Erectile Dysfunction

Answers for Men (Options For Erectile Dysfunction)

 

Mr Katz was recently invited to write the latest update on Erectile Dysfunction management for a journal/magazine targeted at GPs and urologists printclick here to read it

 

Erectile dysfunction, or ED, can refer to a total inability to achieve erection, firm enough for sexual intercourse, an inconsistent ability to do so, or a tendency to sustain only brief erections. It may also be related to problems such as premature ejaculation.

ED is treatable and in many cases curable, irrespective of the age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatment of ED.

Causes

Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence of events includes generation of nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues as well as vasculature in and around the corpora cavernosa. Causes of ED include the following:

  • Diseases : Diseases such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease account for about 70 percent of ED cases. Between 35 and 50 percent of men with diabetes experience ED
  • Lifestyle Choices : Lifestyle choices that contribute to heart disease and vascular problems also increase the risk of erectile dysfunction. Smoking, obesity and sedentary lifestyle are possible causes of ED.
  • Surgery : Surgery (especially radical prosate/bladder surgery as well as certain types of rectal surgery) can injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis can cause ED by injuring nerves, smooth muscles, arteries, and the fibrous tissues of the corpora cavernosa
  • Medications : Some medicines such as antihypertensive drugs, antidepressants, sedatives and hormonal medications can produce ED as a side effect
  • Psychological Factors : Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure may also cause ED. Men with a physical cause for ED frequently also experience some sort of psychological reactions (stress, anxiety, guilt, and depression).
  • Smoking : Other possible causes of ED are smoking, which affects normal blood flow in veins and arteries.
  • Hormones : Hormonal abnormalities, such low levels of testosterone, may also be responsible for ED.

Diagnosis of ED

The diagnosis of erectile dysfunction (ED) involves the following steps:

  1. Patient History : Medical and sexual histories help define the degree and nature of ED. A medical history can disclose diseases that lead to ED, while a simple recounting of sexual activity might distinguish among problems with sexual desire, erection, ejaculation, or orgasm.
  2. Physical Examination : A physical examination can give clues to systemic problems. For example, if the penis is not sensitive to touch, it may indicate a problem in the nervous system. Abnormal secondary sex characteristics, such as hair pattern or breast enlargement, can indicate hormonal problems, which would mean that the endocrine system is involved. Unusual features of the penis itself could indicate the source of the problem for example; a penis that bends or curves when erect could be the effect of Peyronie’s disease
  3. Laboratory Tests : Several laboratory tests for systemic diseases such as blood counts, urinalysis and lipid profile, can help diagnose ED. Measuring the amount of testosterone in the blood can give information about problems with the endocrine system and is useful to measure is some men
  4. Other Tests : Penile ultrasound with Colour Doppler enhancement can give an accurate diagnosis as to the underlying cause the erectile dysnfuction.

Treatment

Erectile dysfunction (ED) can be treated by employing non-surgical methods and surgical methods. Conservative treatment measures to treat erectile dysfunction are always considered before invasive measures such as surgery.

Some conservative treatment measures include the following:

Lifestyle Changes : For some men, making a few healthy lifestyle changes may solve the problem. Abstinence from smoking, weight loss, and increased physical activity may help some men regain sexual function.

Medication Changes : The next step is cutting back on any drugs with harmful side effects. For example, drugs for high blood pressure work in different ways. If you think a particular drug is causing problems with erection, tell your doctor and ask whether you can try a different class of antihypertensive medicine.

Drug Therapy : Drugs for treating ED can be taken orally or injected directly into the penis with a very small needle. Your doctor will discuss the pros and cons of each of these treatments to see if they are suitable.

Click here to get more information on Penile Injection Therapy.

Vacuum Devices : Mechanical vacuum devices cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. The devices have three components: a plastic cylinder, into which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body. One variation of the vacuum device involves a semi rigid rubber sheath that is placed on the penis and remains there after erection is attained and during intercourse.

Surgical Therapy : The most common surgery performed for ED is Penile Implant surgery. Implanted devices, known as prostheses, can restore erections in many men with severe ED.
For more information about surgical therapy, please click here.

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