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Erectile Dysfunction

Erectile Dysfunction – Causes, Diagnosis and its Treatment

 

Introduction

One of the most commonly observed sexual disorders, erectile dysfunction or impotence is a condition wherein a man can’t achieve or maintain the erection of penis during sexual intercourse. Although more than 40% of males are known to suffer from this affliction at one point in time or the other, in many cases erectile dysfunction (ED) can be merely temporary. In addition to physiological factors such as chronic diseases, injury or trauma to penis or hormonal insufficiency; erectile dysfunction can also be caused by psychological disorders. Although the condition in itself isn’t life threatening, it can have seriously debilitating impact on marital relations and on self-confidence of the person suffering from the dysfunction.

Risk Factors

Erectile dysfunction or impotence is a physical inability which can be induced by various risk factors. Over-weight men suffering from chronic diabetes or cardiovascular conditions are at a high risk for developing erectile dysfunction. Excessive use of alcohol, tobacco and recreational drugs is also known to offset temporary or permanent erectile dysfunction. A person suffering from anxiety or post-traumatic stress can also struggle with ED. The risk of erectile dysfunction also increases significantly with advancing age.

Causes

The underlying causes of erectile dysfunction can be one to many and may be present in various combinations. Two broad causal classifications can be thus represented –

  • Physical causes
    • Chronic  disorders like blood pressure and high cholesterol as well as metabolic syndrome can lead to intermittent or permanent erectile dysfunction
    • Diabetes and obesity can also cause impotence in men
    • Diseases like Parkinson’s and multiple sclerosis not only interfere with motor functions, but also inhibit normal erection
    • Scar tissue development in the penis due to Peyronie’s disease can also cause ED
    • Excessive intake of alcohol, tobacco and drug abuse can cause temporary erectile dysfunction
    • Injury or trauma to the spinal cord can result in ED
    • Injury or trauma to the pelvic area, be it the scrotum or penis or surrounding vasculature; can also result in erectile dysfunction
    • Surgeries in the pelvic area to treat prostate cancer or testicular torsion torsion can also result in temporary ED
    • Chemotherapy and radiotherapy for various cancers can also cause ED
    • Androgen Hormonal imbalance due to hypogonadism or an on-going treatment for a disease can also result in erectile dysfunction
    • Psychological causes
      • Post-traumatic stress can result in temporary erectile dysfunction in men
      • Chronic state of stress and anxiety can also cause temporary ED
      • Depression can decrease the chances of achieving and maintaining erection, thus leading to impotence

Diagnosis

Various diagnostic measures are available to substantiate whether the patient has erectile dysfunction due to physiological causes or psychological ones. If the patient is unable to achieve erection ever, then in all probability, causes of ED should be physiological. If however, on rare occasions, the patient manages to achieve erection then the probable causes of erectile dysfunction may be psychological. Furthermore, following clinical tests are conducted to completely diagnose the extent and causes of erectile dysfunction –

  • Duplex ultrasound with the help of prostaglandin induced erection measures the blood flow, venous leaks and penile blood pressure.
  • Bulbocavernous reflex test is conducted to evaluate the nerve sensation in the penis and pelvic area.
  • NPT or Nocturnal Penile Tumescence is a test conducted to check nocturnal erection using snap gauge or strain gauge to ascertain neural and vascular activity in the penis. This also established the presence of psychological reasons behind erectile dysfunction.
  • MRA or Magnetic Resonance Angiography is also a type of MRI, wherein the detailed analysis of blood vessels can be done using contrast agents. Vascular anomalies resulting in erectile dysfunction can be easily diagnosed using this method.

Treatment for Erectile Dysfunction

The treatment for erectile dysfunction heavily depends on the differential diagnosis of the disorder. If the cause of ED is tobacco or alcohol usage, then complete cessation or reduction of the substance abuse can improve a person’s ability to achieve and maintain erection. In patients suffering from blood pressure, cholesterol, obesity and diabetes; lifestyle changes such as including exercise and consuming healthy diet can improve the dysfunction as well. Oral medications having Phosphodiesterase Type 5 inhibitors such as Viagra, Levitra and Cialis are available with prescription. Topical medications such as Vitaros which combines alprostadil and permeation enhancer DDAIP are also used as first line treatment. Vacuum erection devices are widely used by people suffering from erectile dysfunction to achieve erection.

Medications such as Papaverine, phentolamine and prostaglandin E1 can be administered in the form of an injection regime and can treat erectile dysfunction to a great extent. As a last resort, however, surgical implantation of prosthetic rods in the penis is also an option.