ERECTILE DYSFUNCTION
source: netdoctor.co.uk
Erectile dysfunction is a common male sexual disorder.
It is defined as the inability to achieve and maintain competent erection to facilitate satisfying sexual activity.
It may be occasional or permanent, with or without distinct causes.
Though not life-threatening, it may negatively affect the quality of life of both patients and their partners.
Incidence
Erectile dysfunction affects men of all ages.
However, the risk of developing erectile dysfunction is age-dependent, i.e. it increases with age.
Causes
Coronary disease is the most common cause of erectile dysfunction.
Other causes may include:
- Diabetes mellitus
- Damage in the penile or pelvic nerves
- Surgical procedures on the pelvis
- Radiotherapy on the pelvis
- Low testosterone
- Neurological conditions, such as Parkinson’s disease
Risk factors
Erectile dysfunction and cardiovascular diseases share some risk factors, such as:
- Obesity
- Smoking
- High cholesterol
- Hypertension
- Lack of physical activity
Symptoms originating in the urinary tract and erectile dysfunction
Erectile dysfunction is commonly accompanied by symptoms originating in the urinary tract, such as:
- frequent urination
- nocturia (excessive urination at night)
- urge incontinence
These symptoms are also associated with benign prostate hyperplasia.
Erectile dysfunction worsens when urinary symptoms are exacerbated.
Psychological factors and erectile dysfunction
Several psychological conditions have been linked to erectile dysfunction.
These are:
- stress
- depression
- low self-esteem
Social models may also affect erectile function and cause dysfunction.
These models include unrealistic beliefs on the sexuality and social role of men and women.
Diagnosis
Erectile dysfunction is a condition requiring proper diagnosis in order to identify the precise cause and administer the applicable treatment.
Medical history
This is required to assess the overall health status.
Sexual history
Even though any questions regarding a patient’s sexual life are sensitive, they play a key role in the diagnostic and therapeutic process.
The urologist may also ask you to describe the duration and nature of your morning erections.
Questionnaires
They are used in the evaluation process of various factors of sexual life.
Clinical examination
Needed to:
- check any suspected anomalies in the penis, scrotum and testicles
- check the cardiovascular system (blood pressure, pulse)
- assess the size, shape and composition of the prostate gland
If the clinical examination shows pathologic findings, blood tests may be ordered to measure:
- cholesterol
- PSA
- glucose
- testosterone
Cardiovascular risk evaluation
Given the association between erectile dysfunction and cardiovascular diseases, cardiovascular risk evaluation is carried out as part of the diagnostic process.
If there are pathologic findings, the patient may be referred to a cardiologist.
Treatment
Many treatment options are available for erectile dysfunction.
Education and evaluation of the couple
An integral part of the treatment process is the understanding of the situation and its consequences.
The urologist may recommend a combination of medication and psychological approaches.
If you are in a relationship, it helps if your partner consents to the treatment option and knows how it works.
You should also bear in mind that treatment depends on your own status.
What may be helpful to others may be inappropriate in your case.
Advice on lifestyle changes
Improving your overall health status may help improve your symptoms.
To achieve that, you should:
- quit smoking
- drink less alcohol
- exercise regularly
Adjusting the diet (diet low in sugar, salt and fatty food).
Medications
Phosphodiesterase type 5 inhibitors (PDE 5 inhibitors)
PDE 5 inhibitors are a drug class used in the treatment of erectile dysfunction.
These drugs relax the smooth muscle fibers of the penile vessels and induce increased blood flow.
They do not cause erection without sexual stimulation.
There are 4 types of approved drugs.
- sildenafil (VIAGRA)
- tadalafil (CIALIS)
- vardenafil (LEVITRA)
- avanafil (SPEDRA)
The above drugs are the most commonly used in the treatment of erectile dysfunction and are all equally effective
The applicability of each drug to a specific patient depends on the frequency of sexual activities and personal experience in the use of it.
Given the success of these drugs in the treatment of erectile dysfunction, many counterfeit drugs have flooded the market; they are not approved and they may even harm you.
Contraindications for PDE 5 inhibitors:
The use of these drugs is not recommended if you are on nitrates or alpha-blockers, because they cause low blood pressure.
Vacuum erection devices (penis pumps)
source: patients.uroweb.org
A vacuum erection device has a cylindrical shape and comes with a rubber or silicone ring which constricts at the base of the penis.
Such a device can help you achieve and maintain erection.
When vacuum erection device is not recommended – Contraindications
The device is contraindicated if you use medications for blood clotting (anticoagulants) or if you suffer from a blood clotting disorder.
Vacuum erection device side effects
They may cause some discomfort, difficulty in ejaculating and experiencing orgasm, skin bruises and numbness on the penis.
If you leave the ring at the base of the penis for more than 30 minutes, it may result in severe damage to the skin of the penis.
Shockwave erectile dysfunction treatment
source: patients.uroweb.org
What is a shockwave treatment?
A shockwave treatment is a therapeutic procedure in which targeted low-frequency shockwaves are directed onto the penis to improve erection.
The treatment requires many sessions and may be repeated, if necessary.
Shockwaves have been the subject of investigation as a new treatment option in erectile dysfunction.
When should someone opt for shockwave treatment?
In case you suffer from mild erectile dysfunction and you cannot or do not wish to receive any medications (PDE 5 inhibitors).
Intracavernosal injections
source: patients.uroweb.org
Another treatment option for erectile dysfunction.
A drug is injected into the spongy tissue of the penis to provoke vascular dilation.
When should intracavernosal injections be used?
Intracavernosal injections are opted for when all previous treatments, e.g. lifestyle changes or oral drugs, have proven ineffective.
Although most men are squeamish at the idea of a needle being inserted into their penis, more and more opt for this treatment, acknowledging the advantages of the procedure, and overcoming the discomfort from the inserted needle.
Penile prosthesis placement
If all the aforementioned therapies fail, a penile prosthesis procedure may be advised.
This constitutes a permanent solution, and it delivers very good outcomes and high patient satisfaction score.