Erectile Dysfunction

Erectile Dysfunction (ED) is a condition in which a male is unable to achieve or sustain an erect penis for a satisfactory sexual intercourse with the partner. Biologically, to sustain an erection, the penis must have adequate and consistent blood supply. Also, the nerves should be able to send impulses continuously. A penis doesn’t have a bone or a similar supporting structure for erection. The blood vessels in communication with the nervous system enable penile erection. Having a healthy sex life is a must to have a healthy and happy life. There are multiple causes for ED like an inadequate flow of blood to the penile artery, hardening of the artery due to age (atherosclerosis), diabetes, obesity, increased smoking, and alcohol intake, etc. Treatment options include medications, hormone therapy, penile implants, and counselling.

The severity of erectile dysfunction is different in different men suffering from it. The different types of ED are as follows:

• Primary impotence
  In primary impotence, a man hasn’t had and will never have an erection spontaneously. It may be due to a physical abnormality in the structure of the penis or a damaged or trapped nerve which stimulates the erection process.
• Secondary impotence
  Secondary impotence means that a male has had successful erections in the past but is unable to have further successful erections due to unknown reasons.
• Situational impotence
  This means that a man can achieve an erection during a particular situation like masturbation but not during sex with a partner.
• Partial impotence
  It is caused by an inadequate blood supply to the penile artery due to which a man achieves a partial erection but then looses the same.
• Total impotence
  A man with total impotence can never have and has never had an erection at all.

Symptoms related to erectile dysfunction are very few and include:

• Inability to get an erection completely.
• Partial inability to get an erection depending on specific situations or under specific conditions.
• Achieving an erection but unable to sustain it for a considerable period of time to achieve a satisfactory sexual intercourse.
• Reduced sexual desire.

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Causes

Biologically, in a male, the process of having a sexual arousal and getting an erection is a complex process which involves the nervous system (brain and spinal cord, along with, the associated nerves associated), endocrine (hormone) system, and the cardiovascular system (heart). ED can be caused due to a disturbance in any of these bodily systems. Even a physical or structural abnormality in the penis or the testis can lead to ED. Some causes of ED are listed below:

• Heart diseases like high blood pressure.
• Clogged blood vessels (atherosclerosis) due to high cholesterol levels.
• Diabetes Mellitus.
• Obesity.
• Parkinson’s disease, Multiple sclerosis.
• Side effects of certain medications.
• High tobacco intake, alcohol intake or other forms of substance abuse.
• Stress.
• Enlarged prostate gland.
• Spinal cord surgeries which can cause nerve damage.
• Depression, anxiety, and other mental health conditions.
• Abnormal thyroid hormone levels and increased prolactin levels. (Read more - Hyperthyroidism causes and treatment)

Another classification of the causes of ED is based on the extent of libido (sexual arousal):

With reduced libido

• Hypogonadism (reduced testosterone level). 
• Depression.

With intact libido

• Psychological problems, including anxiety.
• Vascular insufficiency (atheroma).
• Neuropathic causes (e.g. diabetes mellitus, alcohol excess, multiple sclerosis).
• Drugs (e.g. beta blockers, thiazide diuretics, antidepressants etc).

Risk factors

As a man’s age advances, achieving a desirable erection may take longer than usual and may not be perfect in nature (rigidity may be less). A person may need a more direct touch to maintain an erection. But, there are certain risk factors associated with ED. These are:

• Medical conditions like diabetes mellitus or heart problems.
• History of pelvic irradiation or surgery, including prostate surgery (radical prostatectomy in people with prostate enlargement or prostate cancer).
• Smoking. Tobacco use restricts blood flow to blood vessels which can lead to ED in long term.
• Obesity.
• High blood pressure.
• Hormonal disorders (such as hypogonadism, hypothyroidism).
• Drug abuse (such as cocaine, methamphetamine).
• Medications like antidepressants, antihistamines and medications for hypertension.
• Psychological conditions like stress, anxiety or depression.
• Chronic and heavy alcohol consumption.

The best possible way to prevent ED is to make healthy lifestyle changes, along with better management of existing health conditions. Here is what you can do to prevent ED:

Quit smoking completely as it linked to heart diseases which in turn are a risk factor for ED.

• Manage your weight by taking up an exercise regimen. Make sure you stay active throughout the day. You can also take up a sport like football or tennis.
• Since diet plays a key role in the prevention of diseases that are linked to ED, make sure you eat healthy. Increase intake of whole grain foods, low-fat foods, fruits, and vegetables. Avoid refined and fatty foods as well as foods with high sodium content.
• Manage your blood sugar and blood pressure levels.
• Avoid alcohol intake if you have ED or limit the intake to minimum amounts to prevent ED.
• Manage stress as it can worsen ED. Take up relaxing activities activities like meditation, deep breathing or yoga.
• Stay away from recreational drugs. 

Depending on the medical and personal history of the patient which the doctor evaluates, the treatment options vary in each person and mainly depend on the causative agent. If there is any underlying medical condition such as diabetes or high blood pressure, then it has to be treated with suitable medications.

Some treatment options are taking medicines such as Sildenafil (Viagra, 50-100mg), Tadalafil, Vardenafil, and Avanafil. All these medications cause relaxation of the muscles of the penis which in turn increases the blood flow and helps achieve a proper and satisfactory erection. If medicines do not work then injections in the penis or urethra, which increase blood flow, may be used.

• Testosterone replacement therapy may be prescribed for some people with ED. It helps to prevent osteoporosis and restore muscle power and libido. Various methods used for administering testosterone are intramuscular injections, subcutaneous injections, transdermal injections or oral medications. (Read more - Natural remedies to boost Testosterone)
• A vacuum device is used in extreme cases. It comprises of an external plastic cylinder and a vacuum pump which pulls blood into the penis which aids to achieve an erection. Sometimes an elastic ring is placed at the base of the penis to prevent backflow of blood in the body.
• Penile implants are used rarely (fixed rod or inflatable reservoir types).
• Vascular reconstructive surgery in young people who have a problem of reduced blood flow into the penis.
• Psychotherapy is performed if the patient and his partner are suffering from an emotional or relationship crisis.
• Alternative treatments include Korean red ginseng (Panax ginseng, 900 mg three times a day) which improves erection.

Lifestyle management

Psychotherapy that involves couple counselling is most useful to discuss psychological problems. Neuropathy and vascular disease are unlikely to improve, but several treatments are available. Oral medications are also available. Surgery may be attempted to improve the patient’s condition.

Lifestyle changes which can be undertaken are:

• Start cardio exercises. Walk and run to get rid of obesity and lose weight easily.
• Opt for a healthy diet. Healthy foods like fruits, vegetables, whole grains, and fish help to decrease the chances of ED.
• Treat the underlying disease. Diabetes Mellitus and hypertension are two major causes of ED. So, proper treatment with medicines and dietary changes, as well as, exercises help to solve ED.
• Try lower body and pelvis exercises such as Kegel exercises. These exercises help in maintaining an adequate muscle tone in the pelvis (waist) and lower body parts.
• Manage stress and get adequate sleep.
• Limit smoking and alcohol.

Prognosis of ED mainly depends on two factors. Firstly, identification of the problem and not neglecting it and secondly, consulting your doctor and sharing your health problems which can help in receiving proper treatment. Systemic conditions are one of the major reasons for ED. So, receiving a healthy treatment plan for diabetes or hypertension and keeping the systemic disorders under control helps in treating the disorder. People with unhealthy dietary habits and other adverse habits like smoking and alcoholism have a poor prognosis. Post-surgical prognosis is generally good. Psychotherapy and counselling have the best possible prognosis.

Complications

Complications pertaining to ED are mostly psychological. It leads to depression, low self-esteem, emotional disturbances, social awkwardness, as well as, relationship problems with the partner. It leads to sterility (the inability to produce children). Penile atrophy (degeneration of penis muscles) is also caused due to lack of blood supply in case of any injury to the penis or scrotum.