Erectile Dysfunction Causes Diagnosis & Treatment

What is Erectile Dysfunction?

Erectile dysfunction is a condition in which a male cannot achieve or maintain a penile erection to participate in satisfactory sexual intercourse sufficiently. It is a condition that is increasingly affecting a large portion of the male population, especially those over the age of 40 years. Penile erection is a physiological process resulting from integrating the central nervous system, peripheral nervous system, vascular system, and hormones. Diseases or problems affecting either of these systems can result in a problem with achieving erection, ejaculation, and orgasm. Erectile dysfunction can be either organic, when there is an identifiable cause due to disease or damage, or psychogenic, when the cause is due to unidentifiable causes or psychological causes. 

Signs and Symptoms

The main signs and symptoms associated with erectile dysfunction include 

1. Inability to achieve an erection
2. Achieving a weak erection that is not sufficient for penetration
3. Inability to maintain an erection until ejaculation is achieved or until the partner has achieved an orgasm
4. Inability to ejaculate or early or premature ejaculation
5. Lack of sexual satisfaction due to weak erection or poor performance. Erectile dysfunction can be transient or can persist, requiring proper management and treatment. 

Causes of Erectile Dysfunction

As mentioned previously, erection is a multifactorial process that responds to smell, touch, and visual stimulation. There has to be proper functioning of the central, peripheral, and autonomous nervous systems, as well as spongy muscles in the penis and their blood supply. According to the best urologists for erectile dysfunction treatment, in a majority of cases, vascular causes are predominant. 
Some of these causes include 

• Vascular causes such as atherosclerosis, peripheral vascular disease, myocardial infarction, high blood pressure, and injury to blood vessels secondary to radiotherapy or prostate cancer treatment, side effects of medications used for the treatment of blood vessel disease. 
• Systemic diseases such as diabetes, hypertension, liver cirrhosis, kidney failure, lipid disorders, COPD, sleep apnea, sickle cell disease, and leukemia, also play a major role
• Neurological diseases and conditions affecting the nervous system, such as Stroke, Epilepsy, Guillain-Barre Syndrome, Alzheimer’s disease, and injuries to the head
• Hormonal disturbances such as hyperthyroidism, hypothyroidism, and hypogonadism can also result in erectile dysfunction.
• Medications - Include antihypertensives, antidepressants, antipsychotics, cholesterol-lowering agents, etc. 
• Lifestyle factors - Such as smoking, alcohol consumption, recreational drug use, sedentary lifestyle and lack of exercise, obesity, and overweight
• Surgical procedures – Brain and spinal cord surgeries, surgical procedures done on the structures in the pelvic region, procedures done on the prostate gland, etc. 
• Psychological causes such as depression, anxiety, performance anxiety, stress, and other mental health disorders
• In addition to the above, individuals with any of the above-mentioned problems, increasing age, and recurrent urinary tract infections are more at risk of developing erectile dysfunction. 

How is Erectile Dysfunction diagnosed?

The diagnosis is done with the help of a thorough medical history, clinical examination, and tests and investigations. Tests and investigations that are commonly advised include laboratory tests such as hormonal tests to check testosterone levels, luteinizing Hormone, prolactin levels, lipid profile, blood sugars, liver and kidney function tests, and urine analysis. 
Other tests that are done include Prostaglandin E injection into the penis to check blood flow, assessment of the nerves supplying the penis through vibrational stimuli, ultrasound imaging through Doppler studies, Nocturnal Penile Tumescence tests to check for the presence of nocturnal erections, etc. 

How do doctors treat Erectile Dysfunction?

The treatment is aimed at treating both the identified underlying cause and erectile dysfunction itself. The treatment will also depend on the duration and severity of the condition. Medical management of erectile dysfunction includes medications such as phosphodiesterase 5 inhibitors (PDE5 Inhibitors) such as sildenafil, tadalafil, etc. Androgen agents may be used for the management of erectile dysfunction caused due to low testosterone levels. 
Interventional procedures such as intracavernosal injections of vasodilators, intraurethral injection of Prostaglandin pellets, penile implants, surgical revascularization procedures, and plugging of venous leaks can help with the management of specific causes of erectile dysfunction. 
Other methods that can help with the management of erectile dysfunction are

Constriction devices 

A special device is placed at the base of the penis, and it helps to maintain the erection. It is useful in individuals with a venous leak phenomenon that prevents them from maintaining a sustained erection. 

Vacuum devices or penis pumps:

They work by creating a vacuum and drawing blood into the penis; they are usually used in combination with a constriction device. 

Psychological and Sexual Counseling:

Sexual and psychological counselling, in addition to other treatments, is important in the management of erectile dysfunction as a whole, in all individuals, whether or not there is a psychological component that contributes to the problem of erectile dysfunction. 

Lifestyle Measures:

Lifestyle measures that can be taken to prevent and manage erectile dysfunction include:

• Avoiding smoking
• Alcohol consumption
• Use of recreational drugs
• Getting regular exercise
• Losing excess body weight
• Getting counselling for psychological issues and mental health problems
• Keeping systemic diseases such as diabetes, hypertension, and heart disease well managed and under control also plays a role in the management of erectile dysfunction

What can happen if erectile dysfunction is left untreated? Are there any side effects of treatment?

Untreated erectile dysfunction can lead to the development of mental stress and depression, low self-esteem and embarrassment, relationship problems, infertility, and inability to conceive. Side effects and treatment complications can include blurred vision, headaches, dizziness, infections, bleeding, painful erections, scarring, priapism or sustaining erections. 
Individuals who have erectile dysfunction should find a specialist and either consult online or book an appointment to get proper medical advice and treatment, as early diagnosis and management provides a good prognosis for the condition. Individuals with erectile dysfunction are also at a higher risk of developing cardiovascular disease, as ED is considered to be an early indicator of cardiac and circulatory problems.