Erectile Dysfunction

Of all the medical conditions that could afflict a man, there is no probably nothing as frustrating, embarrassing and humiliating as erectile dysfunction. As its more colloquial name, ‘impotence’ clearly suggests it signifies a lack of masculinity; and to be accused of impotence by one’s female partner is more painful than death to most men. Needless to say it has serious social, familial and psychological repercussions.

Erectile dysfunction can be defined as the sexual dysfunction that occurs due to the inability of the man to develop or maintain an erection of his Penis during sexual activity.

Causes:

• Drugs such as beta-blockers, alpha-2 adrenergic receptor agonists, thiazides, hormone modulators, and 5α-reductase inhibitors etc
• Diseases that affect the nervous system such as Parkinson’s disease and Diabetes Mellitus.
• Disorders of the Penis such as Peyronie’s disease
• Hormonal issues like Hyperprolactinemia
• Performance anxiety, stress, and mental disorders
• Surgery to the groin region like radical prostatectomy or inguinal hernia repair
• Ageing
• Kidney disease.
• Smoking, obesity and other lifestyle-related problems.

Physiology of Erection:

Penile erection is maintained by two mechanisms:

• The reflex mechanism, which occurs when the penile shaft or glans is touched or stimulated- involves the lower spinal cord and peripheral nerves
• The psychogenic mechanism, which occurs due to erotic thoughts- involves the Limbic system.

Diagnosis:

A complete and detailed history is essential to correctly diagnose a patient with ED. It is important to rule out psychological causes – the presence of nocturnal tumescence (during sleep, the anxiety and stress levels are low), or ability to masturbate signifies that the physical systems are functioning normally. Here there may be some inhibition to a new sexual partner, preconceived notions of sex that could be factually wrong, a homosexual person forced into a heterosexual relation or some such psychological factor.
History of diabetes, poor lifestyle, obesity all contribute to ED This is followed by a thorough physical examination that looks for findings such as a varicocele, inguinal hernia etc which may alter sexual function. If a definite cause is not found after history taking and physical examination, then a penile ultrasound Doppler study may be required to map out the blood flow to the penis during the flaccid and erect state. This will give a clear picture regarding the cause of ED and also guides the clinician as to the line of management.

Treatment:

• Counseling is the mainstay in the treatment of any form of ED as the patients undoubtedly have an abnormal state of mind when it comes to sexual affairs either as a cause or effect of the “flaccid” state of said affairs.
• Medications such as Sildenafil, Tadalafil are the most widely drugs for ED. They act by inhibiting the breakdown of certain bio-messenger like molecules that are essential for penile erection to occur. Side effects such as headache, flushing, dizziness may occur and it is imperative that the patient always takes the medication under the guidance of a doctor.
• Testosterone injections may be helpful in patients who have low levels of the hormone, but should never be used in the male partner of an infertile couple as it can further reduce the sperm count!
• Pumps, surgical implants etc are the last resort in the treatment of ED. The devices available now are very advanced and easy to use.