Erectile Dysfunction

Erectile dysfunction, also known as impotence, has the following symptoms:

• Difficulty in getting an erection
• Difficulty in keeping an erection for long or even short durations
• Reduced sex drive

Sexual arousal in men involves the brain, emotions, hormones, muscles, nerves and blood vessels. If erectile dysfunction occurs, it may be because of a problem with any of these systems. In addition, stress and mental health concerns can also worsen or lead to erectile dysfunction.

In some cases, mental and physical issues have been known to cause erectile dysfunction. For instance, an activity that usually causes an erection may cause anxiety and, thus, difficulty in maintaining an erection. The resulting anxiety thus worsens erectile dysfunction.

Some causes of erectile dysfunction are

• Physical causes of erectile dysfunction
• Heart disease
• Clogged blood vessels (atherosclerosis)
• Metabolic syndrome, in which the patient has high cholesterol, high insulin levels, increased blood pressure, and body fat around the waist
• Parkinson's disease
• High cholesterol
• High blood pressure
• Trauma
• Diabetes
• Obesity
• Multiple sclerosis
• Certain prescription medications
• Tobacco use
• Treatments for prostate cancer or enlarged prostate
• Vascular disease that blocks the supply of blood to the penis
• Surgeries or injuries affecting the pelvic area or spinal cord
• Peyronie's disease
• Alcoholism and other forms of substance abuse
• Sleep disorders
• Low testosterone levels
• Psychological causes of erectile dysfunction

The brain plays a primary role in triggering an erection. However, if any of the factors that stimulate the brain are compromised, impotence may occur. These factors include:

• Depression, anxiety or other mental health conditions
• Stress
• Relationship issues causing stress, poor communication or other concerns

Healthcare providers record medical history and perform a complete physical exam initially. This is enough to diagnose erectile dysfunction. However, if an individual has associated medical conditions or is suspected of having any, they must be addressed first.

Some tests that the doctors may advise are:

• Physical exam: This includes careful evaluation of the penis and testicles and evaluating its nerves for sensation.
• Blood tests: Blood tests are advised to evaluate low testosterone levels, heart disease, diabetes, and other conditions.
• Urine tests (urinalysis): It helps to diagnose diabetes and other underlying conditions.
• Ultrasound: This test helps assess erection-related problems due to restricted blood flow.
• Psychological exam: Psychological evaluation helps diagnose depression and other possible causes of impotence.
• Complete blood count (CBC): CBC helps diagnose anaemia, which can lead to fatigue and, in turn, erectile dysfunction.
• Liver and kidney function tests: These tests indicate whether erectile dysfunction is due to improper functioning of the kidneys or liver.
• Lipid profile: This blood test measures lipid levels in the body, which may indicate atherosclerosis. This condition affects blood circulation in the penis.
• Thyroid function test: Thyroid hormones are responsible for regulating the production of sex hormones. Its deficiency may cause erectile dysfunction.
• Blood hormone studies: Abnormal testosterone and prolactin levels in the blood may lead to erectile dysfunction. It is thus essential to assess their levels.
• Duplex ultrasound: This test is the preferred choice for evaluating erectile dysfunction. It helps assess signs of a venous leak, atherosclerosis or tissue scarring. The test is carried out when the penis is erect and soft.

After diagnosing erectile dysfunction, doctors formulate a treatment plan based on the root cause of the disorder. In most cases, this condition is reversible. However, depending on the severity and cause, doctors may recommend the following treatment options:

Oral medications

In many individuals, oral medications help treat erectile dysfunction. Some advised medications include:

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

These medicines enhance the effect of nitric oxide, a chemical produced by the body that helps relax the penis. As a result, the flow of blood to the penis is increased, and an erection occurs. However, sexual stimulation is needed to produce nitric oxide in the body.

Other medications for erectile dysfunction include:

• Alprostadil self-injection
• Alprostadil urethral suppository
• Testosterone replacement

Surgery, penis pumps, and implants.

Doctors may recommend shock wave lithotripsy, to penis or penile pumps or implant surgery when medications are ineffective.

• Penis pumps: A penis pump is a vacuum erection device like a hollow tube with a hand or battery-powered pump. It aids in getting an erection.
• Use of low-intensity shock waves (LISWL) : It is a new addition in the treatment of ED. It improves penile blood flow naturally by neo vascularisation.
• Penile implants: Surgically placed devices into both sides of the penis help with erection; it allows men to control the timing and duration of the erection. It consists of either inflatable or malleable rods that keep the penis firm.

Exercise/ Yoga/ Meditation

Exercising improves erections. Even less strenuous yet regular exercises have an impact on erectile dysfunction. Yoga and meditation help decrease stress levels to a greater extent.

Psychological counselling

In most cases, stress is the primary cause of erectile dysfunction. Psychological counselling helps ease stress, whether work-related or in relationships.

Complications that may result from having erectile dysfunction may include:

• An unsatisfactory sex life
• Stress, anxiety and depression
• Embarrassment or developing low self-esteem
• Relationship issues, sometimes divorce
• The inability to get their partner pregnant or infertility if the problem is not resolved.

With age, erections are harder to achieve and don't get as firm as before. However, various factors that may lead to erectile dysfunction at an earlier age are

• Medical conditions such as heart conditions or diabetes
• Using tobacco. This substance obstructs the blood flow to the veins and arteries and contributes to chronic health conditions.
• Obesity or being overweight
• Medical treatments such as radiation or chemotherapy for cancer, prostate surgery, and others
• Injuries or damage to the blood vessels that control erections
• Medications such as antihistamines, antidepressants, and medications that help with pain, prostate conditions, or high blood pressure
• Mental pressure, stress, anxiety, or depression can also contribute to erectile dysfunction.
• Drug, tobacco and alcohol abuse

Maintaining healthy lifestyle choices regarding mental health and habits and managing existing health conditions is the best way to prevent erectile dysfunction. For instance:

• Discuss with the doctor to manage heart ailments, diabetes, or other chronic conditions.
• Visit the doctor for regular health check-ups and screening tests.
• Quit smoking, alcohol, and illegal drugs.
• Do exercise, yoga and meditate regularly
• Consult a specialist to manage stress, depression, anxiety or other mental health concerns.

Reviewed byDr. Anjani Kumar Agrawal, Associate Director & Unit Head – Andrology, Urology on 15-Feb-2023.

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