What is erectile dysfunction?
Erectile dysfunction is the inability to get or maintain an erection that prevents a man from having satisfactory sex. A man with erectile dysfunction either loses an erection before intercourse, gets only a partial erection, or may not get an erection at all. Erectile dysfunction is sometimes known as impotence, but it is better called erectile dysfunction.
How common is erectile dysfunction?
Because of the broad concept of erectile dysfunction, it is difficult to determine how many suffer from it; There are no agreed-upon standardized criteria for describing erectile dysfunction in terms of duration and duration for it to be classified as erectile dysfunction. In addition, it is difficult to determine the number of infected, because many men do not like to talk about it.
Globally, an estimated 200 million men suffer from erectile dysfunction or 10% of the general population. It does not have to be a chronic condition for a man to feel that it is there. Some studies indicate that nearly all men have temporary difficulty getting or maintaining an erection. In many cases, it is temporary and requires simple treatment.
Who usually gets erectile dysfunction?
Poor physical and mental health leads to erectile dysfunction. Erectile dysfunction also accompanies some medical conditions such as diabetes, high blood pressure, high cholesterol, and prostate diseases. The more severe these factors are, the more likely a man will develop erectile dysfunction.
Also, the age factor has its effect. Erectile dysfunction often occurs with age, especially after the age of sixty years. The incidence of erectile dysfunction in men at the age of 40 is estimated at 39% of men, while it reaches 67% in men over the age of 70. Erectile dysfunction can occur at any age, even after years of normal sex.
However, age itself does not cause erectile dysfunction. In fact, it was found that the most common cases are in the elderly who suffer from certain health conditions such as vascular disease and diabetes, which explains the increase in the incidence of erectile dysfunction with increasing age.
Cases – Erectile Dysfunction
Erectile dysfunction cases vary with a variety of health problems. Initially, there is a high risk of sexual dysfunction in those with:
- heart attacks
- Radical prostatectomy
Of course, erectile dysfunction cannot only be linked to these health conditions, it may occur due to related medical or non-medical issues.
Common causes – Erectile dysfunction
What are the common causes of erectile dysfunction?
An erection reflects the complex interaction that occurs between the brain and the pelvic region/penis. Nerves and chemical agents cause the muscles of the penis to relax, allowing blood to flow into the penis, increasing its size, and creating an erection.
Anything that interferes with this interaction leads to erectile dysfunction.
Common causes of erectile dysfunction include:
- Organic diseases: diabetes, high blood pressure, high cholesterol, cardiovascular diseases, and poor blood flow to the penis. Also, some hormonal disorders and some medications can cause erectile dysfunction. Stroke or multiple sclerosis – for example – may interfere with the brain’s ability to communicate with the rest of the body, and this lack of communication may cause erectile dysfunction during sex. If parts of the brain, nerves or spinal cord are affected, the appropriate messages will not reach the penis.
- Psychological causes: Erectile dysfunction may result from intimate partner relationships, anxiety about sexual performance, stress (whether due to work, family, or economic conditions), previous exposure to sexual abuse, guilt complexes, fear of sex, depression, and other mental illnesses.
Erectile Dysfunction Diagnosis
It is very easy to diagnose erectile dysfunction, while it is difficult to determine the cause of its occurrence. To find out the exact cause of erectile dysfunction, the specialist often does a comprehensive interview, followed by a physical examination and possibly laboratory tests.
During the interview with the patient, the doctor addresses questions related to the following:
- erection complaint
- medical factors
- psychological factors
- Previous diagnosis or treatment
What are the tests that help identify the causes of erectile dysfunction?
It is very easy to diagnose erectile dysfunction, while it is difficult to determine the cause of its occurrence. Always, the beginning of identifying the causes of erectile dysfunction is a structured interview, followed by a clinical examination and possibly laboratory analysis.
The first step is to determine if the person’s problem is erectile dysfunction and not any other sexual problems such as impaired ejaculation, climax, or sexual desire. After confirming that a person has erectile dysfunction, the doctor will determine the nature of this weakness. The cause is identified by asking many previous questions to obtain a medical, sexual, and psychological history. These questions may help determine the extent of erectile dysfunction and may also indicate possible medical conditions and diseases that may be causing or contributing to the condition’s worsening. Sometimes, the doctor asks the patient to complete a survey regarding his sexual status, which may confirm the presence of erectile dysfunction.
After this detailed interview, a clinical examination is conducted to identify the organic problems causing erectile dysfunction. Simple clinical examination includes;
- Examine the penis and testicles to identify anything abnormal.
- Checking the pulse – including lower extremities, which may indicate circulatory problems.
- Neurological examination – includes gait, postural instability and testing of touch sensation and reflexes.
- Rectal examination – test for sphincter strength and prostate examination.
- Internal examination – looking for symptoms of liver or kidney disease.
Some simple lab tests that may be performed include:
- Blood tests
- Testosterone- Lack of male hormone is associated with sexual dysfunction
- Blood sugar levels – to check diabetes
- Lipid analysis – determines cholesterol and triglyceride levels, and may indicate the presence of arteriosclerosis (may be the reason for the lack of blood flow to the penis).
- Liver and Kidney Function- Kidney or liver impairment may cause hormonal imbalance. Analysis of the level of enzymes and creatinine in the blood is an indicator of the efficiency of these two organs.
- Thyroid analysis – analysis of the function of the thyroid gland because of its importance in regulating the metabolism process.
- Urine analyzes – which may indicate diabetes as well as kidney failure and the presence of infections in the genitourinary system
Some men need further tests that may help identify the cause of erectile dysfunction, including erection tests such as:
- Vascular examination: This is the most common examination.
- Injection test – the injection of elements that cause an increase in blood flow to the erectile chamber of the penis in order for an erection to occur. A reaction caused by the use of the drug may help the doctor determine the cause of the problem.
- Duplex ultrasound – color Doppler or Doppler ultrasound – a type of ultrasound that allows the doctor to see the structure of blood vessels and blood flow through them.
- Dynamic Cavernous Infusion and Cavernous Imaging – a sophisticated test to check blood flow to the penis, done for some men with erectile dysfunction and penile malformation, almost always performed at major medical centers or by erectile dysfunction specialists.
- Neurological examination – these tests are rarely done today.
- Examination of the penis with a vibrometer Electromagnetic vibrations is used to assess the sensitivity of the penis and to examine the nerves.
- Testing the somatosensory cortex of the brain The use of electrical, tactile, or any other type of nerve stimulation to examine nerve function and extent of the injury.
- Pudendal EMG – The pudendal nerve is the main nerve supplying the pelvis, bladder, and urethra. Injury to this nerve may cause erectile dysfunction. An electromyogram is a test that doctors use to check nerve function and to measure electrical activity from muscles. Therefore, this test determines the responsibility of the pudendal nerve for erectile dysfunction.
- Measuring nocturnal erections. It’s normal for men to have an erection at night while they sleep. If they don’t, it could be an indication of a problem with nerve function, hormones, or blood flow to the penis.
Erectile dysfunction treatment
What are the factors that the doctor bases on in determining the appropriate type of treatment for erectile dysfunction patients?
Many psychological and organic causes may cause erectile dysfunction. The beginning of treatment depends on the identification of the possible cause of the occurrence of erectile dysfunction – for each patient. In the past few years, erectile dysfunction treatment options have significantly advanced and new research and drugs continue to improve treatment options. Suggested treatment depends on the doctor’s experience. For example, an andrologist or urologist may give more options for treatment than a family doctor.
Determining which treatments are best depends on several factors, including:
- Is the cause of erectile dysfunction organic, psychological, or both?
- Having other health conditions
- Possible interference with other treatments
- What is the most effective option for each individual patient
- Best for a man and his wife
Organic factors that may cause varying degrees of ED: injury, surgery, certain health conditions such as diabetes and/or cardiovascular disease, lifestyle issues such as smoking, alcohol, or other substance abuse, and side effects of some medications used in the treatment of other diseases. Psychological factors that may lead to erectile dysfunction include: anxiety about sexual performance, stress, or this may be due to secondary sexual dysfunction (prepubertal, delayed, or retrograde ejaculation).
The first step in good medical practice is to remove the triggers (eg: smoking, obesity, alcohol use, anxiety, fatigue, depression, control of prescription medications, etc.), after which most patients with erectile dysfunction require another type of additional treatment. Treatments are currently available: sex education and counseling, oral medication, parenteral therapy, external vacuum devices, and surgical treatments.
To determine the optimal treatment plan, the doctor should have an open and frank dialogue with the patient and his or her spouse to discuss available options. The outlines of treatment to be followed are determined by the process of the care model. The first line of treatment includes: (1) trying to correct the triggers for the injury (2) honestly discussing psychological matters (for example, if erectile dysfunction occurs during the first sexual intercourse after a divorce, after being widowed, or when problems with low self-esteem have not been resolved) This is evident by medical treatment methods, such as psychiatry. (3) Oral therapy (pills), currently limited to the use of phosphodiesterase inhibitors – eg sildenafil citrate (Viagra®), vardenafil hydrochloride (Levitra®) and tadalafil (Cialis®) ).
The second line of treatment includes the use of external suction devices, a suppository, the urethra (urethra), and the injection of the male organ (the cavernous body). This treatment is used if the treatment with pills fails, or if side effects appear or intolerance to them.
The third line of treatment – used for patients who were previously treated with the first and second lines – includes vascular surgery, which is done for a very small number of cases, and penile prosthetic surgery (surgery to implant a prosthetic device inside the penis).
What non-surgical treatments are available for erectile dysfunction?
The most common methods of treating erectile dysfunction:
- Counseling / Psychological / Sexual Therapy
- Oral medications
- Penis injection (corpus cavernosum)
- External Discharge Devices
- Suppository for the urinary tract
What is the content of counseling / psychological / sexual treatment?
Seeking psychiatric treatment is very common for erectile dysfunction as it may be caused by or as a result of psychological stress, sexual anxiety, or other mental health and personal issues.
Often, psychotherapy requires counseling or conversational therapy and includes talking about relationships and experiences with mental health or sexual health professionals. A therapist can find effective ways to deal with many of these problems and can also offer practical strategies that may help reduce sexual tension and encourage communication about sexual matters. Often, meeting a therapist a few times — three or four times — can be very helpful. Many couples who suffer from erectile dysfunction get the best results after talking with a therapist, as good communication between the spouses helps a lot in resolving intimacy issues that may contribute to erectile dysfunction and increased sexual tension.
The benefits and side effects of each treatment should be discussed with the doctor before choosing any type of treatment because the main goal is patient and partner satisfaction.
Does taking vitamins and nutritional supplements contribute to the treatment of erectile dysfunction?
There are many nutritional supplements such as herbs, vitamins, and minerals that are gaining increasing popularity as a way to treat medical conditions and improve health. Some of them have been named and marketed as sexual health enhancers and erectile dysfunction treatments. Don’t believe that “natural” products are safe and effective, as these drugs have not been reviewed and/or authorized by health regulatory organizations such as the US Food and Drug Administration. There is very little clinical research that has been done to verify whether these supplements provide benefits for men with erectile dysfunction. It’s best to discuss the individual side effects and benefits of dietary supplements with your doctor, before taking any, because some may interfere with currently prescribed medication or worsen health conditions.
It is worth noting that in the trials of erectile dysfunction drugs, the response rate to the placebo was found to be 30%, which means that 30% of the men who took the placebo (sugar pills) claimed that they felt an improvement in the process of erection. There are two warnings: first, that some nutritional supplements for men contain androgens (testosterone, DHT, androstenedione), which may not be suitable for some men, and a second warning, that some of these “natural supplements contain drugs such as sildenafil citrate (Viagra®). vardenafil hydrochloride (Levitra®) and tadalafil (Cialis®) Many men choose these supplements because they are not allowed to take these prescription medications: sildenafil citrate (Viagra®), vardenafil hydrochloride (Levitra®) and tadalafil (Cialis®). , due to their use or treatment with medicines containing nitroglycerin.