Definition
ED -erectile dysfunction- is also referred to as impotence/ impotency. It is used to refer to a type of sexual disorder, where male individuals have persistent inability to achieve or maintain an erection for a a sufficient period during sexual activity.
Being the most common sexual problem in men, it causes psychological problems.
Earlier on, it was believed that the problem was due to psychological problems. Currently, it is known that most of the men who suffer from ED, the condition is caused by physical problems. Such problems include poor supply of blood to the penis.
Epidemiology
- Occurs exclusively in males. I t is the most common sexual disorder in males.
- About 18% of males in their 50s report to suffer from this condition.
- More than 30% of males between 70-75 years old have also reported to suffer from this condition.
- More than three-quarters of all diagnosed cases of ED usually remain untreated.
Types
- Vascular ED
- Neurogenic ED
- Hormonal ED
- Psychogenic ED
Risk Factors
- Physical inactivity
- Obesity and having Body Mass Index(BMI) of over 25
- Cardiovascular diseases
- Diabetes especially Type 2 diabetes.
- Ageing. Individuals who are 40 years old and those above are at risk
- Smoking
- Hypertension(High blood pressure)
- Kidney diseases
- Chronic diseases such as kidney failure
- High levels of saturated fats
- Mental disorders
Causes
- Psychological causes. For example, stress and performance anxiety.
- Low levels of testosterone.
- Erectile dysfunction due due some specific prescribed medications taken over a long time. For example, Cimetidine, a H2 antagonist used in peptic ulcer disease. Apart from antihistamines, SSRIs- selective serotonin reuptake inhibitors, Beta blockers and 5 alpha reductase inhibitors are implicated as causative agents of erectile dysfunction
- Surgical procedures such as radical protastectomy.
- Cavernosal disorders such as Peyronie’s disease.
- Neurogenic disorders such as Parkinson’s disease , diabetic neuropathy and multiple sclerosis.
- Drug and substance abuse;
- Alcohol
- Cocaine
- Marijuana
- Opioids
- Nicotine
Below is a list of medications that can cause erectile dysfunction.
These medications should therefore be prescribed with great care among men of reproductive age.
These include;
- Blood pressure medications such as beta blockers
- Anti-depressants
- Anti-histamines such as cimetidine
- Anxiolytics
- Drugs used to treat and manage Parkinson’s disease
- Sedatives
- Anti-seizure medications
- Anti-arrhythmics
Signs & Symptoms
- Only getting an erection before sex
- Complete inability to achieve an erection
- Needing much stimulation in order to keep the penis erect
- Getting an erection before sex but unable to maintain it during the sexual activity
Diagnosis & Tests
- Patient history-taking
- Physical examination of the patient. Checking of penis, testicles and nerves(for sensation)
- Underlying conditions should also be tested for.
Such tests are;
- Blood tests. Blood samples are taken to a laboratory to check for signs and symptoms of diabetes, low testosterone and heart disease
- Urinalysis to check for diabetes
- Psychological examination. This checks for other factors that can cause erectile dysfunction, such as depression.
- Penile Doppler Ultrasound. Ultrasound to check for blood flow problems.
- Magnetic Resonance Angiogram (MRA)
Treatment & Management
Treatment ranges involve drugs, exercise, penile implants, counselling, among others.
- Drugs;
- Oral medications
- Sildenafil, commonly known as Viagra
- Tadalafil
- Vardenafil
- Avanafil
Other medications such as;
- Alprostadil urethral suppository
- Alprostadil self-injection
- Testosterone replacement
- Penis pumps. Battery-powered penis pump for erectile dysfunction
-
Penile implants
-
Surgery
-
Testosterone replacement therapy, which begins to work within 4 weeks.
-
Exercise. Moderate to vigorous aerobic activity can improve erectile dysfunction. Cardiovascular exercises and workout is recommended eg jumping rope, swimming and riding bicycles.
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Counselling. This is helpful for erectile dysfunction caused by stress, depression and other psychological factors.
Prevention
- Adequate physical activity. For example hitting the gym regularly, running and walking.
- Get high quality sleep
- Quit smoking tobacco and other nicotine-related products
- Maintaining healthy weight and normal body mass index range
- Consume healthy foods.
