Sexual Health

Erectile Dysfunction: a Nightmare for Every Male

Written by Dr. Bharat Udey and medically reviewed by iCliniq medical review team.

Image: Erectile Dysfunction: a Nightmare for Every Male

Men in every culture and society are too concerned about their sexual prowess. Performance in the bed is one of the foremost important criteria to determine the sexual prowess. In olden era as well, males were judged on the basis of their sexuality. This is a kind of natural selection running from the origin of mankind, to determine the dominance of one male over the other, hence claiming the right to procreate.

Erectile dysfunction is one of the commonest sexual health related problem faced by men. A whole multibillion industry is thriving on this problem, marketing various products claiming to improve the performance.

Erectile dysfunction (ED) is defined as difficulty in obtaining and/or maintaining an erection during sexual activity and/or have noticed a marked decrease in erectile rigidity in all or almost all (75–100%) sexual encounters. The prevalence estimates of ED had ranged from 10-45%. With age the incidence of ED also increases such that, in men less than 40 years of age 1-10% develop ED, whereas in men more than 70 years of age about 50% complain of having ED.

Comorbid conditions which can occur along with ED are:

  • Poor general health.
  • Substance use.
  • Medical conditions such as cardiac disturbances, hypertension, diabetes, hyperlipidemia etc.
  • Psychological features such as depression and anxiety.

What Causes ED?

1. Genetic basis: involvement of ACE gene, Nitric Oxide Synthase (NOS) gene.

2. Neurobiological basis:

  • Disease or events that cause disturbances in vascularity such as, acute myocardial infarction, cerebrovascular accidents, hypertension, can cause ED.
  • Neuropathic conditions like, multiple sclerosis, epilepsy, encephalitis, parkinson's disease, brain trauma etc., also can lead to ED.
  • Endocrinological disturbances such as hyperthyroidism, hypogonadism, hyperprolactinemia are also know to cause ED.

3. Psychological factors:

  • Performance anxiety, antecedent life changes (for example - divorce or loss of employment) and developmental vulnerabilities are the three common psychological factors associated with ED.
  • Performance anxiety has been referred to as a specific cause of ED and is characterized by a focus on negative thoughts relating to erectile failure that interfere with sexual stimulation, in addition to anxiety and worry about the consequences of failure.
  • Negative attitudes and emotions about sex have also been linked to ED.

4. Social and environmental factors: status and dominance issues, intimacy and trust, and loss of sexual attraction, low socioeconomic status, lower education, these are the common factors associated with ED.

Assessment of ED Includes:

  • Self reporting of difficulties in erection during masturbation, morning erections and partnered sex.
  • Complete medical evaluation and blood work (fasting blood glucose, lipid profile, cholesterol, prolactin, total testosterone, thyroid profile, prostate specific antigen).
  • Manual inspection of penis and testicles.
  • Doppler ultrasonography.
  • Nerve conduction studies need to be done as well, to rule out any organic cause of ED.

Treatment of ED:

Treatment of ED includes both somatic measures as well as psychological measures.

1. Somatic measures:

  • Intracavernosal injections (injection in to the base of the penis).
  • Penile prosthesis.
  • Vacuum pump devices.
  • Hormonal replacement.
  • Shock wave therapy.
  • Phosphodiesterase 5 inhibitors such as Sildenafil, Tadalafil, Vardenafil can be used.

Mechanism of action of somatic measures is to increase the vascularity in the penis, resulting in engorgement of blood vessels via relaxation of smooth muscles, hence resulting in increased tumescence and rigidity.

2. Psychological Measures:

  • Brief psychoeducation focused therapy, regarding the physiological mechanism of erection and age related expectation of erection to be explained.
  • Couple therapy, focusing on increasing the communication between couples and to resolve relational conflicts.
  • Sensate focus, relaxation training and cognitive restructuring can also be used effectively.

Besides this weight loss and regular physical exercise also show reasonable response in mild to moderate cases. Avoid smoking and alcohol consumption, as they also contribute to development of ED.

Best modality of treatment is the combination of both somatic and psychological measures, to be used along with treatment of comorbid condition for complete recovery of premorbid sexual performance.

Last but not the least, ED is just as treatable as other mental and physical ailments.

Consult a sexologist online for queries regarding erectile dysfunction -->

Last reviewed at: 07.Sep.2018



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