Erectile dysfunction (ED) - Causes | symptoms | treatment | complications | prevention - Sentelhealth

Erectile dysfunction (ED) - Causes | symptoms | treatment | complications | prevention - Sentelhealth

overview -

erectile dysfunction is a consistent inability to attain or maintain sufficient rigid penile erection to perform sex. According to a survey in 2018  more than 50% of men aged more than 40 years experience erectile dysfunction.
In a normal healthy person, erection is caused by the intact nervous and vascular systems working together in coordination.
"A person is called to have erectile dysfunction when he is enabled to attain or maintain an erection for 3 months."

However, the basic mechanism of erection is an increase in the inflow of the blood to the penis with a subsequent decrease in the outflow by causing constriction of the veins draining the blood from the penis.

Causes of erectile dysfunction -

In many cases of erectile dysfunction treating the underlying cause eventually relieve the condition.Therefore, a detailed history of the patient is a key factor for finding the cause of the disease.Following are some of the most common causes of erectile dysfunction:

1) Psychological: Psychological factors play a vital role in triggering the events that cause erectile dysfunction mainly depression, anxiety, stress, relationship issues. the psychological component is considered the most important in erectile dysfunction as it is the cause in over half of the cases.

2) Heart disease: Heart disease is one of the most common causes of erectile dysfunction and is preceded by a condition called endothelial dysfunction which is a warning sign of heart disease. A person able to attain but not maintain erection suggests endothelial dysfunction as the causative factor for the disease.

3) smoking: Tobacco use in any form (smoking, chewing) is associated with the risk of erectile dysfunction but, the incidence is highest in smokers. according to a survey, if a person smokes 2 packets(40 cigarettes) a day for ten years there is a 65-70% chance that he will suffer from erectile dysfunction.

4) substance abuse: Drug addicts are more prone to erectile dysfunction as it directly affects your nervous system.

5) Alcohol: consumption of alcohol more than the safe range(60-120 ml per week) exposes to the risk of erectile dysfunction. The incidence of erectile dysfunction in chronic alcoholics is high but not as high as in smokers.

6) Obesity: Obesity has been one of the most consistent causes of erectile dysfunction(ED). Obesity leads to the deposition of cholesterol in blood vessels narrowing the lumen of the vessels and causing a decrease in the blood flow of the penis during erection.
7) Diabetes
8) Parkinson's disease
9) Peyronie's disease
10) High blood pressure
11) Sleep disorders
12) Injuries to the penis or pelvic area

Symptoms of erectile dysfunction -

Symptoms of erectile dysfunction can help to reach the cause as some of the typical presentations can give a clue to the cause.
A) The ability to attain but not maintain an erection can be a sign of endothelial dysfunction which proceeds a heart disease.

B) high blood sugar levels suggest diabetes
C) Patients suffering from any kind of mental stress/depression can be found out by asking friends and relatives who can help to treat the condition.

When to consult a doctor 

A person having a consistent problem attaining or maintain a rigid penile erection sufficient for sexual activity for more than 3 months should consult a doctor.

Whom to consult 

a) Psychiatrist
b) Urologist
These two specialists deal with patients with erectile dysfunction(ED) depending on the cause of the disease.

Treatment of erectile dysfunction -

Treating the underlying cause is a key factor in the treatment of erectile dysfunction. Lifestyle modification and reduction of stress are vital components of the treatment plan, which includes reduction of alcohol intake, smoking cessation, monitoring of diabetes and hypertension. Following are the different kinds of treatments that can be given to the Person with erectile dysfunction, they can be used in combination depending upon the causative factor for the disease and its severity.

A) Behavior therapy and counselling - Patients with significant psychological component to their erectile dysfunction can be treated behavior therapy, oriented sex therapy and counselling.

B) Hormone therapy -Apart from behavior therapy and counseling which are used to treat psychological erectile dysfunction hormone therapy is generally used in the treatment of erectile dysfunction due to androgen deficiency(low testosterone).these patients have documented low levels of testosterone. Restoration of testosterone levels can improve libido and the effectiveness of oral medications.

C) Vasoactive therapy - Vasoactive therapy is divided into two types depending on their mode of administration as follows:

1) Oral agents: These include drugs like Sildenafil, Tadanafil, Vardenafil, and Avanafil which primarily increase blood flow to the penis.All these drugs are equally effective and each drug should be initiated at the lowest dose and should be titrated to the effect.
 # Side effects of oral agents -
a) When taken with a nitrate medication they cause hypotension and hence these drugs are not advised to the people on nitrates or nitroglycerin.
b) Priapism(rare)
c)Loss of libido: if taken on a regular basis for the long term.

2)Injectable agents: Injectable drugs are directly injected into the penis and these include -
   A) Vasoactive prostaglandins
   B) Phentolamine
The base and the sides of the penis are used as an injection site.

D) Vaccum erection device - it is a device that creates a vacuum chamber around the penis and draws blood in it, once a sufficient erection occurs elastic band is placed at the root of the penis to prevent loss of erection. However, these devices can cause penile discomfort but, there is no evidence of any serious complications.
E) Penile prosthesis - These are artificial implants that are placed into the penis (inside the muscle layer of the penis). The implants are semirigid or inflatable and come in a variety of sizes and are custom fit to the individual. Inflatable devices are more preferred as they give a natural appearance and better functionality.
A complication with a prosthesis :
1) Mechanical failure
2) Infection
3) Injury to adjacent anatomic structures while surgery
Personal and partner satisfaction rates are high in patients who choose this method.

F) Vascular reconstruction - This is a newer approach and is for patients with disorders of the vascular system (blood vessels). The following two methods are used to treat such causes of erectile dysfunction
a) Ballon dilatation
b)Arterial bypass operation
experience with such treatment is limited and failures are high.

Complications of erectile dysfunction -

Persistent erectile dysfunction can result in a variety of problems as follows :
1) Relationship problems
2) Stress and depression
3) Inability to have a child
4) Unsatisfactory sex life

Preventing erectile dysfunction -

Erectile dysfunction can be avoidable by taking care of yourself and by lifestyle modifications as follows :
a) Exercise regularly for at least 30 minutes
b) Keep a check on your blood pressure and diabetes
c) Reduction of alcohol intake and smoking cessation
d) Reduce stress
e) Do regular checkups for any heart disease or other health conditions associated with erectile dysfunction.