Erectile dysfunction or impotence is the persistent inability to achieve or maintain a penile erection firm enough for satisfactory sexual performance. A man has to have good nerve function, hormone (testosterone) levels, adequate blood flow, and a willing mind to have normal erections. Problems with any of these factors can result in erectile dysfunction. It is, however, normal to occasionally fail to get or maintain an erection when you are tired, stressed, anxious, feeling nervous or drinking too much alcohol.

 

Risk factors of erectile dysfunction

You have an increased risk of getting erectile dysfunction if you are:

• 40 years and older
• Overweight or obese
• Physically inactive
• Smoke
• Drink alcohol
• Have medical conditions such as diabetes and hypertension and have psychological conditions such as depression and anxiety
• Taking certain medications, including antihypertensives, antidepressants and antihistamines.

 

Types and causes of erectile dysfunction

 Vascular erectile dysfunction

The penis needs sufficient blood flow to become erect and maintain an erection. There are also valves in the penis that close when the penis is filled with blood. Abnormalities of the penile arteries, veins or valves can lead to erectile dysfunction. This is the most common cause of erectile dysfunction, especially in older men. The common vascular causes of erectile dysfunction include:

• Atherosclerosis
• Hypertension
• High Cholesterol
• Diabetes Mellitus
• Trauma e.g. Penile fracture
• Radiation and surgery for prostate cancer
• Peyronie’s disease
• Smoking

 

Neurogenic erectile dysfunction

The brain plays a key role in triggering the processes that cause an erection. The brain sends signals that travel along nerves to the penis to cause an erection. Damage or disease to those nerves can cause erectile dysfunction. Some common causes of neurogenic erectile dysfunction include:

• Stroke
• Spinal cord injury
• Diabetic neuropathy
• Alzheimer’s disease
• Multiple sclerosis
• Parkinson’s disease
• Radical pelvic surgery
• Pelvic injury
• Chronic alcoholism

 

Hormonal-induced erectile dysfunction

Hormones are chemical messengers in the body that inform the body to perform specific functions. Hormonal disorders such as testosterone deficiency, decreased or increased levels of thyroid hormones, increased prolactin, steroid abuse by bodybuilders and hormones to treat prostate cancer can cause erectile dysfunction.

 

Drug-induced erectile dysfunction

Erectile dysfunction is a common side effect of many prescription drugs. Drugs associated with erectile dysfunction include:

• Antihypertensives
• Antidepressants
• Anticonvulsants
• Antihistamines
• Antipsychotic agents
• Antiparkinson agents
• Antiseizure medications
• Diuretics
• Chemotherapy drugs
• Lipid regulators
• Prostate cancer drugs
• Gastrointestinal reflux disease and ulcer-healing drugs

 

Psychogenic erectile dysfunction

Psychological conditions that affect your mental health contribute to erectile dysfunction. Some causes of psychogenic erectile dysfunction include:

• Depression
• Anxiety
• Stress
• Inadequate interpersonal relationships
• Fear of intimacy
• Relationship problems
• Low self-esteem

 

Symptoms of erectile dysfunction

Symptoms of erectile dysfunction are:

• Persistent difficulty in getting an erection.
• Persistent difficulty in maintaining an erection.
• Complete inability to get an erection.
• Reduced sexual desire.
• Requiring a lot of stimulation to maintain an erection.

 

Diagnosis of erectile dysfunction

To diagnose erectile dysfunction, your doctor will take a medical and sexual history and perform a physical and psychosocial examination. Your healthcare provider would ask about your drug history, whether you have any chronic medical conditions and ask questions about your mental health as part of your medical history. The doctor may also ask to talk to your sexual partner. A physical examination would include an examination of your nervous system, secondary sex characteristics such as male hair distribution pattern to rule out hormonal problems and an examination of your penis and testicles. Your healthcare provider may order blood tests, urine tests and a penile Doppler ultrasound to confirm the diagnosis.

 

Treatment

There are different treatment options for erectile dysfunction depending on the cause and severity.

Lifestyle modifications

Some lifestyle changes can help in the treatment and prevention of erectile dysfunction. These include:

• Eat a diet rich in fruits, vegetables, whole grains and fish and reduce highly processed foods such as red, processed, meats and refined grains.
• Quit smoking.
• Avoid substance abuse.
• Reduce or stop drinking alcohol.
• Reduce your cholesterol.
• Engage in aerobic exercise such as brisk walking, jogging and running. Research shows that moderate exercise can help restore sexual performance in obese middle-aged men with erectile dysfunction.
• Lose weight. A man with a waistline of 42 inches is 50% more likely to have erectile dysfunction than a man with a 32-inch waistline.
• Get quality sleep.
• Reduce stress and anxiety.

 

Oral Medications

Drugs known as phosphodiesterase-5 (PDE-5) inhibitors are used to treat erectile dysfunction. These medications are taken orally before sex. They start to work within an hour and help you get an erection with sexual stimulation. They work by increasing the blood flow to your penis. Some of these drugs are sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra). You can buy Viagra online, but you need a prescription for the other drugs.

 

Vacuum device

A vacuum device or penis pump is a hollow tube placed over your penis to aid blood flow to the penis. It has a pump which is used to suck out air from the tube. This creates a vacuum that pulls blood into your penis, causing an erection. Once you get an erection, you place an elastic ring around the base of your penis to maintain the erection and remove the vacuum tube. After sexual intercourse, you remove the ring.

 

Surgery

Surgery is not common in the treatment of erectile dysfunction, but sometimes it may be indicated. An example of a surgical technique in the treatment of erectile dysfunction is the use of penile implants. In this procedure, a malleable or inflatable device is inserted into the penis to help you have an erection.

 

Treating the cause of erectile dysfunction

There are also treatments for the underlying cause of erectile dysfunction. Some of these are:

• Medication change. If you are on long-term medication associated with erectile dysfunction, your doctor will change to an alternative drug with a lower risk of erectile dysfunction.
• Hormonal therapy for hormonal problems.
• Treating high blood pressure, high cholesterol and diabetes with medication.
• Psychological counselling and therapy for mental health conditions such as stress, anxiety and depression.

 

References:

John Hopkins Medicine. Erectile dysfunction. (https://www.hopkinsmedicine.org/health/conditions-and-diseases/erectile-dysfunction).

Harvard Health Publishing. Harvard Medical School. 5 natural ways to overcome erectile dysfunction. (https://www.health.harvard.edu/mens-health/5-natural-ways-to-overcome-erectile-dysfunction).

WebMD. Erectile Dysfunction. (https://www.webmd.com/erectile-dysfunction/understanding-erectile-dysfunction-basics).

Mayo Clinic. Erectile dysfunction. (https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776).

MyClevelandClinic. Erectile Dysfunction. (https://my.clevelandclinic.org/health/diseases/10035-erectile-dysfunction#symptoms-and-causes).