Erectile Dysfunction – Causes, Testing & Evaluation, Treatment

John is the kind of man most men envy. At 42, the suave, successful banker with a beautiful loving wife and two precocious children. 

He loves to travel, plays regular golf and is an avid football fan.  John’s life looks perfect on the outside, but he has been hiding a distressing secret. His problem with erections started a little over a year ago. John initially thought nothing of it, blaming his heavy work schedule as the cause. 

But over the next few months, John found it increasingly hard to maintain an erection during intercourse and sometimes even to attain an erection when called into action. His wife, even though supportive, once asked him if he still finds her attractive and recently asked if he has been having an affair. John was feeling embarrassed, frustrated and knew he needed help to overcome his problem. What was his problem? Is there a cure for such an issue? 

Read on and let’s find out. 

Erectile Dysfunction 

Erectile dysfunction (or impotence) is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance. 

It is a significant and common medical problem affecting many men worldwide. In 1995, scientists believed around 152 million men worldwide experienced ED. By 2025, this is expected to reach 320 million. 

Causes of erectile dysfunction 

An erection is the result of an interaction between the blood circulation system, the nervous system, the hormonal balance and a number of psychological factors. Because this is such a complex mechanism, disruption at any level can result in erectile dysfunction. 

Here are some common causes of and risk factors for ED: 

  • Medical illness – erectile dysfunction is often associated with conditions that affect blood flow in the penis, such as: diabetes, high cholesterol, high blood pressure, cigarette smoking, obesity, heart disease. 
  • Medications – prescribed medicines used to treat high blood pressure, high cholesterol, depression and psychiatric disorders, and prostate disease, may cause or worsen the symptoms of erectile dysfunction. 
  • Nerve or spinal cord damage – Interference with nerve function caused by spinal cord trauma, multiple sclerosis, diabetic neuropathy, pelvic surgery, Parkinson’s disease, and Alzheimer’s disease. 
  • Low testosterone levels– Testosterone (the primary sex hormone in men) is necessary for sex drive (libido) Therefore, men with hypogonadism (low testosterone with symptoms) can have low sex drive and erectile dysfunction. 
  • Recreational drugs– Recreational drugs, including alcohol, amphetamines, barbiturates, marijuana, nicotine, heroin and cocaine, are associated with erectile dysfunction. 
  • Urological problems– such as Peyronie’s disease and pelvic trauma. 
  • Psychological factors – a man’s sexual drive or performance can be affected by stress such as problems at work, relationship difficulties or financial worries. Psychiatric conditions, and feeling depressed or anxious about poor sexual performance can also result in erectile dysfunction. 

Erectile Dysfunction Evaluation and Diagnostic Testing 

The diagnosis of ED requires a detailed sexual and medical history, physical examination, and laboratory tests.

Your doctor will ask several questions to determine if your symptoms are suggestive of erectile dysfunction and to assess its severity and possible causes. In patients with recognized chronic conditions, the focus will be on a genital exam, and will include cardiovascular examination for cardiovascular risk assessment.

Laboratory evaluations will assess:

  • Total and bioavailable testosterone 
  • Luteinizing hormone (LH) and Follicle stimulating hormone (FSH) 
  • Prolactin levels and estradiol may also be included if the patient has a high body mass index (BMI) 
  • PSA 
  • Thyroid hormone 
  • Fasting lipid profile 
  • Liver function studies 
  • Screening for diabetes 
  • Full blood count
  • Additional evaluation if indicated could include imaging tests such as Duplex ultrasonography.

Treatment for erectile dysfunction 

Lifestyle improvements: Quitting smoking, exercising regularly, losing excess weight, reducing alcohol consumption, controlling hypertension, and optimizing blood glucose levels in patients with diabetes are not only important for maintaining good health but also may improve or even prevent progression of erectile dysfunction. 

Medical Therapies:

Oral drugs – Pills such Viagra, Cialis and Levitra are first-line medical therapy for ED and are often prescribed by doctors. 

Penile Injections – Intracavernosal injections such as Alprostadil constitute a second line ED treatment and are often used when oral therapies fail. 

Intraurethral – A tiny medicated pellet, the drug Alprostadil; Medication is placed in the urethra (the tube that transports urine out of the body). 

Topical Cream– Topical alprostadil is applied to the tip of the penis and the surrounding skin. It should be used 5 to 30 minutes before you have sex. 

Hormonal Therapy– Testosterone Replacement Therapy (TRT) can be prescribed by your doctor if low testosterone is detected in blood testing. 

Extracorporeal (ESWT) – Non-invasive low-intensity sound waves that pass through shockwave erectile tissue, restoring natural erectile function by clearing plaque therapy (ESWT) out of blood vessels and encouraging the growth of new vessels. Studies have shown its ability to improve and potentially restore erectile function in men with ED 

Vacuum Erection – Popularly known as a penis pump. It consists of a plastic tube device that fits over the penis, a hand or battery-powered pump attached to the tube, and a band that fits around the base of the penis once it is erect (constriction ring). 

Surgical Therapies 

Penile prosthetic implant – A device that is surgically implanted into the penis. It can enable erections through a mechanism that is activated by squeezing on a specific part of the device. 

Vascular Surgery – Targets the veins and arteries that supply blood to the penis.

Feeling embarrassed about sexual health problems may prevent many men from seeking the medical attention they need, which can delay diagnosis and treatment of more serious underlying conditions. There are many safe, successful options for ED treatment. The biggest obstacle to overcome is that first call to your doctor to make an appointment to discuss the problem. Put yourself on the road to successful treatment today. 

Next read: Cialis | Viagra | Levitra: Their Differences, Similarities and Which Is Better For You?

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