Charlotte, NC
Erectile dysfunction (ED) is commonly known as impotence. It is the inability of an individual to achieve or maintain a sufficient erection for satisfactory sexual activity. Remember, It is normal for someone to have erectile issues sometimes, and it is not usually a matter of concern; the persistence of the issue problem, however, needs to be taken seriously. It is one of the most common sexual disorders in men and affects about 30 million men in the United States [1]. The Massachusetts Male Aging Study (MMAS), a seminal study on male sexual health, found that about 52% of men aged 40-70 years experience some form of ED.
ED involves various mechanisms disrupting the normal process of achieving and maintaining an erection, including vascular, neurogenic, hormonal, and psychological factors.
Vascular issues such as atherosclerosis and endothelial dysfunction reduce blood flow, while venous leak prevents adequate blood retention in the penis leading to erectile dysfunction.
Normally, sensory and psychological stimuli activate the brain signals sent through the spinal cord to penile nerves. This enhances the release of Nitric Oxide (NO), which helps cause vasodilation and maintain an erection. Neurological disorders such as multiple sclerosis, spinal injuries, and pelvic surgeries can disrupt the nerve signals required for erection.
Hormones, particularly testosterone, are crucial for libido and penile tissue health. It influences the synthesis of NO synthesis; low testosterone due to hypogonadism and endocrine disorders like diabetes impair these functions.
Various psychological factors like stress, anxiety, depression, and performance anxiety inhibit the brain’s ability to initiate erections.
Medications like antihypertensives and antidepressants, along with substances such as tobacco, alcohol, and illicit drugs, can interfere with neurovascular mechanisms, leading to ED.
ED is not just about erection; it extends beyond the inability to achieve or sustain an erection, manifesting in a spectrum of associated symptoms. The most common symptoms of ED include:
The most common symptom of ED is difficulty in starting an erection when desired. This can happen occasionally or more frequently and varies in severity from person to person.
It is another critical symptom where an individual can achieve an erection but has difficulty in maintaining it to complete the sexual intercourse. This can cause frustration, anxiety, and decreased sexual satisfaction.
Men with ED often experience a reduced interest in sexual activity. This decrease in libido can be a result of psychological factors, hormonal imbalances, or a response to recurring issues with erectile function.
Some men with ED may also experience premature ejaculation, where ejaculation occurs sooner than desired, either shortly after penetration or even before it.
In contrast to premature ejaculation, some men might find it difficult to ejaculate despite having a sufficient erection. The ejaculation gets delayed, leaving the person tired and frustrated.
The inability to perform sexually can lead to significant emotional distress, including anxiety, depression, low self-esteem, and relationship issues. These emotional responses can, in turn, exacerbate the symptoms of ED.
The proper diagnosis method of erectile dysfunction is given below:
This includes an examination to check for the signs of systemic conditions that might contribute to ED, like hypertension and peripheral arterial disease. Your doctor will do a focused exam of the genitals to identify any anatomical abnormalities, such as curvature of the penis, penile plaque, or testicular atrophy, which all could be the cause of ED.
Blood tests are important for diagnosing ED. Key blood tests include measuring hormone levels, such as testosterone, luteinizing hormone (LH), and prolactin, to detect hormonal imbalances affecting sexual function. Assessing fasting blood glucose and HbA1c levels is important to identify diabetes, a common cause of ED. A lipid profile test evaluates cholesterol levels, which helps assess your cardiovascular risk of developing ED. [3]
In some cases, psychological factors may contribute to ED. Your doctor may inquire about your mental health, stress, and emotional well-being.
This imaging test assesses blood flow to the penis. It can identify vascular problems such as arterial insufficiency or venous leak.
This is a special kind of test that measures erections during sleep. This test is based on the natural physiological phenomenon wherein men experience erections during certain stages of sleep, particularly during rapid eye movement (REM) sleep. This test involves placing a small device called a nocturnal penile tumescence monitor around the penis before bedtime. The monitor records changes in penile circumference or rigidity throughout the night. Normal results typically show multiple episodes of nighttime erections, which are indicative of healthy erectile function. If these erections are absent or insufficient, it may suggest an underlying physical cause of erectile dysfunction, such as vascular problems or nerve damage. Conversely, if nocturnal erections occur regularly, it suggests that the ED may have a psychological origin, such as stress, anxiety, or relationship issues. The NPT test can help differentiate between physical and psychological causes of ED. Average results suggest a psychological cause, while abnormal results indicate a physical cause.
This test uses an injectable vasodilator to induce an erection. The response can help determine if there is a vascular issue causing ED.
Treatment for ED can range from lifestyle changes medications, or other therapies, depending on the cause and severity of the condition.
An oral medication like sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis), or avanafil (Stendra) are commonly used for ED. These medications can come in various forms: oral, intravenous, or as pellets that can be placed in the urethra. It relaxes the smooth muscle present in your penis and dilates blood vessels there, increasing the blood flow and improving erectile function.
However, there is one major side effect of these medications. These medications can cause the erection to last too long, causing you to have pain. This condition is known as priapism, and it needs immediate medical attention. A small percentage of people taking this medication may experience headaches or visual changes.
Alprostadil is a synthetic form of a naturally occurring prostaglandin E1 (PGE1) hormone. It has the same mechanism as other oral medications like Viagra. It can be injected directly into the base of the penis using a fine needle. This medication can produce an erection within 5 to 20 minutes, and the erection can last for up to an hour. It is an effective option for men who do not respond to oral medications.
This is also known as a penis pump, and it draws blood into your penis. To use this device, first of all, you place a tube part of the device around your penis. The pump then creates a vacuum within the tub that pulls the blood into your penis. Once you get an erection, you slide an elastic ring to the base of the penis to hold the blood and keep it firm. The ring is removed after the intercourse.
Many men with ED might benefit from implanted prosthetics in getting an erection. A urologist places these implants surgically. There are two main types of implants: malleable and inflatable. The malleable implants are rods that let you manually modify the position of your penis, and inflatable implants use a pump in the scrotum to make your penis longer and broader.
Some of the potential complications of erectile dysfunction include:
ED can lead to feelings of frustration, embarrassment, and lowered self-esteem. Anxiety, depression, and stress can also result from ED, creating a negative cycle that further exacerbates the condition.
Sexuality forms an important part of an intimate relationship. ED can lead to reduced intimacy, emotional distance, and overall dissatisfaction.
ED may lead to performance anxiety, where a person becomes overly concerned about their ability to perform sexually, making it even more challenging to achieve an erection.
Infertility can be an issue when you have ED. ED can prevent you from having sexual intercourse, indirectly impacting your ability to conceive.
Here are five tips for you to follow to prevent ED:
It would be best if you focused on eating a balanced diet rich in fruits and vegetables. Studies have also shown that the Mediterranean diet can help to improve cardiovascular health and prevent ED.
Smoking is linked to various diseases of the heart and blood vessels, which can lead to ED. Hence, stopping smoking habit can help you to keep your sexual health on point.
Exercise is an integral part of sexual health. You can participate in physical activity such as brisk walking, running, swimming, or strength training.
Chronic stress and anxiety can lead to ED. You can reduce your stress with the help of techniques such as mindfulness, yoga, meditation, and deep breathing exercises.
You should maintain open communication with your partner about sexual preferences and concerns. This would help you to understand each other better and keep your sexual relationship healthy.
It is normal for someone to have ED sometimes, and it may not indicate a significant problem. However, if you are having new onset ED, have them frequently, or it began after starting a new drug, it is advisable to seek medical advice from your doctor. In some cases, the dysfunction can be a sign of underlying health conditions such as diabetes, cardiovascular disease, hypertension, or hormonal imbalances. You should talk to your doctor to find out the cause and get an appropriate treatment.
Viagra, also widely known as the “blue pill,” is a commonly prescribed medication for ED. It increases the blood flow to the penis, thereby helping with the erection. It is typically taken in doses of 25 mg, 50 mg, or 100 mg and taken about 30 to 60 minutes before sex and works for about four to five hours. The common side effects of the drug included headache, flushing, and indigestion. It sometimes can lead to a serious side effect of priapism where the erection does not settle down on its own and sudden onset of vision or hearing loss. Remember, you should not use Viagra with nitrates (your heart medication) and those with severe cardiovascular conditions.
Vaping is commonly linked to erectile dysfunction in men. The association has been found regardless of age, cardiovascular health, or other common risk factors for ED. Studies have found that men who use e-cigarettes are more likely to report ED compared to those who do not vape. The primary culprit appears to be nicotine, which causes the constriction of blood vessels reducing blood flow to the penis, thereby causing ED.
