Erectile dysfunction is the inability to get or keep proper erection of penis, firm enough for sexual intercourse. ED is sometimes also called impotence, but that word is used less often to avoid confusion with other non-medical meanings. Most men have difficulties with erections from time to time. In some men, it is a regular, more severe problem. Although it is a benign disorder, male impotency may affect physical and psychosocial wellbeing and may cause a considerable impact on the quality of life of sufferers and their partners too.
How does erection occur and what causes its dysfunction?
An erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa (chambers in penis) to relax, allowing blood to ﬂow in through the arteries and fill in the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. At the end of sexual intercourse, brain terminates the signals or impulses and there is decreased blood flow to the penis and erection falls down.
There are various reasons for the Sexual Dysfunction in males like physical and psychological disorders.
Physical problems: Because an erection requires a precise sequence of events, impotency can occur when any of the events is disrupted. The following conditions might be the causes:
- Diseases like heart disease, high blood pressure and diabetes may all hinder in the proper erection hence causing this deformity.
- Injury or damage o nerves, arteries, smooth muscles, and ﬁbrous tissues, often as a result of disease
- Smoking, drinking alcohol extremely, being overweight, and less activity are possible causes of male impotence.
- Surgical treatment especially radical prostate and bladder surgery for cancer often injure nerves and arteries near the penis, such injuries may result in ED.
- Hormonal abnormality like the low amount of production of testosterone can also lead to erection problems.
Psychological factors: Stress, anxiety, guilt, depression, low self-esteem, and fear of sexual disappointment can also initiate ED. Even if the Erectile Dysfunction has a physical cause, it may trigger psychological factors, which may make the condition worse.
Medicinal side effects: Some blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine, an ulcer drug may onset erectile dysfunction.
Diagnosis of ED:
- Patient history: The medical history discloses diseases that lead to erection problems, and a simple recounting of sexual activity might identify problems with sexual desire, erection, ejaculation, or orgasm. It hence helps to identify the degree and nature of Erectile Dysfunction.
- Physical examination: A genital examination is done, and it is very essential. A digital rectal examination (DRE) of the prostate is not mandatory in Erectile Dysfunction but should be conducted in the presence of genito-urinary or protracted secondary ejaculatory symptoms. BP, heart rate, waist circumference and weight should be measured so as to find out the core cause of the problem.
- Laboratory testing: Tests for diseases including blood counts, urinalysis, lipid proﬁle, and measurements of creatinine and liver enzymes. The test for hormonal disorders such as hypo production of testosterone, measured by blood test. As these test may help to explain why a patient has decreased sexual desire.
- Psychological testing: It includes interview and questionnaire with the man and his partner to determine expectations and perceptions during sex.
Treatment: To improve erectile function the doctor treats the underlying causes. It may include suggest you change certain lifestyle ways, such as stopping drug or alcohol usage. Treating psychological health troubles, such as relationship conflict, depression also may be adopted.
1. Drug therapy: the drugs described here are not initiators of erection and require sexual stimulation to facilitate an erection.
Oral medication (first line therapy):
Approved by US FDA in 1998, it is the first pill to treat sexual dysfunction. VIAGRA, LEVITRA, and CIALIS these all three belongs to a class of drugs called phosphodiesterase. It is taken an hour before sexual activity they relaxes smooth muscles in the penis during sexual stimulation and allows increased blood ﬂow. Sildenafil is effective from 30-60 min after administration.
Its effectiveness is diminishes after a heavy, fatty meal due to prolonged absorption. It is administered in doses of 25, 50 and 100 mg. The recommended starting dose is 50 mg and it should be taken as per the needs and side effects on the patient.
This drug was licensed for treatment of Erectile Dysfunction in February 2003, it becomes effective after thirty minutes of application, and its peak efficiency arises after 2h. This efficiency is maintained up to 36 hours.
Commercially they became available from March 2003. 5, 10 and 20 mg doses have been approved for treatment of Erectile Dysfunction. The suggested starting dosage is 10 mg and should be adapted according to the response of patient and side effects.
Injectable medications (second line therapy)
Drugs such as Papaverine hydrochloride, Phentolamine, and Alprostadil widen the blood vessels. They are available as injections. As the oral medicines do not trigger the quick erection, some men consider Injectable drug as a more convenient choice for that matter as these drugs produce strong erection. However these drugs may produce unwanted side effects like: scarring of penis and persistent erection.
2. Vacuum devices: (third line therapy)
A vacuum erection device is a tool which draws blood into the penis, and causes an erection to form. Once an erection occurs, the elastic ring at the base of the penis grips the blood in the penis for up to half an hour. The elastic ring maintains the erection during the intercourse by preventing blood from ﬂowing back into the body. The erection achieved with a vacuum device may not sense like an erection that is achieved naturally. The penis may start feeling cold or numb and have a purple color. Bruising on the shaft of the penis may occur, but the bruises are usually painless and disappear in a few days.
The process of surgical implantation of a needful device in penis is called penile prosthesis. Surgery is basically meant for three purposes:
- To implant a device that can cause erection
- To repair and reconstruct the arteries that bring blood to the penis
- To block the veins that leak back the blood from the penis