause:
Use alternate medications for drugs that cause ED e.g. for high BP use calcium channel blockers (Norvasc) instead of beta-blockers (Tenormin)
ED specific medications can be divided into:
Oral agents: Includes sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis); are all FDA approved agents
Note: The above agents are not recommended to be used with some drugs used for angina/ heart disease such as nitroglycerine.
Alprostadil(the prostaglandin PGE1): Injected into the base of the penis, maybe painful not recommended for daily use. Inject 10-20 mins before sex; erection may last up to an hour
Alprostadil: Gel inserted with an applicator into a small opening at the tip of the penis (urethra)
Penile ring: Patient who can acquire but can’t sustain an erection can use metal or plastic or leather ring which snaps around the base of the penis placed immediately after attaining the erection, to prevent blood draining out of the penis too quickly
Vacuum devices: Removes air from the vacuum chamber over the penis, creating a suction that draws blood into the penile region. Once the blood rushes into the penis an elastic tourniquet at the base holds blood so the erection can be sustained for sexual activity
Surgical implantation of penile prosthesis:
Reserved for patients who fail the first and second line of treatment
Medications which are used to treat erectile dysfunction are as follows:
Risk Factors and Prevention:
Medications such as antidepressants, antihistamines, etc.
Prostatic surgery and radiation therapy for cancers
Psychological conditions such as stress, anxiety or depression
Drug and alcohol misuse
With the variety of treatments available for erectile dysfunction, leads to satisfactory outcomes
The patient is unable to get the partner pregnant due to the dysfunction