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Erectile Dysfunction: Causes, Symptoms & Treatment

Erectile dysfunction is common among men. According to the Indian Journal of Medical Research, erectile dysfunction is a medical condition that affects approximately 100 million men globally and is expected to increase more than 320 million by 2025 [1] .

What Is Erectile Dysfunction?

Erectile dysfunction (ED) or impotence is the inability to get and keep a firm erection during sexual intercourse. It is a cause of concern if unsatisfactory sexual performance has occurred on a number of occasions. This causes stress, disrupts your relationship and self-confidence [2] .

What Causes Erectile Dysfunction

Erectile dysfunction is caused due to a combination of physical or psychological factors.

Physical causes

  • Heart disease [4]
  • Atherosclerosis (clogged blood vessels) [5]
  • High cholesterol
  • Multiple sclerosis
  • Metabolic syndrome
  • High blood pressure [7]
  • Parkinson's disease
  • Smoking, alcohol and substance abuse [8] , [9]
  • Peyronie's disease
  • Sleep disorders
  • Certain prescription medications
  • Treatment for prostate cancer
  • Surgeries that affect the spinal cord or pelvic region
  • Radiation therapy in the pelvic region
  • Thyroid conditions [10]
  • Testosterone deficiency

Psychological causes

  • Stress, depression, anxiety or other mental health conditions [11]
  • Relationship problems [12] .

Symptoms Of Erectile Dysfunction

The obvious symptom of ED is the inability to achieve or sustain an erection before sex or struggling to maintain an erection for long enough to complete sexual intercourse and unable to ejaculate. A man is considered to have erectile dysfunction when he has these symptoms occasionally.

Due to this other emotional symptoms occur such as shame, anxiety, embarrassment, and low self-esteem.

Risk Factors Of Erectile Dysfunction

As a man gets older, erections take longer to develop and might not be firm [13] . Various risk factors that cause erectile dysfunction are as follows:

  • Diabetes or heart conditions
  • Consumption of tobacco
  • Being overweight
  • Medical treatments
  • Injuries
  • Psychological problems
  • Medications
  • Drug and alcohol use

Complications Associated With Erectile Dysfunction

  • Unsatisfactory sex life
  • Relationship problems
  • Anxiety or stress
  • Embarrassment and low self-esteem
  • Unable to get your female partner pregnant

Diagnosis Of Erectile Dysfunction

The doctor will first ask you about your medical history and erection problem, and then will conduct a physical examination and suggest some lab tests.

During the physical examination, the doctor will visually examine your penis for any external causes which might be responsible for your sexual dysfunction. The external causes may include lesions from sexually transmitted infections (STIs).

If the doctor suspects an underlying cause, he or she will suggest some tests like blood tests, ECG, ultrasound, and urine test.

Treatment For Erectile Dysfunction [14]

Depending on the causes and severity of erectile dysfunction, there are various treatment options.

    Oral medications

Oral medications like sildenafil, avanafil, tadalafil, and vardenafil can aid in treating erectile dysfunction successfully [15] . These medications increase the effects of nitric oxide in the body. Nitric oxide is a natural chemical your body produces that relaxes the muscles in the penis which in turn improves blood flow and allows firm erection in response to sexual stimulation.

The dosage of these medications vary and the possible side effects include nasal congestion, headache, backache, flushing, stomach upset, and visual changes.

    Other medications

Alprostadil urethral suppository - This therapy involves placing a tiny alprostadil suppository inside the penis in the penile urethra. After which the erection starts within 10 minutes, and when effective it could last between 30 to 60 minutes. The side effects of this medication include minor bleeding, pain, and formation of fibrous tissues inside the penis.

Alprostadil self-injection - A fine needle is used to inject alprostadil into the base or side of the penis. Each injection dose gives an erection that doesn't last longer than an hour because the needle is very fine. The side effects include prolonged erection and mild bleeding from the injection.

Testosterone replacement - Low testosterone levels also lead to erectile dysfunction for which testosterone replacement therapy is recommended along with a combination of other therapies.

    Penis pumps and penile implants

If medications are not effective, the doctor recommends the following treatments:

Penis pumps - A penis pump is a vacuum erection device which is a hollow tube used either by hand or runs with batteries. The tube is placed over the penis and the pump is used to suck out the air inside the tube which creates a vacuum that pulls blood into the penis. The erection lasts long enough and the side effect is the penis might get bruised.

Penile implants - Penile implants are devices that are placed fully inside the body to create a stiff penis that allows you to have normal sexual intercourse. This type of treatment has a high degree of satisfaction among men.

Ways To Prevent Erectile Dysfunction

  • Make healthy dietary choices to prevent any chronic health conditions.
  • Exercise regularly to maintain a healthy weight.
  • Quit smoking and drinking.
  • Don't take too much of stress.
  • Get plenty of sleep.
  • Go for regular check-ups and medical screening.
View Article References
  1. [1] Kapoor, R., & Kapoor, A. (2016). Erectile dysfunction: A present day coronary disease risk equivalent.The Indian journal of medical research,144(3), 307.
  2. [2] Yafi, F. A., Jenkins, L., Albersen, M., Corona, G., Isidori, A. M., Goldfarb, S., … Hellstrom, W. J. (2016). Erectile dysfunction.Nature reviews. Disease primers,2, 16003.
  3. [3] Chu, N. V., & Edelman, S. V. (2001).Diabetes and Erectile Dysfunction. Clinical Diabetes, 19(1), 45–47.
  4. [4] Kloner, R. A. (2008). Erectile dysfunction as a predictor of cardiovascular disease.International journal of impotence research,20(5), 460.
  5. [5] Kloner, R. A., & Speakman, M. (2002). Erectile dysfunction and atherosclerosis.Current atherosclerosis reports,4(5), 397-401.
  6. [6] Skrypnik, D., Bogdański, P., & Musialik, K. (2014). Obesity--significant risk factor for erectile dysfunction in men.Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego,36(212), 137-141.
  7. [7] Javaroni, V., & Neves, M. F. (2012). Erectile dysfunction and hypertension: impact on cardiovascular risk and treatment.International journal of hypertension,2012, 627278.
  8. [8] McVARY, K. T., Carrier, S., & Wessells, H. (2001). Smoking and erectile dysfunction: evidence based analysis.The Journal of urology,166(5), 1624-1632.
  9. [9] Prabhakaran, D. K., Nisha, A., & Varghese, P. J. (2018). Prevalence and correlates of sexual dysfunction in male patients with alcohol dependence syndrome: A cross-sectional study.Indian journal of psychiatry,60(1), 71.
  10. [10] Krassas, G. E., Tziomalos, K., Papadopoulou, F., Pontikides, N., & Perros, P. (2008).Erectile Dysfunction in Patients with Hyper- and Hypothyroidism: How Common and Should We Treat? The Journal of Clinical Endocrinology & Metabolism, 93(5), 1815–1819.
  11. [11] Mekhtiev, T. V. (2013). Stress, anxiety, depression and erectile dysfunction in patients with diabetes mellitus.Georgian medical news, (220-221), 77-81.
  12. [12] Rosen, R. C., Heiman, J. R., Long, J. S., Fisher, W. A., & Sand, M. S. (2016). Men with sexual problems and their partners: findings from the international survey of relationships.Archives of sexual behavior,45(1), 159-173.
  13. [13] Gareri, P., Castagna, A., Francomano, D., Cerminara, G., & De Fazio, P. (2014). Erectile dysfunction in the elderly: an old widespread issue with novel treatment perspectives.International journal of endocrinology,2014, 878670.
  14. [14] Mobley, D. F., Khera, M., & Baum, N. (2017). Recent advances in the treatment of erectile dysfunction.Postgraduate medical journal,93(1105), 679-685.
  15. [15] Doggrell, S. A. (2005). Comparison of clinical trials with sildenafil, vardenafil and tadalafil in erectile dysfunction.Expert opinion on pharmacotherapy,6(1), 75-84.
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