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What is Erectile Dysfunction or ED?

Erectile dysfunction (ED) is when a male has problems in maintaining an erection during sexual activity. It at times is synonymous to impotence.

How common is Erectile Dysfunction?

It is more common than we think it is. Approximately 1 in 5 males experience some degree of Erectile Dysfunction. The occurrence of ED increases with age.

Are Erectile Dysfunction and Poor Libido/Lack of Interest in Sexual Activity the same thing ?

No. Men suffering from ED usually have a normal Libido. In ED, the body does not respond to the stimulation and an erection is not attained despite the desire.

What increases the chances of Erectile Dysfunction?

Age: ED increases in age from roughly 5%-15% from 30-50 years.

Lifestyle: Smoking, Excessive Alcohol and Obesity increase the risk of ED. Control of all these factors can improve the symptoms of ED. Many studies have proven that regular exercise reduces the risk of ED. Excessive and prolonged cycling without proper seat cushioning may cause damage to nerves and blood vessels in the perinial region. Therefore excessive unprotected cycling is also associated with Erectile Dysfunction.

Diabetes and other medical disorders like multiple sclerosis: Diabetes and other similar diseases increase the risk of ED as they reduce the blood supply, damages the vessels and cause nerve damage.

Obesity: Many studies have revealed that ED is more common in obese individuals. This may be associated with other medical conditions such as Atherosclerosis, High Blood Pressure, High sugar levels etc.

Hypertension: Same effect as diabetes but mainly damage is caused by hardening of the blood vessels.

Surgical Causes: Surgeries done in the bladder and prostrate region may damage the blood or nerve supply near the penis. This at times may cause ED. Sometimes the ED is reversible and improves on its own with regeneration of nerves and blood supply.

Psychological Causes: Usually ED has a reason but in some cases may be purely psychological in origin. Depression, Lack of Self esteem, Stress, Anxiety all these may cause ED on their own and worsen ED which has an obvious medical cause. This is why counselling and alleviation of psychological factors is extremely important while managing ED. Males who have psychological ED will have nocturnal erections and only need counselling.

How to Diagnose Erectile Dysfunction?

ED mainly is diagnosed on the basis of the history provided. All the tests and Investigations done are to find the cause of ED.

Which Tests and Investigations are done and why?

Complete Physical check up and Examination: To evaluate the physical condition and detect factors like obesity, hypertension, local injury etc.

Serum Testosterone and Prolactin Levels: To exclude hormonal disturbances

Complete Blood Count (CBC), Blood Sugar Levels, Cholesterol and Lipid Profile: To diagnose medical causes of ED

ECG: This may be required if there are multiple high risk factors like High BP, Diabetes etc. ED is associated with an increased risk of heart problems and at times is the first marker of heart disease. Therefore an ECG may pick up early cases of heart problems whereby treatment can be initiated early.

Colour Doppler Ultrasound: Used to see and assess blood flow to the penis and various abnormalities likes thickening, scarring, vascular leaks etc. Mainly gives an idea about the vascular condition and related problems.

What are the Treatment Options?

Treatment depends on the cause of ED.
Exercise, Cessation of Smoking, Weight loss for Obese Males: All help in improving Erectile Dysfunction.

Counselling and Psychotherapy: Even when ED has a known cause, counselling helps improve ED. Should be offered to all males and couples facing this problem.

Oral Medication: Phosphodiesterase type 5 inhibitors increase the blood supply. Drugs in this category are Viagra, Cialis, levtra. All these have potential serious cardiac side effects and therefore should only be taken once the concerned physician approves its use.

Topical Creams: Local application of Alprostadil cream has been approved in some countries for treatment of Erectile Dysfunction.

Injections: A few injections like papaverine, phentolamine and prostaglandin E1 can be used to treat ED. All these injections are associated with side effects and should always be taken under medical supervision.

Extracorporeal Shock Wave Therapy: Relatively new mode of therapy and without any side effects. Only problem is that it is not commonly available.

Vacuum Erection Pumps: This is an external pump device which creates vacuum thereby increasing the blood flow and causing an erection. Many types of pumps are available and their use has been approved by medical agencies like FDA.

Surgery: If ED is because of blockage of a major blood vessel, surgical correction can resolve the problem. This
option is usually offered to young men who have sustained an injury causing blood vessel obstruction.

Implants: Penile implants can be offered to patients of ED. These implants are usually inflatable. Drawback of this method is usually the cost implication.

Alternative Therapies: Ginseng and Ginkgo biloba are very popular traditional medicines used for ED. Unfortunately this is not backed by any research and sometimes taking supplements which contain more than 10 ingredients, most of them being unknown, may cause other problems. So beware of what is being taken

Ways to avoid ED

  • Get some Exercise
  • Keep a tab on weight
  • Eat a heart healthy diet
  • Don’t allow Blood pressure to be uncontrolled
  • Prevent or treat diabetes early
  • No smoking or quit smoking
  • Drink in moderation
  • No illicit drugs
  • Cut down on stress levels
  • Know your medicines: One of them may be causing the problem
  • Get help early if you feel it’s consistently a problem

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