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Erectile Dysfunction

What is Erectile Dysfunction?

Erectile Dysfunction is the inability to achieve or maintain an erection firm enough for sex. Erectile dysfunction (ED) is a common and under-reported symptom that significantly impacts the sexual health and general well being of a man. Upto 15% of men can suffer from ED, and the prevalence increases with age and coexisting conditions like Diabetes, heart disease, kidney disease, and obesity. Infact, more than 50% of Indian men with Diabetes were found to suffer from ED.  

How does an erection happen?

Penile erection is a complex process which involves the adequate functioning of many human systems. Erection happens primarily because of an increase in the blood flow TO the penis and reduction in the blood flow OUT of the penis. This process is initiated by a nerve signal that dilates the arteries in the penis, just like opening floodgates on the dam. This nerve signal is mainly  triggered by sexual desire (libido) or physical touch,  through various stimuli or thoughts.  However, the maintenance of this erection requires many other local factors and hormones which can be hampered in various conditions. 

What causes Erectile Dysfunction?

There are many underlying reasons why one develops ED.

  • The dominant one being Diabetes. Long standing Diabetes impairs the neural stimuli that are required for erection. Therefore, even with a good libido, a man fails to achieve proper erection, which can be really frustrating. 

  • The next common reason is hormone disorders, mainly testosterone deficiency. Testosterone is crucial in initiating sexual desire and in the maintenance of penile erections.

  • Many medications, mainly used in heart disease and  psychiatric illness can cause ED.

  • People with pre-existing heart disease, kidney disease and liver disease can suffer from ED.

  • Psychiatric conditions like Depression and anxiety play a major role in reducing libido and impacting the quality of erections.

  • Psychosocial factors also play an important role in causing ED. For example: stress at work/life can reduce libido as well as cause ED. Relationship issues with partner/ spouse can also lead to ED. 

What should I do?

Visit an Endocrinologist or Andrologist/Urologist. Get evaluated for the above causes. A simple panel of blood tests should help in finding a cause. Once a cause is found we can focus on treating the cause.

Treatment

ED can be a difficult issue to bring up with your partner. To approach a doctor with the same complaint can also be daunting. However, this is a common complaint that we regularly address and treatment generally works well.

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A patient with ED can approach an Endocrinologist or a Urologist. They will then take a detailed history, assess the risk factors, and identify any offending medications. Following are some of the common investigations ordered while evaluating ED:

  • Thyroid Profile

  • Blood Sugar Levels

  • Serum Free Testosterone

  • Serum Lipid Profile

  • Prolactin Levels

  • Cardiac Assessment using ECG, Echo, or TMT. This varies from patient to patient

  • Penile Doppler Ultrasound may sometimes be needed. This tells the doctor whether there is arterial blockage or a leak from the veins

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Treatment of ED is usually a combination of the following:

  • Treating the cause: Correction of Hormonal Imbalance, Weight loss (if obese), Lipid-Lowering drugs (if lipid abnormality detected), Diabetes management, etc.

  • Vasodilators medicines: Treatment of the root cause may take time. Meanwhile, your doctor may prescribe you tablets to improve the blood circulation of the penis. Medicines such as Sildenafil, Tadalafil, etc dilates the blood vessels and thus improving the blood flow and erections. These may be prescribed on-need basis or on daily basis. Daily basis is usually preferred because it maintains healthy blood flow to the penis and thus preventing further narrowing of vessels.

  • Shock Wave Therapy: Penile Shock Wave Therapy is a new treatment that opens up the blood vessels of the penis. This therapy works only for vasculogenic ED, effects on Neurogenic ED are still debatable. Treatment is usually done twice a week for 3 weeks. A wand-like device is moved over your groin area. It's a painless and comfortable procedure. 

  • Penile Stenting: If the blood vessel blockage is severe, then a penile stent is what you need. An angiogram is done to localize the exact area of blockage (similar to cardiac angiography). A Penile Stent is then placed in the blocked vessel. Penile Stenting is a minimally invasive procedure done under local anesthesia.

  • Vacuum Constriction Devices: Vacuum Devices are external pumps that may be used just before intercourse to achieve an erection manually. 50-80% of people report an improvement in their erections with the use.

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