Erectile Dysfunction
Figure 1. Anatomy of the penis.
What is Erectile Dysfunction?
Getting an erection is a process that includes physical, hormonal, and psychological elements. Nerves send signals to the blood vessels to increase blood supply to the erectile chambers of the penis to make it grow in size and become rigid. (Figure 1)
Erectile dysfunction (ED) is a common male sexual disorder. It is the inability to get or keep an erection that allows for satisfying sexual activity. ED is not a life-threatening disorder, but it can have a negative impact on your quality of life and that of your partner.
How common is Erectile Dysfunction?
Erectile dysfunction is a common condition in men of all ages and ethnicities. The risk of having Erectile dysfunction increases with age. 40-50% of patients over the age of 50 have experienced ED.
What causes Erectile Dysfunction?
Erectile dysfunction has many causes including:
Psychological e.g. depression, relationship problems etc.
Hormonal e.g. low testosterone
Damage to blood vessels or nerves of erectile tissues in pelvis and in the penis from surgery or radiotherapy, trauma or neurological diseases.
Medications
Risk factors for ED and cardiovascular disease (CVD) are similar. In fact, ED can be an early sign of heart disease. Risk factors are diabetes, high blood pressure, smoking, obesity and high cholesterol.
How is Erectile Dysfunction diagnosed?
Your urologist will take a detailed medical history (including filling out questionnaires) and perform a physical examination to understand your general state of health and what factors may be contributing to your ED. Your doctor will also ask you questions about your sex life, which could be very personal but are necessary for proper diagnosis and treatment.
Further laboratory testing may be conducted including checking your PSA, blood glucose and your testosterone levels in the morning. In specific cases a penile doppler ultrasound and a intracavernous injection test may be done.
What is the treatment of Erectile Dysfunction?
Your urologist will often recommend a combination of psychological and physical approaches to treat Erectile Dysfunction.
Lifestyle changes
Your urologist will aim to improve your general health by stopping smoking, drinking less alcohol, maintaining a healthy diet and exercising regularly. If there are psychological aspects to your ED, you may be referred to a counsellor.
Medications
Phosphodiesterase 5 inhibitors (PDE5Is) such as Viagra, Cialis are a group of medications used for the treatment of ED. It is important you take these medications exactly as prescribed by your doctor to increase efficiency and reduce side effects (most commonly headaches, flushing, heartburn, a stuffy nose, and dizziness). These medications must not be taken if you have heart conditions or you take specific medications (nitrates or alpha-blockers) so it is important to discuss this with your doctor.
Vacuum erection device
The vacuum erection device (VED) is a cylinder shaped device, which creates a vacuum with a manual or an electronic pump and draws blood into the penis making it possible to get and maintain an erection. VEDs are not recommended if you take blood thinning medication or or if you have a bleeding disorder.
Shockwave therapy
Shockwave therapy is being researched as a new treatment option for ED and is not a standard treatment option.
Intracavernosal injections (ICI)
ICI are a treatment option for ED where you inject drugs into the spongy tissue in the penis to open the blood vessels. This results in an erection 10-15 minutes after the injection, even without sexual stimulation. The most common drug used for intracavernous injections is alprostadil (Caverject). You will need an in-office training session from your urologist/nurse to learn how to inject yourself.
Penile Prosthesis / Implants
This is a medical device, which is surgically implanted into the erection chambers of the penis. Inflatable prostheses are the most common type implanted today. The device is inflated and deflated by squeezing a hand-controlled pump in the scrotum several times to move the fluid from the reservoir to the cylinders causing an erection.
This is an option for patients in cases of severe ED, which has not responded to treatment options mentioned above. In addition, if have have tried the above treatments but are unhappy with the results and you want a permanent solution, a penile implant may be an option for you.
Living with Erectile Dysfunction
ED can have a negative effect on your physical, sexual and psychological quality of life as well as that of your partner. If you experience bothersome erectile dysfunction (ED) for more than 6 months, you should seek professional help.
Erectile Dysfunction is a very intimate and personal condition, however this should not prevent you from seeking help and improving your quality of life.