Erectile Dysfunction: Causes, Diagnosis and Treatments

Each one of us must deeply care about our health and recognize the significance of it. But why escape, whenever there is a discussion about sexual health care??

There is no need for hesitation when it comes to talking about sexual health. Having open and honest conversations about sexual health is crucial for promoting overall well-being and preventing any sexual illnesses. It allows individuals to make informed decisions, access necessary resources, and seek appropriate medical care when needed. So, have you heard of erectile dysfunction (ED) before? It is the most prevalent sexual condition and approximately thirty million men worldwide suffer from it.

What is Erectile Dysfunction (ED)?

Erectile dysfunction (ED), more commonly known asimpotence, is one of the most common forms of male sexual dysfunction. It is the condition in which a man has difficulty achieving or maintaining an erection. As people get older, they are more likely to experience ED. However, it is not a normal consequence of becoming older so, it can be a sign of a problem with your health, and it could mean that your arteries are blocked, or it could mean that your diabetes has hurt your nerves.

Even if you are embarrassed, you should talk to your doctor about not being able to get an erection. Sometimes, treating the cause of erectile dysfunction is enough to fix the problem. In other cases, medicines or other direct treatments might be needed.

How Erections Work

During sexual arousal, nerves release chemicals that increase blood flow into the penis. Blood flows into two spongy muscle chambers in the penis that causes an erection (the corpus cavernosum).

The spongy tissues relax and trap blood during an erection. Blood pressure within the chambers causes the penis to contract, resulting in an erection.During an orgasmic episode, a man's penis receives a second set of nerve signals, so these signals cause a contraction of the penile muscles, which allows blood to flow back into the man's circulatory system. As a result, the erection begins to fade and eventually disappears. But when sexual arousal is absent, the penis is soft and limp. Men may notice that the size of their penis varies according to heat, cold, or anxiety; this is normal and reflects the stability of blood entering and leaving the penis.

Causes of Erectile Dysfunction

The brain, hormones, emotions, nerves, muscles, and blood vessels all play a role in the complex process of sexual arousal in men. Problems with any of these can lead to impotence and it can be caused by a combination of physiological and psychological causes.

Physical Causes

Physical causes of ED include:

• Stroke
• Blood vessel blockages (atherosclerosis)
• High cholesterol
• Hypertension
• Diabetes
• Obesity
• Parkinson's disease
• Multiple sclerosis
• Certain prescription medications
• Tobacco use
• Peyronie's disease — development of scar tissue inside the penis
• Alcoholism
• Insomnia
• Prostate cancer
• Pelvic or spinal surgery

Psychological causes

An erection begins with sexual excitation in the brain, so psychological emotions interfere with sexual feelings which can affect sexuality and cause erectile dysfunction, these include:

• Depression, anxiety
• Stress
• Relationship issues caused by stress
• Low self-esteem

Symptoms of Erectile Dysfunction

A lack of or inability to maintain an erection during sexual activity is the most common sign of erectile dysfunction.

• Early ejaculation
• Delayed ejaculation and
• Anorgasmia or difficulty having an orgasmic experience while having adequate sexual stimulation

Diagnosis

Finding the root cause of your ED will help you in identifying potential treatments. To find the problem, doctors can choose it from a number of possible tests, which include a physical examination and examining your health and sexual history.

Physical exam

You can anticipate a physical exam during which your doctor will:

• Listen into your respiratory system and heart
• Make sure your blood pressure levels are normal
• Check for decreased blood flow to the pelvic area and inspect your testicles and penis
• Evaluate the health of the pelvic nerves
• They will also recommend a rectal check for prostate screening
• Ultrasound: To diagnose an issue with penile blood flow, an ultrasound can be used to look at the penile blood vessels
• Nocturnal penile tumescence test: The quality of your night-time erections is measured by a portable, battery-operated device called a nocturnal penile tumescence tester. This device is intended to be worn on the outer thigh. Your doctor can retrieve the stored information later. However, its use has declined in recent years.
• Injection test: A drug is injected into the penis to induce an erection for the injection test. The strength and duration of your erection can be assessed by your doctor in this way. Ultrasound can be used in conjunction with this exam to get a more complete picture of the erection's health.
• Urine tests: Tests conducted on the urine can reveal the presence of diseases like diabetes or other hidden health issues.
• Blood tests: Diseases including diabetes, heart disease, thyroid problems, and low testosterone levels can all be detected with a simple blood test.

Psychosocial Examination

Your doctor will be able to determine the severity of your erectile dysfunction based on the information given in the psychosocial examination, including your symptoms, medical history, and sexual history. Some of the questions may feel intrusive due to the personal nature of an individual. However, it is essential to respond truthfully to those questions. The possible questions include:

• What drugs or medications are you currently taking? prescribed medications, over-the-counter medications, herbal supplements, and illegal narcotics??
• Have you ever experienced psychological issues like stress, anxiety, or depression?
• When did you sensitize ED symptoms?
• What has been the frequency, quality, and duration of your erections?
• What are the exact circumstances that contributed to the start of ED?
• Have you ever experienced erections during the night or in the morning?
• What sexual practices do you use?
• Are there issues in your current relationship?

Treatment

Treatment for erectile dysfunction (ED) depends on the patient's level of dysfunction and the doctor's assessment of the true cause. A wide range of options for treating erectile dysfunction can help a man regain normal sexual function which includes:

• Oral medications
• Sexual treatment
• Injections to the genitalia
• Vacuum devices
• Intraurethral treatment
• Surgery (penile implant) 

Oral medications

Men's sexual function may be improved by drugs that increase blood flow to the penis, such as

• Sildenafil (Viagra)
• Vardenafil (Levitra)
• Tadalafil (Cialis)

Oral ED drugs should not be taken by men who are taking nitrate-containing prescriptions (nitro-glycerine). When it is taken together nitrates and these specific medications can cause low blood pressure (hypotension).

Indigestion, nasal congestion, flushing, headaches, and a sort of vision disruption are one of these drugs' most common side effects.

Sexual treatment

Even when there is a clear organic basis for erectile dysfunction, psychological factors may play a role. Seeking out professional counselling is one way to deal with emotional issues like anxiety, stress, or guilt that may be contributing to sexual dysfunction. Most men can benefit from sex therapy when a qualified sex therapist administers it.

Sex therapy also supports the man's partner in accepting and resolving the issues.

A patient with erectile dysfunction (ED) who has a clear psychological cause should first have sex therapy counselling before pursuing any medication treatments.

Penile injection therapy

An erection is achieved by injecting drugs directly into the penile erection chambers which is useful in treating a wide range of erection problems, including those stemming from problems with blood vessels, nerves, and the mind.

The man injects a small amount of medicine into the side of his penis using a tiny needle and syringe. Due to the medicine's vasodilatory effects, blood flow might be increased to the penis.

• Prostaglandin E1 (alprostadil)
• Papaverine (Papacon) and
• Phentolamine (Regitine) are most widely used treatment

Although it is extremely rare, patients with cerebrovascular illness or severe cardiovascular disease may not be able to endure the dizziness and elevated blood pressure that can occasionally result from injectable therapy.

Injection therapy has been associated with priapism, a painful erection that lasts longer than two to three hours. This can be lessened by using the right doses and following the treatment guidelines, suggested by your Andrologist.

Vacuum devices

Vacuum erection devices are made of a plastic tube that is slipped over the penis and sealed against the skin. To achieve an erection, a pump on the opposite end of the tube creates a low-pressure vacuum surrounding the erectile tissue. The penile base is then encircled by an elastic ring. After using this, your penis will remain hard for up to 30 minutes without bleeding. Seventy-five percent of men can successfully use a vacuum erection device after obtaining the correct instruction.

Intraurethral treatment (IU)

Treatment with IU entails inserting a small pellet of the medication Alprostadil into the urethra (the tube that carries urine out of your body). Penile discomfort and burning are the most prevalent adverse reactions to IU alprostadil and any erection that lasts more than four hours require medical intervention.

Surgery (penile implant)

If drugs are ineffective, your doctor may propose surgical therapy. Implants and vascular surgery are the two methods.

Implants:

A surgeon inserts a penile implant, often known as a prosthesis, into the penis to create a stiff penis that supports normal sexual activity in the man.

Vascular Surgery:

It is used to treat blocked arteries. This kind of surgery is uncommon and often only performed on patients who have suffered pelvic trauma that results in vascular injury and this surgery can help to restore the penis's blood supply. Typically, younger individuals are preferable candidates for this surgery.

Prevention

Making good lifestyle choices and taking care of any pre-existing medical concerns is the best way to prevent erectile dysfunction. Here some suggestions are listed, they are:

• Maintain a balanced diet: A healthy diet rich in fruits, vegetables, and whole grains can help men with erectile dysfunction. In addition, a plant-based diet may be helpful in treating ED, according to the results of a small study from 2021.
• Bring down your cholesterol levels: The arteries leading to the penis may become hardened, narrowed, or blocked due to high cholesterol. Cholesterol in men can be reduced with dietary changes medication and physical activity.
• Keep a regular exercise routine: It has been suggested that regular exercise can lower the risk of developing ED. Kegel exercises, aerobic exercises and yoga help to lower the risk.Select physical activities from it that you will look forward to doing daily and before starting the exercise routine consult your doctor.