A detailed explanation of erectile dysfunction

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Erectile dysfunction can be a physically and mentally challenging condition for a man. Find out what commonly causes it and how it can be treated.

A detailed explanation of impotence_mdhil

What is erectile dysfunction?

Erectile dysfunction (ED, earlier known as impotence) is the inability to achieve and maintain an erection that is adequate for intercourse that is mutually satisfying to the man and his partner.

The inability to achieve the required erection one or two times is actually quite normal. It’s when the failure is persistent and recurrent that it becomes a cause to be looked into. This physical condition also causes marked distress or interpersonal difficulty.

ED can be lifelong or recently acquired and may be generalised or restricted to a particular situation or situations.

While the exact prevalence of the disorder is uncertain, experts say there is an incidence of about 20% in young adults and 50% in people over the age of 60.

Causes of erectile dysfunction

Psychological causes - The most common cause of erectile dysfunction in young healthy males is psychogenic (originating in the mind).

This is associated with sexual anxiety, fear of failure, concern about sexual performance and decreased subjective sense of excitement and pleasure, as well as previous negative experiences of sex.

Smoking is also a key cause of erectile dysfunction in many healthy young adults.

Organic or Medical causes – Conditions like diabetes mellitus and other endocrine disorders like hypothyroidism, hypogonadism, cardiovascular and peripheral vascular disorders, drugs (anti-depressants are the most common), neurological disorders (spinal cord and brain disorders), local genital disorders, surgery and radiation therapy of the prostate, bladder, or rectum may damage the nerves and blood vessels involved in erection. Kidney failure can also be a cause.

Diagnosis of erectile dysfunction

Getting a complete and thorough history of the patient is an absolute must. Some of the key questions that should be asked revolve around the following:

  • How long has this condition been there?
  • Is there a complete absence of erections or is there diminished quality?
  • Is penetrative intercourse at all possible?
  • Is the man suffering from ED able to masturbate?
  • Is he getting early morning erections?
  • Is his libido normal, or decreased?
  • Is there any pain or curvature of erection? (This is asked to rule out local pathology)

Psychogenic impotence is diagnosed when the patient is young, and is able to achieve morning and nocturnal erections, as well as erection with masturbation. In this case, the ED may be partner-specific or have a sudden onset.

Medical or major biological cause of ED can be considered when there is gradual deterioration, decrease in morning erections and nocturnal erections, there are no erections with masturbation, no loss of libido, and there is a presence of other medical conditions like diabetes or cardiovascular disorders.

Investigation of ED

Diagnosing ED requires a combination of blood sugar levels, hormonal profile, lipid profile and other specific tests like duplex ultrasound of the penis, penile nerves function and magnetic resonance angiography.

Treatment of ED depends on the cause, and whatever it may be, today a variety of remedies are available.

Treatment of ED

  • General guidelines - Sex education and self-help exercises like sensate (perceived by the senses) focus technique and other relaxation exercises performed along with partner are helpful.
    Cutting down on alcohol and smoking and increasing aerobic exercise have been known to produce good results amongst those suffering from psychogenic impotence.
  • Medication - Although Sildenafil (Viagra) is the most commonly used, it should only be taken under proper medical guidance, as it has got side effects and may not be suitable for certain people.
  • Training in self-administration of injectable prostaglandin E1 into the penis prior to intercourse is sometimes done.
  • In some cases, use of a vacuum constriction device, surgical implantation of a semi rigid or inflatable penile prosthesis may also be tried.
  • Relapse is common, and usually related to clear triggers. This improves naturally through the use of previously successful techniques.

Written by Dr Pallavi Joshi, MD in Psychiatry currently practicing at Vydehi Medical College, Bangalore

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