Erectile Dysfunction is the inability to sustain an erection during sexual stimulation followed by absence of nocturnal erections. It is sometimes referred to as impotence.
EPIDEMIOLOGY
Its prevalence increases with age. It affects about 50% of men above the age of 40 years. Research has shown that nowadays, erectile dysfunction doesn't affect only older men but even the younger men (this can be in relation to one's lifestyle choices, medications etc.)
PATHOPHYSIOLOGY
For an erectile activity to occur, series of events are involved in making this happen through the psychologic, neurologic, endocrine, vascular and local anatomic systems. In the study of the mechanism behind this condition, erectile dysfunction have shown that the process involved in the sexual arousal of a man takes place in the higher cortical centers that then stimulates certain signals in the brain.
These signals descend through a complex neural network resulting in the activity of the parasympathetic and sympathetic nervous system. These events which occur lead to the inhibition of adrenergic tone and which in turn causes the release of nonadrenergic, noncholinergic neurotransmitter, known as nitric oxide.
Nitric oxide activates the relaxation of corporal cevernosa smooth muscle tissue resulting in increased blood flow into the penis resulting in an erection.
CAUSES
Certain factors could cause one to suffer from this condition and this can be either physical or psychological.
Its physical causes include;
Lack of exercise
Diabetes
Obesity
High blood pressure
High cholesterol
Clogged blood vessels
Heart disease
Smoking
Alcohol
Medications used in the treatment of prostate cancer and enlarged prostate
Substance abuse
Certain prescription medications
Sleep disorders
Injuries or surgeries that affect the pelvic area or spinal cord.
Low testosterone levels
Psychological causes include:
Stress
Anxiety and depression
Relationship issues
Trauma
RISK FACTORS
Medical conditions
Overweight
Medications such as antidepressants, some anti-hypertensive, antihistamines, some pain medications
Drug and alcohol
Smoking
Injuries, which damage the nerves or arteries responsible for causing an erection.
SYMPTOMS
Reduced sex drive
Soft erections
Problem getting an erection at any time
Being able to get an erection but not lasting longer
TREATMENT
Pharmacological action
Oral drugs: e.g., PDE type 5 inhibitors (sildenafil citrate, tadalafil, Anafranil etc.) help in increasing blood flow to the penis. These drugs should not be taken with nitrates.
Testosterone therapy: This form of treatment is used in situations where the testosterone levels are low and sex drive are also low. This is used in combination with PDE type 5 inhibitors to normalize erections.
Use of dietary supplements:
L-arginine: It improves erectile dysfunction by stimulating blood vessels to open wider for improved blood flow (should not be taken with sildenafil)
DHEA: It is a steroid prohormone which plays an important role in sexual function. It does this by increasing the production of estrogen and testosterone levels in the body.
Other supplements include horny goat weed, ginseng, zinc etc.
Non-pharmacological action
- Massage: Massaging the tissues around the groin area to promote blood flow to the penis. The length of massage is dependent on the symptoms presented.
- Diet:
Focus on eating whole grains, vegetables, and fruits.
Limit your consumption of full- fat diary, red meat etc.
Drink less of alcohol
- Exercise:
Engage in exercises such as level exercises, aerobic exercises, yoga.
- Surgical procedure:
It involves the insertion of an implant to the penis but is not used in older males that PDE5 inhibitors IU therapy didn't work for. They are placed fully inside the body.
- Intraurethral (IU) therapy
- Sexual counselling
Prevention
Avoid stress
Avoid substance abuse
Alcohol cessation & smoking
Regular check up with your doctor
Manage disease conditions such as diabetics etc. effectively with the help of your doctor
Change certain food habits
References
Davies K.P. (2015). Development and therapeutic applications of nitric oxide releasing materials to treat erectile dysfunction. Future science OA, 1(1), FSO53. https://doi.org/10.4155/fso.15.53
Mayo clinic. (n.d.). Dietary supplements for erectile dysfunction: A natural treatment for ED?
Everything you need to know about Erectile dysfunction (ED). Medically reviewed by Alana Biggers, M.D., MPH -Written by the Healthline Editorial Team - Updated on December 23, 2019
Edward David Kim, MD, FACS; Stanley A Brosman Updated on November 02,2020 Erectile Dysfunction: Practice Essentials, Background, Anatomy.
Urology Care Foundation. (Updated June 2018). What is Erectile Dysfunction?
Mayo clinic. (n.d.) Erectile dysfunction- Symptoms and causes.
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