ERECTILE DYSFUNCTION

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Andrology , Psychiatry , Urology

ABOUT THE DISEASE

The inability to achieve and sustain an erection long enough to be suitable for sexual intercourse on a continuous basis (more than 25% of time) is termed as erectile dysfunction (ED). This is a fairly common problem and one of every ten men will suffer from ED at some point during his lifetime. In majority of cases, ED is a symptom of an underlying problem. This condition is not considered normal at any age and should not be confused with premature ejaculation. This is sometimes also referred to as Impotence.

SYMPTOMS

An absence of night time erections, is a very important indicator of ED. Normally, men have 3 to 5 erections per night. Each erection lasts for up to 30 minutes.

CAUSES

A host of factors can cause ED, such as:
- Diabetes
- Hypertension
- Atherosclerosis
- Stress, anxiety or depression including problems in relationship with your partner
- Alcohol and tobacco use
- Some prescription medications, such as antidepressants, pain medicine, antihypertensives, muscle relaxants, diuretics, etc
- Fatigue
- Brain or spinal-cord injuries
- Hormonal problems
- Hypogonadism (which leads to lower testosterone levels)
- Multiple sclerosis
- Parkinson`s disease
- Radiation therapy to the testicles
- Stroke
- Some types of prostate or bladder surgery

DIAGNOSIS

- Medical history (any medications taken, past history, addiction to recreational drugs or alcohol etc)
- Physical examination (penis and rectum)
- Hormone profile
- PSA
- Nerve Testing
- Nocturnal penile tumescence (NPT) to check for normal night time erections
- Penile ultrasound to check for blood vessel or blood flow problems

TREATMENT METHODS

The treatment plan varies depending upon the exact cause identified and may include any of the following options:

Medication

Medications such as sildenafil (Viagra), varderafil (Levita), or tadalfil (Cialis) may help improve sexual function in men by increasing blood flow to the penis. But should be taken only after consultation with the doctor.

Trans urethral pharmacotherapy may be advised- where a suppository (containing the medicine alprostadil) is placed into the urinary tube (urethra) using a plastic applicator. It gets absorbed into the bloodstream and relaxes the blood vessels, allowing blood to flow into the penis.

Men with low levels of testosterone may benefit from hormone replacement.

Mechanical aids

Aids such as vacuum devices and penile constriction rings serve as erectile aids for some men.

Penile injection therapy (intracavernosal injection therapy)

Men are taught how to inject medications directly into the erection chambers of the penis to create an erection.

Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve, and psychological conditions.

The most common side effects are pain and penile scarring (fibrosis).

A painful erection that lasts longer than two to three hours is called priapism and may occur with injection therapy.

Psychology and sex therapies

Psychological causes may contribute to erectile failure even when there is a clear organic cause.

Sex Therapy with a trained counsellor can help a person address feelings of anxiety, fear, or guilt that may have an impact on sexual dysfunction.

Penile prosthesis surgery

Inflatable penile prostheses (Penis implant) are implanted during outpatient surgery. This enables to have an erection whenever the man desires. The use of a prosthesis preserves penile sensation, orgasm, and ejaculation for most men.