Erectile Dysfunction

Erectile dysfunction (ED) is a medical condition in which the male cannot maintain or achieve the ideal erection. The condition is often experienced by men usually by the age of 40 but it might occur at any point in time.

Causes of Erectile Dysfunction

An erection is a result of a chain of events and when any of the events fail to happen in the right manner erectile dysfunction (ED) may happen. The common events in the chain include nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa. Any harm or damage or shock to the nerves, arteries, smooth muscles, and fibrous tissues can cause ED. Moreover, in many cases, diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease might be the cause.

In handful of cases, any surgery of the prostate region can also affect the functioning and cause ED. Medication such as blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine are also reported to be a contributory factor in the case of ED.

Diagnosis

• Patient History
  While medical history opens the account of diseases that might be a reason for ED, sexual history can help in identifying the exact extent of the problems. The problems may be with sexual desire, erection, ejaculation, or orgasm.Substance use is also reported as a major reason for ED and hence withdrawal is highly recommended.
• Physical Examination
  A doctor performs a thorough physical examination to outline any systemic problems. Some of the common causes identified on physical examination include:
  1. Insensitive penis
  2. Neural problem
  3. Secondary sex characteristics: breast enlargement, hair pattern, etc.
  4. Hormonal problems
  5. Circulation problem
• Laboratory Tests
  The test recommended for the diagnostics of ED include:
  1. Blood counts
  2. Urinalysis
  3. Lipid profile
  4. Measurements of creatinine and liver enzymes.
  5. Measurement of the amount of free testosterone in the blood
• Other Tests
  Tests for nocturnal erections are also performed to identify physiological factors affecting the body.
• Psychosocial Examination
  The patient might be recommended to attend a psychosocial examination. A questionnaire is presented and an interview is conducted to assess the psychosocial factors.

Treatment

The first measures are lifestyle changes, however, depending upon the case, the doctor might recommend invasive techniques. The doctors may recommend cutting down on alcohol, certain drugs, enhancing physical activity and so on. Psychotherapy and behaviour modifications are also recommended to specific patients.

• Psychotherapy
  The experts here work on decreasing the anxiety level of the patient.
• Drug Therapy
  Drug therapy can be administered in a number of ways including oral consumption, injection into the penis or insertion into the urethra. Viagra, vardenafil hydrochloride (Levitra) and tadalafil (Cialis) are phosphodiesterase (PDE) inhibitors, which have been approved by the Food and Drug Administration (FDA) for this treatment. However, it is also recommended that the inhibitors must not be consumed more than once in a day.

  The doctors might also recommend Oral testosterone as it aids in reducing ED in case of low levels of natural testosterone.

  In certain cases, drugs like yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone are also claimed as effective.

• Vacuum Devices
  A range of mechanical vacuum devices is used to pull the blood into the penis and cause an erection. The increased blood flow causesengorging and expands the penis. It is a typical device comprised of three different parts: a plastic cylinder, tube where one places the penis; a pump, which creates the vacuum by drawing out the air; and an elastic band, which firmly grips the penis after it is erected and ensures that the erection remains the same, even after the device is removed. The exercise is done before intercourse and the elastic band prevents the blow from flowing back to the body during intercourse.

Surgery

Erectile Dysfunction surgery is a critical surgery but offers the best results, in case of severe problems. The surgery is performed to seek one of the three below mentioned goals:

• Implanting a device in the penis that causes an erection.
• Reconstruction of the arteries in the penis to ensure higher blood flow in the organ.
• Blocking the veins that support the backflow or leakage of the blood from the penile tissues to the body.

Implanting the Devices:

The devices implanted in the penis are known as prostheses and are responsible to restore the erection in males who are suffering from ED. While they are very much a success, there are a few downsides of mechanical devices as well. This includes mechanical breakdown and infection. While modern development has limited the downsides to the minimum extent, there are very rare cases reported of problems with the implants. The malleable implants are usually made of paired rods, which are surgically placed into the corpora cavernosa. The patient, post operation is free to adjust the position of the penis and therefore the implants automatically get adjusted. Adjusting the implant nowhere affects the length and width of the organ.

In the case of inflatable implants, the structure contains paired cylinders, which are surgically inserted inside the penis. These cylinders are then expanded by using pressurized fluid. There are tubes connecting the cylinders to a fluid reservoir and a pump, which are placed inside the body through surgery. The patient can anytime access the small pump which is located under the skin of the scrotum and inflate the cylinders. In this way, the length and width of the penis are however affected as it may expand to a certain extent. Moreover, when the cylinders aren’t inflated, the penis appears in a more natural state than any other treatment.

In case of a surgery aimed to repair the arteries, the prime focus is on removing any blockage the affects the flow of blood into the penis. The surgery is recommended to those men who are young in age and have been identified for having a discrete blockage of an artery. The blockage can be a result of an injury to the crotch or fracture of the pelvis. The procedure, however, is never reported to be successful for men older in age and those who have a widespread blockage.

On the other hand, the surgery of the veins to prevent blood from draining out the penis, the procedure is the complete opposite. Here the doctors create an intentional blockage. Through the blockage, the doctors prevent the leakage of blood that diminishes the rigidity of the penis during an erection. However, there are doubts about the long term effectiveness of this procedure and thus it is rarely recommended.