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What is Erectile dysfunction(ED)?
Erectile dysfunction (ED) means that any male cannot get and/or maintain an erection. In some cases the penis becomes partly erect but
not hard enough to have sex properly. ED is sometimes called impotence. In other words ED is the persistent inability to attain and
maintain an erection sufficient to permit satisfactory sexual performance.
ED affects physical and psychosocial health and has a significant impact on the quality of life of sufferers and their partners and
families.
How common is erectile dysfunction?
Most men have occasional times when they cannot get an erection. For example, you may not get an erection so easily if you are tired,
stressed, distracted, or have drunk too much alcohol. For few men it is only temporary, and an erection can occurs when you are
sexually aroused.
However, some men have persistent, or recurrent ED. It can occur at any age, but becomes more common with increasing age. About half
of men between the ages of 30 and 70 have ED. About 7 in 10 men aged 70 and above have ED.
How does an erection normally occur?
When you are sexually aroused, messages from your brain travel
down nerves to your penis. Chemicals called neurotransmitters are then released from the ends of the nerves in the penis. Stimulation
of the penis can also cause local nerve endings to release neurotransmitter chemicals.
The neurotransmitters which are released in the penis cause another chemical to be made, called cyclic guanosine monophosphate (cGMP).
This chemical causes the arteries in the penis to widen (dilate). This allows extra blood to flood into the penis. The rapid inflow
of blood causes the penis to swell into an erection. The swollen inner part of the penis also presses on the veins nearer to the skin
surface of the penis. These veins normally drain the penis of blood. So, the flow of blood out of the penis is also restricted, which
enhances the erection.
Once you stop having sex, the level of cGMP falls, the blood flow to the penis returns to normal, and the penis gradually returns to
the non-erect state.
What causes erectile dysfunction?
There are several causes which tend to be grouped into those that are mainly physical and those that are mainly due to mental health
(psychological). In most cases due to physical causes (apart from injury or after surgery), the ED tends to develop slowly. So, you
may have intermittent or partial ED for a while, which may gradually get worse.
Physical causes
About 8 in 10 cases of ED are due to a physical causes.
Physical or Organic impotence is the most common and is caused by a disorder of the penis or mechanisms related to erection.
Several types of erectile dysfunction:
Vascular
Reduced blood flow to the penis is the most common cause of ED in men over the age of 40. Like in other parts of the body, the arteries which take blood to the penis can become narrowed. It occurs when little blood to the penis comes or not properly retained within the corpora cavernosa, resulting in a leakage of blood and a sharp decrease in erection The blood flow may then not be enough to cause an erection. Risk factors can increase your chance of narrowing of the arteries
Like heart diseases, hypertension and other vascular diseases
The root cause of the narrowing of the arteries is caused by atheroma. Atheroma is like fatty patches or plaques that develop within
the inside lining of arteries. (This is similar to water pipes that get furred up with scale.) Plaques of atheroma may gradually form
over a number of years in one or more places in the body, commonly in arteries going to the heart, brain, legs and penis. In time,
these can become bigger and cause enough narrowing of one or more of the arteries to cause symptoms and problems.
Certain risk factors increase the risk of more atheroma forming which can make atheroma-related conditions worse. Briefly, risk factors
that can be modified and may help to prevent atheroma-related conditions from getting worse are:
Smoking: Smoking is one of the
biggest risk factors for developing an atheroma-related condition. Smoking roughly doubles your chance of developing ED. Young
smokers may not be aware that they have a much greater risk of developing ED by middle age compared with non-smokers. - High blood pressure: Make sure your blood pressure is checked at least once a year. If it is high, it should be treated,but not with beta blocker group medicines
- A high cholesterol: This can be treated if it is high.
- Inactivity. We should all aim to do some moderate physical activity on most days of the week for at least 30 minutes. For example, brisk walking, swimming, cycling, dancing, gardening, etc. If you are overweight, losing some weight is advised.
ExcessiveAlcohol intake:- Diabetes: If you have diabetes, good control of the blood sugar level and blood pressure can help to minimise the impact of diabetes on the blood vessels.
- Excessive outflow of blood from the penis through the veins (venous leak),Pelvic steal syndrome. This is rare but can be caused by various conditions of the penis.
Neurological
When there are problems in the transmission of orders that the brain and spinal cord sent to the penis through nerve sparing, for an erection to occur.
Produce this type of impotence diabetes, cancer, spinal diseases and surgeries for prostate, bladder and rectum (damage to nerve sparing) Diseases which affect the nerves going to the penis. For example, multiple sclerosis, a stroke, Parkinson's disease, spinal injury, fractured pelvis, radiotherapy to the genital area, etc.
Hormonal Causes
- For example, a lack of a hormone called testosterone which secreted in the testes. The pituitary gland makes a hormone that stimulates testes to make testosterone. Other symptoms of a low testosterone level include a reduced sex drive (libido) and changes in mood.Abnormal level of Prolactin,Leutinizing hormone(LH),Follicle stiumulating hormone(FSH),Thyroid gland hormones, etc may cause erectile dysfunction.
- Drug Induced For exampleSide-effects of certain medicines. The most common are some antidepressants; beta-blockers such as propranolol, atenolol, etc; some 'water tablets' (hydrochlorthazide diuretics); cimetidine.
- Alcohol and drug abuse.
Psychological causes
In these cases the penile rigidity mechanism is normal, but the erection is complicated by psychological problems. Typically, the ED develops quite suddenly if it is a symptom of a mental health problem. In some cases, ED causes poor self-esteem, anxiety, and even depression & vice versa. These reactions to ED can make the problem worse.
Various mental health conditions may cause you to develop ED. They include:
- Performance anxiety
- Stress - for example, due to a difficult work or home situation.
- Anxiety.
- Relationship difficulties.
- Depression.
The ED may resolve when your mental state improves - for example, if your anxiety or depression eases. However, some people
become even more anxious or depressed when they develop ED. They do not realise it is a reaction to their mental health problem.
This can make matters worse and lead to a vicious circle of worsening anxiety and persisting ED.
As a rule, a psychological cause for the ED is more likely than a physical cause if there are times when you can get a good erection,
even though most of the time you cannot. (For example, if you can get an erection by masturbating, or wake up in the morning with an
erection.)
What should I do if I develop persistent erectile dysfunction?
It is best to consult a qualified Sexologist. He is likely to discuss the problem, go over any medication you may be taking, and do a physical examination. This can help to identify or rule out possible underlying causes. Before treatment, your sexologist may suggest some tests.
What tests may be done?
Depending on your symptoms, likely cause of the ED, age, etc, your doctor may suggest that you have some tests. These are mainly to check up on any risk factors listed above.
Following tests are available at SEXOLOGY SUKH SAGAR HOSPITAL & Health Centre (SSSH).
All types of Laboratory Investigation- Hormonal Assays
- Doppler Studies
- Vac Erection
- System
- NPT Monitoring
- AV Response test
- Multi Sex diagnostic module
- TREATMENT
- Medicines—Allopathy,ayurvedic ,Homeopathy.Depending on the cause and natyre of disease.Aim to provide permanent cure. Principle of treatment is ,We have to treat the cause not the disease.
- Sex counselling (Individual/Couple)
- Intercav. Injections
- Vacuum Erection Device
Multi sex therapy
