Erectile dysfunction (ED) is a type of sexual dysfunction that leads to a failure to begin and maintain a penile erection during sexual activity. Major health issues can contribute to getting or maintaining an erection and treatment needs to be sought to resolve any underlying conditions.
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Dr Lee Fang Jann speaks about erectile dysfunction.
ED can be primary or secondary:
Primary ED: It is present from the first experience of sexual intercourse Secondary ED: When an individual develops ED after a period of normal penile function
Epidemiology ED is more common in older individuals and it is estimated to occur in 5 to 10 % of the population.
Risk Factors The risk factors for ED are:
Increase age Diseases like high blood pressure or diabetes Smoking Alcohol consumption Obesity Physical inactivity High cholesterol level
Causes of erectile dysfunction
There are multiple causes of ED, ranging from psychological to external causes such as medications. Some of the common causes include:
Psychogenic causes such as depression and anxiety disorders
Anxiety Depression Fatigue Guilt Stress Marital discord Excessive alcohol consumption
Diseases associated with blood vessels that may present as ED:
Atherosclerosis Hypertension
Trauma: Injuries around the penis can also contribute to ED.Medical conditions that may contribute to ED:
Neurological disorders that may contribute to ED: Nerves to the penis can be damaged due to conditions such as a stroke or diabetes
Medications that may contribute to ED:
Certain prescription drugs such as diuretics (to decrease blood pressure by decreasing urine flow), antihypertensives (to reduce high blood pressure), antidepressants, or antihistamines may cause ED Use of recreational drugs affect CNS, damage the arteries, and may lead to permanent ED
Clinical Features ED is characterised by the following features:
Difficulty getting and maintaining an erection during sexual activity Decreased libido or a decreased desire to have sex
Other sexual disorders that can be associated with ED include:
Premature or delayed ejaculation
Diagnosis ED is diagnosed through medical and sexual history taking as well as mental and physical examinations which includes a physician asking about the frequency, quality, and duration of erections.
Some diagnostic tests for ED include:
Nocturnal penile tumescence testing: This measures the patient’s erection during sleep. Involuntarily erections occur four to five times during sleep and normal sleep erections in ED suggest emotional problems. However, if the patient does not experience erections while sleeping, the cause of ED might be more physical in nature Doppler ultrasonography: This is done to observe the blood flow around the penis to identify any obstructions in the arteries supplying it Routine blood test: A blood test is done to rule out medical conditions that may lead to ED such as diabetes, heart or kidney disease Psychiatric consultation: A psychiatric consultation can be done to assess mental or emotional issues such as depression or anxiety
Differential Diagnosis
Other medication conditions that may have similar symptoms to ED include:
Andropause: This is a condition where a decrease in the male sex hormone testosterone may result in a lowered sex drive or difficulties getting erections Diabetes : This can affect the blood vessels that allow for penile erection and its maintenance Heart disease: The formation of plaque inside the arteries may hinder blood flow to different parts of the body parts including the penis Kidney disease: This can affect hormone levels, blood flow, and the nervous system, which are all required to maintain a healthy erection Neurological problems: Parkinson’s, Alzheimer’s and multiple sclerosis can lead to ED.
Complications of erectile dysfunction Potential complication that may result from ED include:
Dissatisfied sex life Infertility Relationship problems
Treatment of erectile dysfunction Treatment for ED includes managing any underlying issues, making lifestyle modifications , and addressing psychosocial problems that may exist.
General measures
Smoking cessation Reduced alcohol consumption Weight loss if obese Exercising regularly
Medications
This includes prescribing oral medications to stimulate blood flow to the penis Testosterone therapy
Vacuum devices
These create suction and draw blood to the penis to stimulate a penile erection
Psychosexual therapy
Many psychosexual factors can cause ED including stress, anxiety, depression, and post-traumatic disorders. These can be addressed through counselling and medication.
Surgery
An inflatable implant, can be placed surgically in the penis to make it longer and wider Malleable implants such as rods allow manual adjustments to the position of the penis Blood vessel reconstruction where the artery of the penis is surgically repaired to reverse any obstruction of blood flowing to the penis
Prognosis ED can be treated by addressing underlying medical issues and psychological conditions that may be present. Proper treatment of ED through medication or lifestyle modifications can improve its prognosis. Men with ED have a higher risk of anxiety and depression.
Prevention of erectile dysfunction ED can be prevented through the following ways:
Managing medical conditions such as diabetes, heart disease, and other long-standing medical conditions Seeking help to cope with anxiety disorders, depression, or other mental health problems Ceasing alcohol consumption and smoking Regular exercise and stress management
Conclusion
Erectile dysfunction may be a psychologically distressing issue for many men, but it can be prevented with lifestyle modifications such as quit smoking and reducing alcohol consumption. If you need help, do not be afraid to speak to a trusted healthcare professional!
