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Erectile dysfunction (ED) is the inability to get or keep a firm erection sufficient for sexual intercourse.
In an erection, impulses from the brain and local nerves cause the muscles of the corpora cavernosa, two chambers in the penis, to relax and allow blood to flow in through the arteries and fill the spaces. The engorged chambers expand the penis and the tunica albuginea, a membrane covering the two chambers, helps to sustain the erection. The erection ends when muscles in the penis contract to stop the inflow of blood and open the veins for blood outflow.
Erectile dysfunction (ED) can be categorised into several types:
You should see a doctor if erectile dysfunction becomes a persistent issue, affects your confidence or relationships or is accompanied by other health concerns like diabetes, heart disease or anxiety. Early intervention can help identify underlying causes and improve treatment outcomes.
Physical causes of erectile dysfunction (ED) include cardiovascular disorders affecting blood supply to the penis, nerve damage, hormonal disorders, physical abnormalities of the penis, certain prescription drugs, and drug abuse. These factors can lead to difficulties in achieving or maintaining an erection
Psychological causes of ED encompass depression, stress, performance anxiety, and traumatic experiences. These psychological factors can significantly impact sexual function and contribute to the development or exacerbation of erectile dysfunction
Chronic illnesses such as diabetes, high blood pressure, nerve disease or damage, multiple sclerosis, atherosclerosis, and heart disease can damage the nerves and arteries to the penis, resulting in ED
Poor lifestyle choices such as smoking, excessive alcohol intake, being overweight, and lack of exercise can also contribute to erectile dysfunction
Pelvic surgery, such as radical prostatectomy for prostate cancer or cystectomy for bladder cancer, can potentially injure nerves and arteries near the penis, leading to difficulties with erections
Additionally, medications such as beta-blockers, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine, an ulcer drug, can have adverse effects on erectile function. Hormonal abnormalities, such as low levels of testosterone, are also known to be associated with erectile dysfunction
The prevalence of ED may increase with age as well. As men age, the likelihood of ED rises due to natural declines in testosterone levels and the increased incidence of underlying health conditions.
Age
Prevalence
45 years
5%
65 years and older
15 – 25%
75 years and older
50%
These diverse factors can contribute to the development of erectile dysfunction, highlighting the multifaceted nature of this condition.
Laboratory tests, including blood tests to check the level of male hormones and to identify other medical problems causing ED, are essential. Measuring the amount of available testosterone in the blood can yield information on problems with the endocrine system and may explain decreased sexual desire. Low testosterone level can be treated with testosterone replacement therapy in selected cases.
Psychosocial examination, using an interview, can reveal psychological factors contributing to ED. Sometimes, a man's sexual partner may also be interviewed to determine expectations and perceptions during sexual intercourse.
In addition to the above, specific tests may be performed to further evaluate the condition. Doppler ultrasound can help determine if the blood circulation to the penis is sufficient for an erection. Neurological tests, including a physical examination to check for nerve damage, are important, especially in cases of spinal cord injury. These comprehensive screenings and tests are helpful in diagnosing and understanding the underlying causes of erectile dysfunction.
Treatment options may include :
Oral medication
Vacuum erection devices: Mechanical vacuum devices cause an erection by creating a partial vacuum, which draws blood into the corpora cavernosa, engorging and expanding the penis. An elastic ring is moved from the end of the cylinder to the base of the penis as the cylinder is removed to maintain the erection. At the end of the erection, the ring must be removed to allow for blood circulation though the penis.
Penile implant: Implanted devices, known as prostheses, can restore erection in many men with ED. The implants may be malleable implants or inflatable implants. Once a man has either a malleable or inflatable implant, he must use the device to have an erection, and they are very effective with high satisfaction rates. Possible problems with implants include mechanical breakdown and infection, although the incidents of mechanical problems have decreased in recent years because of technological advances.
Extracorporeal Shock Wave Therapy or ESWT is a type of treatment for ED. It is a low intensity shockwave treatment when applied to different areas of the penis and perineum results in the stimulation of new blood vessel growth.
With more blood vessels, there is improvement blood flow to the penis which improves the ability to achieve a full erection.
Read more about Extracorporeal Shock Wave Therapy (ESWT).
