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Erectile Dysfunction: What You Should Know

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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.

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!

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