Sexual Health

Erectile dysfunction

Description

Erectile dysfunction (ED), or impotence, is an inability to achieve or sustain an erection to have a satisfactory sexual intercourse. More than 30 million alone in the United States suffer from this defect. Erectile dysfunction occurs due to certain health related issues that restrict the natural blood flow in the penile region. Damage to penile nerves and emotional stress are also leading cause of this defect, which can affect the person’s normal life and contribute to relationship issues.


Causes and symptoms

There are many medical and psychological reasons for erectile dysfunction, which vary from person to person. These could be:

  • Older age

  • High blood pressure

  • Diabetes

  • High Cholesterol

  • Cigarette smoking

  • Atherosclerosis

  • Depression

  • Spinal cord or never damage

  • Alcoholism

  • Low testosterone level

  • Obesity

  • External injury to the penile area

  • Cardiovascular disease

  • History of Prostate cancer treatment

Symptoms of erectile dysfunction are not getting or keeping an erection to enjoy sexual activity, reduced sexual desire, premature and delayed ejaculation.

Diagnosis

After examining the symptoms, certain tests will be performed by the doctor to check your overall health. These tests include physical examinations, rectal exam, blood tests and urine tests. Further erectile tests may be carried out to see the performance of your blood vessels, muscles, nerves and other penile tissues. A normal nocturnal penile tumescence (NPT) is a test performed during sleep that shows the functionality of blood supply and nerves.

Imaging tests such as x-ray, ultrasound and MRI gives a clear image of the penile region to see if any leaking, clogged arteries, weakened blood flow or any internal injuries are causing the condition.

Erectile Dysfunction Treatment

Once your test results are out, the doctor will make the decision to choose the right treatment depending on the cause and severity of the disease, and medical history of the patient. He/she will explain the entire treatment along with their risks and complications. There are different types of treatment for erectile dysfunction. Below are given some of the widely and most successful treatment options:

Oral treatment

Oral treatment has a very high chance of curing erectile dysfunction and is one of the safest options as well. It involves certain drugs such as Slidenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra, Staxyn), Avanafil (Stendra), which enhance the effects of nitric oxide that contributes highly in relaxing the penile muscles. By taking these medications properly, the restricted blood flow will be back to normal and help you get a better erection that will further help you get in the mood for sexual intercourse. However, right medications need to be given at a right dosage to get better results, which will consider by the doctor. Moreover, the dosage and prescription of oral supplements vary depending on the medical condition of the patient.

Other procedures

  • Self injection: Medications such as alprostadil, phentolamine, and papaverine are commonly injected into the penis directly to attain an erection. This procedure aims to provide an erection for over 20-40 minutes. If it lasts more, the dosage needs to be adjusted in order to avoid long term complications.

  • Testosterone replacement: One of the main reasons for erectile dysfunction is the low level of hormone testosterone. If that is the case, then testosterone replacement therapy is used to increase the level of hormone through injection, gel, gum, patch, subcutaneous pellet, intranasal or oral supplements.

  • Alpostadil urethral suppository: This therapy requires placing a little alprostadil suppository in the penis through penile urethra, which provides erection quickly that lasts over 30-60 minutes.

  • Penis surgery and implants: If the oral treatment is not effective to cure the condition, then the doctor may recommend surgical procedure. These could be:

    • Penis pumps: Penis pump is vacuum erection battery powered device in a shape of a tube, which is placed over the penis. It then begins pumping that suck out the air inside the tube creating a vacuum which increases the blood flow in the penis. This provides erection that lasts long enough to perform an intercourse.

    • Penile implants: This treatment involves placing semirigid or inflatable rods like devices on both the sides of the penis that allow you to control how long and when you achieve an erection.

With an inflatable implant, fluid-filled cylinders are placed lengthwise in the penis. Tubing connects these rods to a pump that is placed inside the scrotum. When the pump pushes fluid into the cylinders, they make the penis hard. Inflatable implants are the most natural feeling of the penile implants, as they let you control firmness and size.

There are 2 types of inflatable implants, 2 part and 3 part.

  • In 2 part inflatable implants, the pump moves a small amount of fluid into the cylinders for erection then out again when erection is no longer needed. One part is the paired cylinders and the second part is the scrotal pump.

  • In a 3 part inflatable penile implant paired cylinders, a scrotal pump, and a fluid reservoir is implanted in the belly. With these three-part devices, a larger volume of fluid is pumped into the cylinders for erection and out of the cylinders when erection is no longer needed.

The surgery itself takes one hour under anesthesia. One small surgical incision is made either above the penis where it joins the abdomen or under the penis where it joins the scrotum. Blood loss is minimal and no tissue is removed. Patients are usually kept under observation for 1 night.

Pain Post surgery may last upto 4 weeks and pain killer are prescribed. Abstinence is recommended for about a month and limited physical activity is recommended.

Most men and partners find implants deeply satisfying however once an implant is placed, non surgical intervention willnot work.

Penile implant surgery cost varies from US$ 6000 to US$ 10,000 depending upon the type of implant

Penile Arterial Revascularization is a surgery to help men who have injured their pelvis or penis.

In this treatment method, obstructed penile arteries are bypassed to improve flow of blood which will cause the penis to have an erection. This procedure can only be carried out for men with no risk factor for hardened arteries.

Venous Ligation Surgery helps by binding leaky vessels that cause a soft erection or men to lose an erection. An erection depends upon blood flow through the arteries and blocking off leaky veins ensures good blood supply for a good erection.

Both penile arterial revascularization or venous ligation surgeries arenot treatment options in case of the following problems

  • High blood Sugar, insulin-dependent

  • Hardened arteries

  • High cholesterol levels

  • Damaged and injured blood vessels and nerves

Complications

Treatment for erectile dysfunction can also cause some mild or severe side effects, if improper dosage or inappropriate medicines are taken. Below are given some of the risks involved:

  • Bleeding

  • Prolonged erection (Priapism)

  • Fibrous tissue formation

  • Muscles Pain

  • Bruising on the penis

  • Infection

  • Headache

  • Stuffy nose

  • Dizziness

  • Vision changes

Post operative care

Having erectile dysfunction can damage your self confidence and greatly affect your relationship. Hence, it is necessary to talk to your partner about your medical condition. Share your doctor’s views and discuss ways to cope with it

You can also join couples counselling to improve your relationship.

All of the treatments except for penile implant surgery are used as and when needed and the effect will wear off afterwards.

Erectile dysfunction isn’t a kind of disease that will be cured instantly. It takes time for treatment methods to provide long term benefits.

If you have diabetes or are hypertensive, talk to your doctor about how to prevent these factors from developing chances of erectile dysfunction.

Quit smoking and alcohol consumption, and follow a healthy diet filled with vitamin intake. Perform regular exercise and follow the prescription given by your doctor.