Erectile Dysfunction

Erectile Dysfunction - What it is

What is erectile dysfunction?

Erectile dysfunction (ED) is the inability to get or keep a firm erection sufficient for sexual intercourse.

In an erection, impulses from the brain and local nerves cause the muscles of the corpora cavernosa, two chambers in the penis, to relax and allow blood to flow in through the arteries and fill the spaces. The engorged chambers expand the penis and the tunica albuginea, a membrane covering the two chambers, helps to sustain the erection. The erection ends when muscles in the penis contract to stop the inflow of blood and open the veins for blood outflow.

anatomy of penis without erectile dysfucntion

Erectile Dysfunction - How to prevent?

How is erectile dysfunction prevented?

Steps that can be taken to reduce the possibility of erectile dysfunction are:-

limiting the use of alcohol or drugs
not smoking
maintaining a healthy lifestyle
maintaining good mental health (reducing stress, dealing with anxiety and depression)

Erectile Dysfunction - Causes and Risk Factors

What causes erectile dysfunction?

Physical causes of erectile dysfunction (ED) include cardiovascular disorders affecting blood supply to the penis, nerve damage, hormonal disorders, physical abnormalities of the penis, certain prescription drugs, and drug abuse. These factors can lead to difficulties in achieving or maintaining an erection
Psychological causes of ED encompass depression, stress, performance anxiety, and traumatic experiences. These psychological factors can significantly impact sexual function and contribute to the development or exacerbation of erectile dysfunction
Chronic illnesses such as diabetes, high blood pressure, nerve disease or damage, multiple sclerosis, atherosclerosis, and heart disease can damage the nerves and arteries to the penis, resulting in ED
Poor lifestyle choices such as smoking, excessive alcohol intake, being overweight, and lack of exercise can also contribute to erectile dysfunction
Pelvic surgery can potentially injure nerves and arteries near the penis, leading to difficulties with erections
Additionally, medications such as blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine, an ulcer drug, can have adverse effects on erectile function. Hormonal abnormalities, such as low levels of testosterone, are also known to be associated with erectile dysfunction
The prevalence of ED may increase with age as well

Age	Prevalence
45 years	5%
65 years and older	15 – 25%
75 years and older	50%

These diverse factors can contribute to the development of erectile dysfunction, highlighting the multifaceted nature of this condition.

Erectile Dysfunction - Diagnosis

How is erectile dysfunction diagnosed?

Patient history, including medical and sexual histories, is crucial in defining the degree and nature of erectile dysfunction (ED). It can disclose diseases leading to ED, and a simple recounting of sexual activity may identify problems with sexual desire, erection, ejaculation, or orgasm. Additionally, the use of certain drugs can suggest a chemical cause, as drug effects are a frequent cause of ED.

A physical examination can provide valuable clues to systemic problems. For example, if the penis is not sensitive to physical touch, a problem in the nervous system may be the cause. Abnormal secondary sex characteristics, such as unusual hair patterns or breast enlargement, can point to hormonal problems, implicating the endocrine system. The doctor may also discover a circulatory problem by observing a decreased pulse rate in the wrist or ankles. Furthermore, unusual characteristics of the penis itself could suggest the source of the problem, such as Peyronie’s disease.

Laboratory tests, including blood tests to check the level of male hormones and to identify other medical problems causing ED, are essential. Additionally, tests for systemic diseases, such as blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes, can provide valuable insights. Measuring the amount of available testosterone in the blood can yield information on problems with the endocrine system and may explain decreased sexual desire.

Psychosocial examination, using an interview and a questionnaire, can reveal psychological factors contributing to ED. Furthermore, a man’s sexual partner may also be interviewed to determine expectations and perceptions during sexual intercourse.

In addition to the above, specific tests may be performed to further evaluate the condition. Ultrasonography can help determine if the blood circulation to the genitals is sufficient for an erection. Neurological tests, including a physical examination to check for nerve damage, are also important. Blood pressure tests, involving the injection of a dye in the blood vessels, can help determine any abnormalities in the flow of blood through the penis. These comprehensive screenings and tests are essential in diagnosing and understanding the underlying causes of erectile dysfunction.

Erectile Dysfunction - Treatments

How is erectile dysfunction treated?

Treatment options may include :

Lifestyle changes such as quitting smoking, reducing alcohol consumption, losing excess weight, and increasing physical activity may help some men regain sexual function.
Cutting back on or replacing medicines that could be causing ED.
Psychotherapy: techniques that decrease anxiety associated with intercourse can be taught together with the help of the partner.
Oral or locally injected drugs

Oral drugs called phosphodiesterase (PDE) inhibitors enhance the eff ects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow in the penis. Men who take nitrate-based drugs such as nitroglycerin pills for heart problems should not use any of these drugs because the combination can cause a sudden drop in blood pressure.
Drugs such as prostaglandin E1, papaverine hydrochloride, and phentolamine, are injected into the shaft of the penis to relax the smooth muscles of the corpora cavernosa, causing it to become engorged with blood. Patients using such medications should be warned about persistent erection, known as priapism, which requires emergency treatment.

Vacuum erection devices: mechanical vacuum devices cause an erection by creating a partial vacuum, which draws blood into the corpora cavernosa, engorging and expanding the penis. An elastic ring is moved from the end of the cylinder to the base of the penis as the cylinder is removed to maintain the erection.
External suction devices: involving the use of suction devices to pull blood into the penis so as to attain and maintain an erection for intercourse.
Surgery

Penile implant: Implanted devices, known as prostheses, can restore erection in many men with ED. The implants may be malleable implants or inflatable implants. Once a man has either a malleable or inflatable implant, he must use the device to have an erection. Possible problems with implants include mechanical breakdown and infection, although the incidents of mechanical problems have decreased in recent years because of technological advances.
Vascular surgery: Surgery may be performed to repair arteries with discrete blockage because of an injury to the groin or fracture of the pelvis. Surgery to block off veins, called ligation, can reduce the leakage of blood that diminishes the rigidity of the penis during an erection.

Extracorporeal Shock Wave Therapy (ESWT)

Extracorporeal Shock Wave Therapy or ESWT is a type of treatment for ED. It is a low intensity shockwave treatment when applied to different areas of the penis results in the stimulation of new blood vessel growth.

With more blood vessels, there is improvement blood flow to the penis which improves the ability to achieve a full erection.

Erectile Dysfunction - Other Information

References

Team, T. H. E. (2024, May 31). Complete Guide to Erectile Dysfunction (ED): Causes, symptoms & treatments. Healthline. https://www.healthline.com/health/erectile-dysfunction
MediLexicon International. (n.d.). Erectile dysfunction: Causes, symptoms, and treatments. Medical News Today. https://www.medicalnewstoday.com/articles/5702
U.S. Department of Health and Human Services. (n.d.). Symptoms & causes of erectile dysfunction - NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes
Assessment of erectile dysfunction. (n.d.). Management of Erectile Dysfunction in Clinical Practice, 40–49. https://doi.org/10.1007/978-1-84628-399-4_4