A Family Doctor's Tale - ERECTILE DYSFUNCTION

DOC MY PENIS CANNOT ERECT

Erectile dysfunction is a rare problem seen in the family clinic in the 1970 -1990. Most men do not want to talk about the problem at that time. The treatment at that time for one of my patient who has partial transverse paralysis of the lower half of his body was the painful injection of medicine into his penis to harden it before sexual intercourse. With the introduction of Viagra and other ED medicine like Cialis and Levitra, men do ask their family doctor about the usage of these medicines and their side effects. Since then you will have at least 4 or 5 patients asking for these medicines every month.

Erectile dysfunction is defined by the WHO as "the consistent or recurrent inability of a man to attain and/or maintain a penile erection of the penis sufficient for sexual performance"
The WHO sponsored Consultation recommend" a minimum of three months of erectile difficulty qualified for a diagnosis of Erectile Dysfunction."


The incidence of ED is unknown:
ED is currently under diagnosed and under treated.
More than 50% of all men 40-70 years old are likely to experience it.


Erectile dysfunction can be due to:
1.Medical causes
2.Lifestyle causes
3.Psychosocial causes
4.or a combination of these.


Medical causes:

1.Vascular disease-is the most common cause of ED.
atherosclerosis(hardening of the arteries)
high blood pressure
high cholesterol
heart disease
stroke

All these conditions affects the blood flow in and out of the penis.


2.Diabetes-
can cause nerve damage and damage to the blood vessel to the penis resulting in two thirds patients developing ED


3.Nerve disease-
such as spinal cord disease, nerve degeneration from diabetes and alcohol can reduce the sensitivity of the nerves to the penis
 
4.Hormonal problems-
low levels of testosterone(male hormone) can cause ED


5.Surgery-
any surgery of rectum,colon or prostate cancer and radiation therapy in the genital area may damage nerves and blood vessels to the penis.


6.Trauma-
spinal cord injury and pelvic fractures damages the nerves and blood vessels to the penis.


7.Side effects of medications (e.g. certain high blood pressure medications, antidepressants,tranquillizers) may reduce the blood flow to the penis


8. Urinary infections and a disease called Peyronie's Disease(causing scar tissue in the penis) can cause ED.


Lifestyle causes:

1.Alcohol -
heavy drinking reduces the ability to have a strong erection. long term excessive drinking damage nerves and blood vessels to the penis.


2.Smoking-
The incidence of ED in smokers are higher than in non smoker because the toxic chemicals in the cigarettes can damage nerves and blood vessels to the penis.


3.Substance abuse such as heroin etc can cause damage to the nerves and blood vessels to the penis.


4. Sedentary lifestyle-
Lack of exercise may lead to ED due to poor blood circulation


Pycho-social Causes:

1. Performance anxiety -nervousness and worry about poor sexual performance 

2. Stress due to any cause

3. Depression

4. Relationship Problems- marital problems and tensions may affect sexual relationship

5. fatigue. 

Diagnosis is by:
1.medical history especially about diabetes, hypertension, medications, alcohol , drug abuse, smoking.


2.medical examination including genitals and prostate


3. Blood tests of testosterone, cholesterol, sugar and PSA( in males above 50)


Successful treatment of erectile dysfunction includes:

1. Lifestyle modifications:
exercising
dieting
quitting smoking
reducing alcohol/drug abuse
counseling to manage anxiety/stress/marital problems


2.treatment of underlying medical conditions such as diabetes


3.change of medications


4.medication for treatment of ED. 

Medications:
There are now oral medications  available to treat erectile dysfunction.
They belong to a group of drugs known as phosphodiesterase inhibitors e.g. Viagra, Cialis, Levitra.
There is no instant erections when taken but with physical and psychological stimulation erections do occur. 
Most of the men who has taken the drugs have had improvements in their erectile functions regardless of the cause of the ED.


Certain patients with heart problems or a history of stroke are advised against taking medications belonging to this group.


6.Other treatments for erectile dysfunction

a.Penile Injection therapy- medication which increases the blood flow in the penis is injected into the penis to cause erection before sexual activity


b.Intrautrethral therapy -pellets of medications which increases blood flow is inserted into the urethra which is the tube from the bladder to the outside.


c.Vacuum therapy :
This procedure holds the blood in the penis using a ring at the base of the penis


d:surgery for blocked blood vessels


e.penile implants -these are inserted into the penis and inflated when there is a desire for sexual intercourse. This surgery is offered when all other options failed.


Erectile dysfunction can cause a lot of stress on one’s marital relationship.


Communication and honesty with the spouse is important in ED so that she understands the problem and that she is not the cause of the problem.


In recent years, more men are becoming aware of the treatment of erectile dysfunction and are seeking help.