Erectile Dysfunction

1 What is Erectile Dysfunction?

Erectile dysfunction is the medical term for impotence or inability to have or sustain an erection necessary for sexual activity.

It is normal for anyone to experience difficulties achieving an erection or keeping it firm from time to time. However, it becomes a problem if you experiencing it frequently and already reduce satisfaction to your sex life.

Men tend to find erectile dysfunction a significant source of stress and poor self-confidence. Erectile dysfunction can be a sign of conditions like heart disease, so it requires medical evaluation and treatment.

Because of its effect on self-image, many men worry about seeing a doctor for treating erectile dysfunction. If you suspect to have erectile dysfunction, it is perfectly okay to seek help from your doctor. Most cases of erectile dysfunction have an underlying cause and can be reversed.

2 Symptoms

Here are the symptoms of possible erectile dysfunction:

  • Difficulty achieving an erection
  • Difficulty keeping an erection
  • Low or loss of interest in sexual activities

You should see a general practitioner or family doctor if you have concerns with your erection or if you feel other sex-performance issues like premature or delayed ejaculation.

You also need to see a doctor if you also have existing conditions like diabetes and heart disease.

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3 Causes

Many cases of erectile dysfunction are caused by minor health problems worsened by negative emotions like anxiety.

However, erectile dysfunction can have physical causes.

Erection seems simple, but it actually involves several complex processes. The brain, heart, blood vessels, nerves, gonads and other glands, muscles, and hormones all work together to achieve a good erection. Any problem affecting these organs can cause erectile dysfunction. Stress, emotions, and mental health issues play a role in the severity of erectile dysfunction.

Here are the conditions that may cause erectile dysfunction:

  • Heart disease
  • Atherosclerosis, or blockage of arteries
  • Abnormally high cholesterol levels
  • Hypertension
  • Diabetes
  • Parkinson’s disease
  • Multiple sclerosis
  • Obesity
  • Having metabolic syndrome – a combination of hypertension, high cholesterol, elevated insulin levels and having lots of fat around the abdomen
  • Peyronie’s disease, which is caused by a scar tissue inside the penis that causes pain during erections
  • Use of certain medications like beta blockers, which is used to treat hypertension
  • Smoking and use of tobacco
  • Alcohol abuse
  • Use of recreational drugs and illegal substances
  • Sleep deprivation and having sleep disorders
  • Having treatments for enlarged prostate and prostate cancer
  • Having injuries and surgeries in the pelvis and spinal cord

Erectile dysfunction also has psychological causes. Keep in mind that desire and motivation to have sex starts in the brain, triggering processes and physical events that result to erection and sexual excitement. Mental issues can interfere with sexual feelings that result in erectile dysfunction.

Here are those mental issues:

  • Stress
  • Depression, anxiety and other mental health conditions
  • Relationship problems like poor communication, conflict and stress

Erectile dysfunction can also be caused by watching too much porn. Porn-induced erectile dysfunction occurs for a number of reasons. 

Watching porn actually increases the level of dopamine in your brain. If you watch porn too much, the receptors in your brain become desensitized to watching porn, as well as participating in sexual activity. You might need to watch more porn and more graphic porn in order to get an erection, and it will also become more difficult to get an erection to participate in real life physical activity.

Many men who are confident about their sexual approaches use porn films positively in their lives for enhanced pleasure. However, men who are conservative in their relationship, who are not confident about themselves, or have some kind of stigma related to sex may experience erectile dysfunction symptoms from watching porn.

Some men, based on what they see in porn videos, set unrealistic expectations in real life related to their partner and how their ideal sex life should be. When the reality doesn’t meet their fantasies, it makes it difficult for men to engage themselves in sexual activity. Sometimes, men also develop self-confidence issues from watching porn if they think they cannot perform like the men they see on screen. This can lead to anxiety and frustration, causing erectile dysfunction. 

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4 Making a Diagnosis

Erectile dysfunction can often be diagnosed by your family doctor or general practitioner after assessing your situation and doing a physical examination.

You can start seeking treatment for erectile dysfunction by going to a family doctor or general practitioner. In case you need further evaluation or treatment, you may be referred to specialty doctors – either to a urologist (treats problems in male sexual organs) or endocrinologist (treats problems in hormones).

Before the actual appointment, you should be prepared to absorb plenty of information.

Here are things you can do:

  • Ask your doctor on what to do before the appointment. You might have to do restrictions before the test.
  • List down your symptoms, including those that might be unrelated to erectile dysfunction
  • List of major life changes and sources of stress.
  • Medicines, vitamins and supplements you are currently taking
  • If possible, bring your partner along during checkups. He or she can help you recall important information you might miss.

You can also ask questions to your doctor.

Here are some good questions to ask:

  • What is the likely cause of my erection difficulties?
  • What are the tests I have to undertake?
  • Is this condition temporary or will last for a time?
  • What is the best treatment for my case? What are the alternatives?
  • Can I manage my other health conditions?
  • Are there any restrictions I have to follow?
  • Do I need a specialist for my case? What would be the cost? Would it be covered by my insurance?
  • Are there any generic versions of the prescribed medications?
  • Can you share printed materials or websites to help me understand my condition better?

The doctor will expect you to ask questions, so do not hesitate.

During the appointment, the doctor may ask you to share information about the following:

  • Present or previously diagnosed health conditions and illnesses
  • Existing problems at sex, like reduced desire or pain
  • Problems felt by your partner, like existing sexual or relationship issues
  • Do you achieve erections during masturbation, while at sleep or with a partner?
  • When did the erection difficulties start? Does it occur only occasionally or all the time?
  • Do you have anxiety? Depression? Lingering stress?
  • Are you diagnosed with mental disorders? If yes, did you have treatment or psychotherapy?
  • Do you smoke, drink alcohol or use illegal substances?
  • What are the medications, vitamins or supplements you are taking?
  • What are the things that seem to improve (or worsen) the symptoms?

5 Treatment

Erectile dysfunction tends to have an underlying cause, so doctors determine and treat that first. Since many health conditions cause erectile dysfunction, correcting those issues might resolve erection difficulties. You might have treatment for hypertension, correct blood sugar and cholesterol levels, or the doctor might recommend you to lose weight.

In some cases, the doctor may recommend you the following treatments. Each treatment has its own risks and benefits.

Drugs

These are the drugs approved for treating erectile dysfunction:

  • Sildenafil (Viagra, Revatio)
  • Taladafil (Cialis)
  • Vardenafil (Levitra, Staxyn)
  • Avanafil (Stendra)
  • Alprostadil self-injection (Caverject Impulse, Edex) – this drug is injected into the base or side of the penis using a very fine needle (you do this yourself). The pain from the injection is very small and produces an erection that lasts for an hour.
  • Alprostadil urethral suppository (Muse) – this drug appears as a tiny pill that can fit inside the urethra of the penis – you will place the drug inside using the packaged applicator. This produces an erection within 10 minutes and lasts for 30 to 60 minutes.
  • Testosterone replacement – this is a choice for men with low testosterone hormone levels. Testosterone is given through injections, gels or in pellets injected under the skin.

These medications work by improving the effect of nitric oxide – a substance in the blood that enlarges the opening of blood vessels so blood can flow easier to alow more blood to flow into the penis. This means that taking a dose will not automatically produce an erection. These drugs improve erections in response to sexual stimulation and have no effect on men with normal erections. These drugs have no effect on sexual desire and excitement.

Side effects of these drugs include stomach upset, visual changes, runny nose, flushing, and headache. The side effects of alprostadil injections and suppositories include prolonged erection, the formation of fibrous tissue at the injection site, and minor bleeding in the urethra.

You need to go to the doctor regularly determine the effective dose and its effects to you. You need to tell your doctor first before taking any supplements or herbal products. These substances may interfere with drugs used to treat erectile dysfunction.

Drugs for erectile dysfunction may not work or cause adverse effects if you are:

  • Taking nitrate drugs used for managing hypertension and angina. Examples include nitroglycerin (Nitrostat, Nitro-Dur, Minitran), isosorbide mononitrate(Monoket) and isosorbide dinitrate(Isordil, Dilatrate-SR).
  • Have severe low blood pressure (hypotension) or uncontrolled hypertension.
  • Have severe liver or kidney disease

Penis pumps, implants and surgery

In case of medications don’t work to improve erections, the doctor may recommend the following devices and procedures:

  • Penis pumps – these devices work by placing your penis under vacuum to pull up blood and produce an erection. A flexible ring is then placed to keep the penis firm for sex. You might feel some restriction during ejaculation, and the penis might be cold to touch and have some bruises. Penis pumps prescribed by your doctor are very different from ones advertised in magazines and sex ads, which are not rated for safety or effectiveness.
  • Penile implants – this involves implanting semi-rigid rods to both sides of your penis, making them firm but still bendable. Penile implants help you have better control on your erection. This treatment is only a choice to those who failed on other methods. Penile implants are inserted using surgery, which has its own risks like bleeding or infection.
  • Blood vessel surgery – some cases of erectile dysfunction are caused by leaking or obstructed blood vessel supplying the penis. The surgeon may open blocked blood vessels using stents, or bypass damaged vessels by grafting a bypass.

Psychological approach

Many cases of erectile dysfunction have psychological causes. In such cases, there is nothing wrong in areas like blood vessels, nerves or the penis, but there are stressors that make the person incapable of achieving good erections for sex. In that case, your doctor may refer you or your partner to a psychologist for counselling.

6 Prevention

Healthy lifestyle and resolving health problems can prevent you from having erectile dysfunction. Contrary to popular belief, erectile dysfunction is not part of aging. 

Here are strategies to prevent erectile dysfunction:

  • Treat or manage existing diabetes, heart disease and other health problems. Work closely with your doctor to treat symptoms and reduce complications.
  • Have regular medical checkups and screening for prostate problems, diabetes or heart conditions.
  • Quit tobacco use and avoid exposure to cigarette smoke. Limit or avoid alcohol, and do not use illegal drugs.
  • Exercise every day.
  • Learn to control stress. Some stress-relieving activities include rest, doing hobbies, socialization and doing sports.
  • If you feel you are depressed or bothered with anxiety, look for help and see your mental health professional.

7 Alternative and Homeopathic Remedies

If you are diagnosed to have erectile dysfunction, consult with your doctor before starting any alternative and homeopathic remedies.

You will find plenty of supplements or devices on the internet and magazines full of promises or claims to cure erectile dysfunction.

The US Food And Drug Administration (FDA) has issued several warnings and recalls on many types of supplements labelled as ‘herbal’ or ‘natural’. Some of these are dangerous to your health because they contain harmful substances or contaminants.

These substances may interact with prescribed medicines, and especially harmful to individuals taking nitrates.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to treat erectile dysfunction.

Erectile dysfunction can be caused or worsened by lifestyle choices.

Here are causative factors that you can modify to treat erectile dysfunction:

  • Quit smoking or use of smokeless tobacco. Seek help in quitting by going to your doctor.
  • Try losing body weight. Increase levels of physical activity. Try to exercise or do more physical work every day. You can exercise or do sports.
  • If you abuse alcohol or illegal substances, seek help. Too much alcohol and drugs can cause erectile dysfunction.
  • Try to resolve relationship issues through communication and professional counselling.

9 Risks and Complications

There are several risks associated with erectile dysfunction.

Aging may have some effect on erections. Older men may need more stimulation and take a longer time to achieve erections.

Taking certain medicines and having health conditions can increase your risk of having erectile dysfunction, especially in older men. Here are those risk factors:

  • Having diabetes or heart disease. These conditions cause issues in blood circulation, which can cause erectile dysfunction.
  • Smoking and using smokeless tobacco. Tobacco contains several substances that cause blockage of the arteries, which is a risk factor for erectile dysfunction.
  • Obesity is known to be associated with erectile dysfunction and other conditions like heart disease and diabetes.
  • Certain medical procedures, like having radiation treatment and prostate surgery, can increase the likelihood of having erectile dysfunction.
  • Injuries to blood vessels or nerves in the spinal cord area, pelvic area or genitals.
  • Bicycling for prolonged periods is associated with erectile dysfunction. Bicycle seats can compress nerves and blood vessels, making it harder to achieve erections.
  • Medicines like certain antidepressants, antihistamines, antihypertensives, pain and prostate medications can cause erectile dysfunction as a side effect.
  • Abuse of alcohol and illegal drugs, which can adversely affect ability to achieve erections.
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