Erectile
Dysfunction (ED)
Overview
Erectile dysfunction is a form of male sexual dysfunction where the penis cannot become erect or fails to maintain an erection. While occasional instances of erectile dysfunction are not a significant cause for concern, frequent occurrences can negatively affect self-image and other psychological areas.
The regulation of erections relies on numerous systems, including blood vessels, muscles, nerves, hormones, and psychological factors. Erectile dysfunction is often caused or worsened by stress or other mental health factors.
Physical causes are typically related to an inability to supply sufficient blood flow to the penis to maintain an erection. These can include various types of heart disease, high blood pressure, diabetes, and obesity. Low testosterone is another common cause, especially in older men.
Many lifestyle factors affect the extent and severity of erectile dysfunction. For example, tobacco use is known to limit blood flow and can cause erectile dysfunction. Many prescribed medications can also lead to the condition, such as medication for high blood pressure and antidepressants.
Symptoms
The core symptoms of erectile dysfunction are:
- Difficulty achieving erection
- Difficulty maintaining an erection
- Lower sexual desire
Other symptoms can include indirect effects on mental health and self-image, such as reduced self-esteem or depression. Erectile dysfunction can also be an indicator of undiagnosed cardiovascular conditions.
Diagnosis
It is typical for erectile dysfunction diagnosis to include a patient review, medical history review, and a physical exam. Underlying conditions often impact erectile dysfunction, so that diagnosis could entail referral to a specialist of a known or suspected condition.
A physical examination of the penis and testicles can help doctors identify some causes. They can also determine the extent of your condition by evaluating the level of sensation in your nerves. A psychological examination can screen a patient for possible mental health-related causes.
Doctors can also use blood and urine tests to check for a variety of likely underlying conditions. Heart disease, diabetes, and low testosterone are possible causes doctors can identify using specific tests. An ultrasound evaluation can also distinguish any issues with blood supply to the penis.
Treatment
Treatments for erectile dysfunction are wide-ranging. Your physician will base their decision on the underlying cause and contributing factors to the patient’s erectile dysfunction, along with compatibility and other concerns.
Oral Medication
Several prominent oral drugs have shown success in the treatment of erectile dysfunction. These drugs stimulate blood flow to allow for regular sexual stimulation to lead to an erection. Some examples of erectile dysfunction drugs are:
- Tadalafil (Adcirca and Cialis)
- Vardenafil (Levitra and Staxyn)
- Sildenafil (Viagra)
These medications are not suitable for patients with very low blood pressure, a history of heart disease or heart failure, or those who take nitrate drugs, which are common to treat chest pains.
Psychological Treatment
Psychological aspects are often a primary or contributing cause of erectile dysfunction. Psychological counseling can help manage the anxiety, depression, or stress responsible for erectile dysfunction.
Lifestyle Changes
For some patients, increasing cardiovascular health through regular exercise can improve erectile dysfunction. The same is valid for reducing significant contributing factors, such as smoking and obesity.
Penile Prosthesis
Placement of a penile prosthesis is done in men who have failed other conventional treatments for erectile dysfunction such as medication and injection therapy. It is also done at times in men suffering from Peyronie’s disease which causes penile curvature in order to straighten out the penis as well as treating underlying erectile issues. It involves placement of two cylinders along the length of the penis as well as a pump that is placed in the scrotum and a reservoir which is placed in the abdomen. A general or spinal anesthetic is required and one scrotal or lower abdominal incision is typically made. The procedure takes about 90 minutes to perform and patients usually stay one night in the hospital.
What to expect afterwards:
After discharge the patient can expect bruising and swelling of the penis and scrotum. Patients are sent home with antibiotics and pain medication. Patients are also instructed to ice the scrotum and use scrotal support to help with swelling. Your urologist may also recommend that you gently milk the scrotal pump downward 2-3 times a day to keep the pump as low in the scrotum as possible. The device is left inactive for 4-6 weeks after placement. On follow up with the doctor the patient is taught how to use the device. Prior to sexual activity the pump in the scrotum is compressed several times which shunts fluid that is stored in the abdominal reservoir into the penile cylinders creating a rigid and straight erection. Following sexual activity a release button is pressed and the penis is gently squeezed sending the fluid back into the reservoir for storage.
Patients should understand that the erection with the prosthesis might not have the same length or girth that it once had with a normal spontaneous erection. Patients also need to be sure they desire this procedure because once done it is not possible to go back to normal spontaneous erections.
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FAQ’s
The first consultation will likely be with a urologist, a doctor specializing in the urinary tract and male sexual organs. Due to the diverse range of causes and factors in erectile dysfunction cases, advice from specialists in cardiovascular medicine, neurology, endocrinology, or psychiatry could be required.
Penile implants are a surgical intervention that entails implanting malleable rods or inflatable devices into both sides of the penis. The rods maintain firmness while remaining bendable, while the inflatable devices allow for a controlled erection. These procedures are not recommended until other treatments have tried and failed.
A penis pump relies on a vacuum pressure to draw blood into the penis, achieving an erection. Once the user gains an erection, he must apply a tension ring to the base of the penis to prevent blood from withdrawing during intercourse. The effect generally lasts long enough for intercourse. This step can cause bruising of the penis.
Many lifestyle choices can contribute to erectile dysfunction. Avoiding smoking, excessive alcohol consumption, and illicit drugs can help. Aerobic exercise of moderate intensity is another good preventative measure.
For those who have or are at increased risk of underlying conditions, working with a physician to manage heart disease, diabetes, or other conditions can reduce the likelihood or severity of erectile dysfunction.
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