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Summary

Erectile dysfunction (ED) is the inability to maintain a firm penile erection (erect penis) for having sex. Erection is a neurovascular event (involves nerves and blood vessels) which happens due to sexual stimulation either by thoughts or by contact. ED is caused by many different reasons like medications, alcoholism, physical weakness, diabetes. It is a common disorder in males but not much discussed. Men with ED are reluctant to consult a doctor due to the sensitive nature of the health problem. Untreated ED can lead to psycho-social problems with the partner.

  1. What is Erectile Dysfunction
  2. Types of Impotence
  3. Erectile Dysfunction (Impotence) symptoms
  4. Erectile Dysfunction causes & risk factors
  5. Prevention of Impotence (Erectile Dysfunction)
  6. Diagnosis of Erectile Dysfunction
  7. Erectile Dysfunction (Impotence) treatment
  8. Erectile Dysfunction risks & complications
  9. Ayurvedic medicine, treatment and remedies for Erectile Dysfunction
  10. Medicines for Erectile Dysfunction
  11. Doctors for Erectile Dysfunction

What is Erectile Dysfunction

Erectile Dysfunction (ED) is a condition in which a male is unable to achieve or sustain an erect penis for a satisfactory sexual intercourse with the partner. Biologically, to sustain an erection, the penis must have adequate and consistent blood supply. Also, the nerves should be able to send impulses continuously. A penis doesn’t have a bone or a similar supporting structure for erection. The blood vessels in communication with the nervous system enable penile erection. Having a healthy sex life is a must to have a healthy and happy life. There are multiple causes for ED like an inadequate flow of blood to the penile artery, hardening of the artery due to age (atherosclerosis), diabetes, obesity, increased smoking, and alcohol intake, etc. Treatment options include medications, hormone therapy, penile implants, and counselling.

Types of Impotence

The severity of erectile dysfunction is different in different men suffering from it. The different types of ED are as follows:

  • Primary impotence
    In primary impotence, a man hasn’t had and will never have an erection spontaneously. It may be due to a physical abnormality in the structure of the penis or a damaged or trapped nerve which stimulates the erection process.
  • Secondary impotence
    Secondary impotence means that a male has had successful erections in the past but is unable to have further successful erections due to unknown reasons.
  • Situational impotence
    This means that a man can achieve an erection during a particular situation like masturbation but not during sex with a partner.
  • Partial impotence
    It is caused by an inadequate blood supply to the penile artery due to which a man achieves a partial erection but then looses the same.
  • Total impotence
    A man with total impotence can never have and has never had an erection at all.

Erectile Dysfunction (Impotence) symptoms

Symptoms related to erectile dysfunction are very few and include:

  • Inability to get an erection completely.
  • Partial inability to get an erection depending on specific situations or under specific conditions.
  • Achieving an erection but unable to sustain it for a considerable period of time to achieve a satisfactory sexual intercourse.
  • Reduced sexual desire.

Erectile Dysfunction causes & risk factors

Causes

Biologically, in a male, the process of having a sexual arousal and getting an erection is a complex process which involves the nervous system (brain and spinal cord, along with, the associated nerves associated), endocrine (hormone) system, and the cardiovascular system (heart). ED can be caused due to a disturbance in any of these bodily systems. Even a physical or structural abnormality in the penis or the testis can lead to ED. Some causes of ED are listed below:

Another classification of the causes of ED is based on the extent of libido (sexual arousal):

With reduced libido

With intact libido

  • Psychological problems, including anxiety.
  • Vascular insufficiency (atheroma).
  • Neuropathic causes (e.g. diabetes mellitus, alcohol excess, multiple sclerosis).
  • Drugs (e.g. beta blockers, thiazide diuretics, antidepressants etc).

Risk factors

As a man’s age advances, achieving a desirable erection may take longer than usual and may not be perfect in nature (rigidity may be less). A person may need a more direct touch to maintain an erection. But, there are certain risk factors associated with ED. These are:

  • Medical conditions like diabetes mellitus or heart problems.
  • History of pelvic irradiation or surgery, including prostate surgery (radical prostatectomy in people with prostate enlargement or prostate cancer).
  • Smoking. Tobacco use restricts blood flow to blood vessels which can lead to ED in long term.
  • Obesity.
  • High blood pressure.
  • Hormonal disorders (such as hypogonadism, hypothyroidism).
  • Drug abuse (such as cocaine, methamphetamine).
  • Medications like antidepressants, antihistamines and medications for hypertension.
  • Psychological conditions like stress, anxiety or depression.
  • Chronic and heavy alcohol consumption.

Prevention of Impotence (Erectile Dysfunction)

The best possible way to prevent ED is to make healthy lifestyle changes, along with better management of existing health conditions. Here is what you can do to prevent ED:

Quit smoking completely as it linked to heart diseases which in turn are a risk factor for ED.

  • Manage your weight by taking up an exercise regimen. Make sure you stay active throughout the day. You can also take up a sport like football or tennis.
  • Since diet plays a key role in the prevention of diseases that are linked to ED, make sure you eat healthy. Increase intake of whole grain foods, low-fat foods, fruits, and vegetables. Avoid refined and fatty foods as well as foods with high sodium content.
  • Manage your blood sugar and blood pressure levels.
  • Avoid alcohol intake if you have ED or limit the intake to minimum amounts to prevent ED.
  • Manage stress as it can worsen ED. Take up relaxing activities activities like meditation, deep breathing or yoga.
  • Stay away from recreational drugs. 

Diagnosis of Erectile Dysfunction

There is no preferred or first line of diagnostic modalities for ED. Also, unlike other medical conditions, ED is not checked as part of a routine health check-up. A detailed history and physical examination are usually sufficient to make an accurate diagnosis. For the diagnosis, the doctor inquires about the onset of the disorder, any past or present medical illness which may trigger ED, any injury or strenuous physical activity that may have caused ED, and the medicines which you take for other illnesses.

 A detailed sexual history of is often the best tool to determine the cause for ED. The history focuses on details such as duration of erection, adequacy, libido, quantity of semen, as well as, appearance if possible with every ejaculation and the associated pain, penile curvature (curved penis) etc. Blood tests are also helpful in determining Diabetes mellitus or high cholesterol which could be the underlying cause of ED. (Read more - Low sperm count treatment)

There are many other investigations which may be carried out for establishing the cause of ED. Nocturnal tumescence monitoring is on such test which uses a plethysmograph placed around the shaft of the penis overnight to establish whether blood supply and nerve function are sufficient to allow erections to occur during sleep. Other investigations include intracavernosal injection of papaverine or prostaglandin E1 to test the adequacy of blood supply, internal pudendal artery angiography, and tests of autonomic and peripheral sensory nerve conduction.

Erectile Dysfunction (Impotence) treatment

Depending on the medical and personal history of the patient which the doctor evaluates, the treatment options vary in each person and mainly depend on the causative agent. If there is any underlying medical condition such as diabetes or high blood pressure, then it has to be treated with suitable medications.

Some treatment options are taking medicines such as Sildenafil (Viagra, 50-100mg), Tadalafil, Vardenafil, and Avanafil. All these medications cause relaxation of the muscles of the penis which in turn increases the blood flow and helps achieve a proper and satisfactory erection. If medicines do not work then injections in the penis or urethra, which increase blood flow, may be used.

  • Testosterone replacement therapy may be prescribed for some people with ED. It helps to prevent osteoporosis and restore muscle power and libido. Various methods used for administering testosterone are intramuscular injections, subcutaneous injections, transdermal injections or oral medications. (Read more - Natural remedies to boost Testosterone)
  • A vacuum device is used in extreme cases. It comprises of an external plastic cylinder and a vacuum pump which pulls blood into the penis which aids to achieve an erection. Sometimes an elastic ring is placed at the base of the penis to prevent backflow of blood in the body.
  • Penile implants are used rarely (fixed rod or inflatable reservoir types).
  • Vascular reconstructive surgery in young people who have a problem of reduced blood flow into the penis.
  • Psychotherapy is performed if the patient and his partner are suffering from an emotional or relationship crisis.
  • Alternative treatments include Korean red ginseng (Panax ginseng, 900 mg three times a day) which improves erection.

Lifestyle management

Psychotherapy that involves couple counselling is most useful to discuss psychological problems. Neuropathy and vascular disease are unlikely to improve, but several treatments are available. Oral medications are also available. Surgery may be attempted to improve the patient’s condition.

Lifestyle changes which can be undertaken are:

  • Start cardio exercises. Walk and run to get rid of obesity and lose weight easily.
  • Opt for a healthy diet. Healthy foods like fruits, vegetables, whole grains, and fish help to decrease the chances of ED.
  • Treat the underlying disease. Diabetes Mellitus and hypertension are two major causes of ED. So, proper treatment with medicines and dietary changes, as well as, exercises help to solve ED.
  • Try lower body and pelvis exercises such as Kegel exercises. These exercises help in maintaining an adequate muscle tone in the pelvis (waist) and lower body parts.
  • Manage stress and get adequate sleep.
  • Limit smoking and alcohol.

Erectile Dysfunction risks & complications

Prognosis of ED mainly depends on two factors. Firstly, identification of the problem and not neglecting it and secondly, consulting your doctor and sharing your health problems which can help in receiving proper treatment. Systemic conditions are one of the major reasons for ED. So, receiving a healthy treatment plan for diabetes or hypertension and keeping the systemic disorders under control helps in treating the disorder. People with unhealthy dietary habits and other adverse habits like smoking and alcoholism have a poor prognosis. Post-surgical prognosis is generally good. Psychotherapy and counselling have the best possible prognosis.

Complications

Complications pertaining to ED are mostly psychological. It leads to depression, low self-esteem, emotional disturbances, social awkwardness, as well as, relationship problems with the partner. It leads to sterility (the inability to produce children). Penile atrophy (degeneration of penis muscles) is also caused due to lack of blood supply in case of any injury to the penis or scrotum.

Dr. Priyadarshini Maurya

Dr. Priyadarshini Maurya

पुरुष चिकित्सा

Erectile Dysfunction की जांच का लैब टेस्ट करवाएं

Semen Analysis

20% छूट + 10% कैशबैक

FSH (Follicle Stimulating Hormone)

20% छूट + 10% कैशबैक

LH (Leutinizing Hormone Test)

20% छूट + 10% कैशबैक

Testosterone Total

20% छूट + 10% कैशबैक

Medicines for Erectile Dysfunction

Medicines listed below are available for Erectile Dysfunction. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.

Medicine NamePack SizePrice (Rs.)
Penegra TabletPenegra 100 Mg Tablet193
Manforce TabletManforce 100 Mg Tablet185
Viagra TabletViagra 100 mg Tablet844
Xylo(Astra)Xylo 2% Infusion28
Tazzle FM StripTazzle 10 mg FM Strip25
VigreksVigreks 100 Mg Tablet96
XylocaineXylocaine 1%W/V Injection27
VigronVigron 50 Mg Tablet8
Xylocaine HeavyXylocaine Heavy 5% Injection3
VistagraVistagra 100 Mg Tablet9
XylocardXylocard 2% Injection0
VygexVygex 100 Mg Tablet29
XyloxXylox 0.2% Gel29
WavegraWavegra 100 Mg Tablet9
AlocaineAlocaine Injection14
WingoraWingora 100 Mg Tablet8
LcaineLcaine Injection24
Schwabe Muira puama MTSchwabe Muira puama MT 284
ZeagraZEAGRA LONG STAY GEL 15GM0
ADEL 36 Pollon DropADEL 36 Pollon Drop200
ZestograZestogra 100 Mg Tablet8
NircaineNircaine Injection64
1 2 31 2 3 100 Mg Tablet9
UnicainUnicain 2% Injection11

Do you or anyone in your family have this disease? Please do a survey and help others

References

  1. Urology Care Foundation [Internet]. American Urological Association; Erectile Dysfunction.
  2. Hormone Health Network [Internet]. The Endocrine Society; Washington, DC: Erectile Dysfunction.
  3. National Institute of Diabetes and Digestive and Kidney Diseases [internet]: US Department of Health and Human Services; Erectile Dysfunction (ED).
  4. Stuart H. Ralston, Ian D Penman, Mark W J Strachan, Richard Hobson. Davidson's Principles and Practice of Medicine E-Book.. 23rd Edition; Elsevier, 23-Apr-2018 - Medical - 1440 pages.
  5. Joel J. Heidelbaugh, University of Michigan, Ann Arbor, Michigan. Management of Erectile Dysfunction.. American Family Physician. 2010 Feb 1;81(3):305-312.
  6. National Institute of Diabetes and Digestive and Kidney Diseases [internet]: US Department of Health and Human Services; Preventing Erectile Dysfunction..
  7. Health Harvard Publishing. Harvard Medical School [Internet]. 5 natural ways to overcome erectile dysfunction.. Harvard University, Cambridge, Massachusetts.
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