Erectile Dysfunction (ED): Symptoms, Causes and Treatment

There are many genital problems which males face. Out of these, erectile dysfunction is one of the common complaints. So let’s discuss about it in detail. Erectile dysfunction can occasionally occur or during a limited period to permanent loss of erectile function. Of erectile dysfunction in medical purposes, the person can achieve within 6 months from about 70% of the experiments a sufficient erection.

1. What is Erectile Dysfunction?

Erectile dysfunction is a medical condition of Penis, where two situations are associated. First, difficulty to have an erection and second, not being able to maintain erection during course of sex.

Most of the men suffer from ED during some time of their life. Occasional erection trouble is not a matter of concern, but if erectile problem is an on-going issue, it may lead towards other sexual and psychological problems.

The sexuality of men can be affected by several disorders. One of the best known is erectile dysfunction, also known as erectile dysfunction. It refers to the inability to ensure sufficient stiffness (Erection Gain) of the male member (Penis) for satisfactory sexual intercourse. This includes neither the required Erection do not reach long enough to be able to maintain. Sexual pleasure (Libido) Is often still present. In time, but can also disappear, the libido, as people so not with their alleged “failure,” must be confronted.

From erectile dysfunction are 2 different concepts that are sometimes used synonymously: Impotence and Sterility.

1.1. Erectile dysfunction and impotency:

Impotency is a condition where a man neither achieves full erection during sex neither ejaculates. Whereas erectile dysfunction is a condition where person gets erection and also ejaculates, but cannot sustain erection for long duration of time. Ongoing ED can lead towards impotency and treatment of ED can lead towards healthy sexual life.

Moreover, impotence is a very general and ill-defined concept since exercise earlier between the inability to have sexual intercourse has been distinguished (impotentia coeundi), and the inability to reproduce (Impotentia generated).

1.2. Erectile dysfunction and sterility :

Sterility means the inability of a man to reproduce, also known as impotence, with the erectile function is not restricted in the rule.

2. Symptoms of Erectile Dysfunction:

• Trouble in getting an erection
• Trouble in maintaining erection
• Premature ejaculation
• Loss of sexual desire

3. Cause of Erectile Dysfunction:

Erectile dysfunction causes are mostly psychological than physical. Although number of physical factors also play important role in it. All causes of ED can be divided into three parts:

• Physical causes
• Psychological causes
• Drug-related causes

The causes of erectile dysfunction are extremely diverse, often several causes come together. Basically, one can assume that predominate in younger men psychological reasons, while with increasing age, more and more primary underlying physical illness.

It is estimated that an erection weakness in the age of 50 years, physically conditioned to about 80%. Overall, probably about 50% of erectile dysfunction is a purely organic cause, at about one third, it must be from a purely psychogenic disorder and 20% of patients, both come together.

a. Physical reason of erectile dysfunction:

Physical causes of erectile dysfunction is often a side effect of sometimes serious systemic or the result of birth defects and pathological changes in the genital area. Moreover, the debate can occur in certain surgical procedures erection problems.

• Blood vessel and heart: Weakness of blood vessel and heart causes difficulty in blood flow towards penis.
• Muscle: Penis is a muscular organ. Weakness of penis muscle is an important cause of ED.
• Neuromuscular and hormonal: Brain,neurone and hormone are messenger of body. Deficiency or less communication between neurone causes ED.

It is always a good option to consult your doctor before coming toward conclusion of ED. There are numerous health conditions which affect sexual health as well. Such as:

• High cholesterol
• Heart disease
• High blood pressure
• Diabetes
• Obesity
• Multiple sclerosis
• Low testosterone
• Neuromuscular deficiency like in Parkinson’s disease
• Hormonal problem like hyper and hypothyroidism
• Old injury or surgical mark
• Blood vessel disease like atherosclerosis
• Extra growth like prostrate
• Myocardial infarction
• Chronic liver disease
• Chronic renal dysfunction (renal insufficiency)
• Metabolic syndrome, a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol.
• Urogenital malformations and diseases
• Narrowed foreskin of the penis (Phimosis)
• Bladder and bowel surgery
• Congenital malformations of the urethra (hypospadias) or the penis (epispadias)
• Inflammation of the testicles; Epididymis, Prostate
• Peyronie’s disease, development of scar tissue inside the penis.
• Treatments for prostate cancer or enlarged prostate
• Surgeries or injuries that affect the pelvic area or spinal cord
• Bad habits like tobacco, alcoholism, drugs etc.

Diabetes mellitus, atherosclerosis and vascular anomalies represent among the physical illnesses, with approximately 45% of the main causes of erectile dysfunction. For some diseases, there are now more accurate prior knowledge, why these are often associated with erectile dysfunction.

To lead mellitus, especially in poorly controlled diabetes occurring polyneuropathy, diseases of small and large blood vessels and hormonal disorders with lowered testosterone to erectile dysfunction. American scientists have also discovered the mid-1990’s, years, that people with diabetes compared to non-diabetics have a 3-times as likely to develop erectile dysfunction too.

If a arterioscleros is be fore the blood vessels are usually affected by the blood flow to the penis. Even patients who participated in a Renal insufficiency suffer, often complain about erection problems. The cause is, among other things reduced-approved testosterone production, which is triggered with kidney failure.

At multiple sclerosis are dysfunctions of the neural pathways, blamed mainly in the area of the spinal cord for erectile dysfunction. Those affected exhibit sensitivity disorders, a weakened pelvic muscles and bladder weakness.

b. Physiological reason of erectile dysfunction:

The significance of psychological causes of erectile dysfunction is controversial. Urologists are often organic disease as causes of erectile dysfunction in the foreground, while sexual Physicians often consider psychogenic factors are more important.

Sex is a complex phenomenon.Complete and healthy sexual course needs full communication between brain, nerve, muscle, hormones, mood and emotions. Anxiety, tension, stress, depression, fatigue, fear,inferiority complex and all play negative role in maintaining sexual health. There is a complete cycle of sexual issues which are related with psychological issues. For example nervousness and tension cause difficulty to maintain erection, then inability to maintain erection causes nervousness and tension.

The penile tissues are constricted and erection is not maintained due to performance anxiety. There can be reduced sensory stimulation in all these tissues which can be arousing. About 80 percent of impotency cases have these problems and appear in the form of secondary reaction due to some physical causes.

The erectile dysfunction caused by any psychological or physical factor can become source of emotional, mental and physical stress. There can be profound effect of ED on the self confidence and self esteem. The sexual functions help men to shape their identity and define their role. It can be very devastating to lose erection.

Many men have this problem in silence and they are convinced that no one understands it. These men think that others will blame him and these men don’t like to talk about their problem with others. There can be many worries for men having ED which can compound their problem. These men think that they are failure and their partner can leave them. Emotional pain is associated with ED due to which these men will tend to make excuses to avoid sex. The partner can feel unattractive, loneliness, leading to rejection, and depressed in this situation.

The women might think that their partners are having affair with someone else. The matters can become worse for men because they don’t communicate their condition. The patients of the erectile dysfunction can also feel stress when they are looking to get help for their problem. Many men can stop seeking medical advice due to apprehension although many doctors are well versed about the causes and reasons of the erectile dysfunction.

The treatment of the erectile dysfunction is quite similar to the treatment of other diseases. It is important for the patient to understand their problem and then communicate it to the partner and to the doctors so that they can help you to come out of this problem. The failure comes for the patients if they don’t communicate their problem effectively.

c. Drug-related causes:

Drug-related causes erectile dysfunction is a known side effect of various drugs. However, the physician often can not distinguish whether the cause with the help of drugs to treat disease or even erectile dysfunction drugs administered. A typical example is the blood pressure of a patient who is treated with an antihypertensive drug. Erectile dysfunction through drugs usually disappear after discontinuation of the drug.

Below is a selection of potentially sexual influence drugs or drugs:

• Cardiovascular resources
• Beta-receptor blockers (Medicines to lower blood pressure and pulse rate)
• Diuretics (diuretic effect, e.g., thiazides)
• Digoxin (drug in heart failure to increase cardiac output)
• Antiarrhythmic drugs (drugs for the treatment) of cardiac arrhythmias
• ACE-inhibitors (means for hypertension, heart failure) after myocardial infarctionPsychotropics
• Antidepressants (Preparations with mood-brightening effect, such as tricyclic antidepressants, MAOIs)
• Neuroleptics (Means of reducing the mental stress, such asPhenothiazines)
• Sedatives (eg benzodiazepines)
• Appetite suppressants (eg, mazindol, fenfluramine)Other
• Hormones and anti-hormones (synthetic substances which reverse the effects of sex hormones)
• Gastrointestinal drugs
• Medicament against Parkinson’s
• Drugs for alcohol cessation
• Antirheumatic
• Muscle-relaxing drugs (muscle relaxants)
• Anticonvulsant agents (antispasmodics)

4. Complications of Erectile Dysfunction:

• Erectile dysfunction can cause number of psychological problems, like depression, anxiety, low self-esteem and others.
• Impotency
• Relationship problems

5. Erectile Dysfunction Test:

There is no definitive test to diagnose erectile dysfunction but your doctor may advise some blood tests and ultrasound to find out any other physical health issue.

There are some clinical ways to diagnosed between physical ED and psychological ED. If a person has never had an erection, even during masturbation or in night fall, it is always a physical ED. Person with physiological ED do develop erection during masturbation and also have orgasm and ejaculation, but fear and low self-esteem in front of sexual partner causes erection problem.

Read more: Genital Herpes in Men and Women

6. Treatment of Erectile Dysfunction:

6.1. Psychological Counseling:

There can be ED due to psychological factors. Therefore, you will require counseling to lessen anxiety to reduce the impact of ED. Therapy can be used in this treatment. The problems of ED are evaluated by the therapist first, and then performance anxiety and other problems are also solved in this treatment. The couple is educated by the professional about the normal sexual response in this problem. Men are trained how to obtain an erection and longer time for ejaculation. You can use antidepressant medications for premature ejaculation. The sexual partner is also involved in this treatment.

6.2. Muscle Toning:

Muscle toning is essential for erectile tissues inside the body as there can be a more robust erection with nervous tissues and ejaculation on their contraction. You are not required to put conscious effort into this ejaculation. There are pelvic floor exercises available that can help you in muscle toning.

6.4. Oral Medications:

Oral medications can be good in case of anxiety and emotional problems. You can take these medications for physical ED problems. Lots of men are taking Viagra with its effective results. You can also have Cialis and Levitra oral medications, which are available in pill form. Yohimbine is another oral medication that can be good for men with erection problems. You have to be careful about these medications because there can be chances of side effects as well.

6.5. Hormone Supplements:

There can be ED problems due to hormonal imbalance like excess prolactin, low testosterone levels, and excess estrogen. The doctors will prescribe intramuscular testosterone injections if the testosterone level is low. The prostate grows more significantly with the testosterone, due to which there can be urination problems. There can be increased risks of circulatory problems as well blood thickening due to hormones.

6.6. Vacuum Devices:

There are vacuum devices available as well for the treatment of ED aside from medications. Erection is produced and maintained with the help of a vacuum device by creating a vacuum around the penis. The blood is drawn to the penis to make it erect.

6.7. Injection Therapy:

Self-injection medication is involved in the injection therapy into the penis shaft. There can be good quality of erection with this injection therapy for men who have erectile dysfunction problems. Prescription is required for injection therapy. The correct dose should be taken by the patient so that he can be able to get good results. You can have a good erection for 30 to 60 minutes with this injection therapy. There are fewer risks in injection therapy than surgery, and you can have a more natural erection than a vacuum device. The downside of this therapy is that the needle has to be put into the penis, which cans turn off to many men.

6.8. Physical health training:

All the physical causative factors need to be treated with aproper treatment like other health issues.

• Erectile dysfunction exercise: Yoga and stretching are effective in treatment of erectile dysfunction.
• Pashchimotasan: Sit on the floor and spread legs straight. Bend forward and Try to touch your toe by finger. This exercise squeezes pelvic and abdomen muscles and increases blood flow towards genitals.
• Butterfly exercise: Sit on mat and place both of your heals near your pelvis organs. Then move your knee up and down.
• Squat: It is very important exercise to provide strength to pelvic organs for both male and female.
• Cardio exercise: Do cardio exercise for 5-10 min as per your strength. Cardio not only increases muscle tone and blood circulation, but also relaxes mind and releases excessive negative hormones through sweat.
• Erectile dysfunction medicine: Sildenafil (Viagra) is drug of choice for ED treatment. Viagra is orally taken medicine but it can cause palpitation and severe tachycardia (increase heart beat). Please do not take Viagra without the consultation of doctor. Alprostadil ointments are also available on medical prescription.

6.9. ED treatment options:

Here are some options for the treatment of erectile dysfunction which can help you. Have you considered your other medication?

There can be ED due to some other medications. Therefore, you should check the cause of ED. You should talk to your doctor about this condition and don’t stop taking your medications. You can switch to the new medication as well.

7. Erectile Dysfunction and Surgery:

7.1. Penis:

Root, body and glans penis are three parts of the penis. The root is attached to the pelvic and abdominal wall. The middle portion of the penis is called body which consists of three cylindrical soft tissue spaces. There is corpora cavernosa which are larger cylindrical soft tissues. Corpus spongiosum is third cylindrical soft tissue which makes urinary passage. The head of penis is cone shaped which makes termination of corpus spongiosum.

7.2. Scrotum:

Thin muscle and thin sac of skin is called scrotum which is climate control system and keeps testicles away from the body. It also keeps the body temperature cooler than normal for sperm development. The cremasteric muscles in the scrotum move testicles within scrotum according to the surrounding temperature.

7.3. Testes/Testicles:

Olive sized oval bodies are called testers one on right and other on left side. Testosterone and sperm are produced by testes. The sperm cells are transported by vasa deferentia and epididymides after these cells are developed in testes. Testes and surrounding structures are included in term testicles like epididymis and deferens. Testers and testicles are slightly different things although they are used interchangeably.

7.4. Vas Deferens and Seminal Vesicles:

The sperm travel through epididymis which is collection when these sperms are produced. Then these sperm pass through duct which is connected with seminal vesicles to make ejaculatory duct. Fluid is produced in the seminal vesicles to provide nutrient to the sperms and it also lubricate the urethra. Then semen is produced by this fluid. The muscles contract surrounding the seminal vesicles during ejaculation and sperms are pushed from seminal vesicles which are located behind bladder and prostate.

7.5. Prostate Gland:

Prostate is located below urinary bladder surrounding the urethra and it is walnut sized gland. Prostatic fluid is produced by prostate gland. The sperms are supported, protected and nourished by the fluid. Most of the semen volume is formed by the sticky white fluid from prostate forms. Reproduction is the only known function of prostate and it usually grows throughout the life which can cause blockage in urethra.

This blockage can affect voiding with symptoms like excessive voiding at night and urinary frequency, weakening of urinary stream and urgency of urination. The enlargement of prostate is called benign and it can be treated with the help of medications or surgical procedures. Laser or microwave therapy can be used for prostate treatment. The prostate cancer can be detected with prostate specific antigen test.

7.6. Urethra:

There is corpus spongiosum around urethra which is soft tissue of penis. Urethra works in dual way. It can transport semen out of penis tip and urine is also transported from the bladder. Seminal vesicles and prostate are formed by fluid and sperm cells. There can be urinary difficulty due to strictures which is scar tissue in the passage.

8. Erectile Dysfunction and Diseas:

8.1. Erectile Dysfunction and Diabetes:

This problem can be due to poor blood sugar control which can cause damage to the blood vessels and nerves. This problem is also linked with other conditions of diabetes in men like coronary artery disease and high blood pressure. ED can be real challenge for men and leave their partners discouraged and frustrated.

a) Talk to an expert:

It is important for men to talk their doctor about erectile dysfunction without feeling embarrassment which can make big difference.

• Your doctor can find underlying causes of erectile dysfunction if you tell him what’s going on. He will prescribe medications according to the situation.
• You should also ask your doctor about diabetes control. There can be damage to the blood vessels with erectile dysfunction so you have to be careful in controlling blood sugar level.
• You can also ask about other problems associated with diabetes like chronic conditions which can cause ED.
• You should also address other health problems.
• You should also tell the medications which you are using for other medical conditions like high blood pressure or depression.
• Erectile dysfunction can become worse with stress and anxiety therefore you should seek counseling from mental health provider.

b) Consider your treatment options:

You can have different ED treatments and you can ask your doctors for specific treatment.

• ED medications like Viagra, Levitra and Cialis can be used to increase blood flow in to the penis which can make your erection easier. You can ask your doctor about certain medications.
• You can have option of tiny suppository into penis tip if these oral medications are not effective. The medications can also be injected into the penis. The blood flow can be increased with these drugs to maintain an erection.
• Penis pump can be used which is hollow tube. Blood is pumped to the penis which can create erection. This device is very simple and easy to operate and can be good treatment option.
• Surgical penis can be implanted if medications and penis pumps are not effective. It is a safe and effective treatment for men having erectile dysfunction.

c) Make good lifestyle choices:

You can be able to improve your erectile dysfunction and overall health with the help of these approaches.

• The blood vessels can become narrow with smoking and tobacco use due to which erectile dysfunction become worse. Therefore it is good for you to stop smoking.
• There can be damage to the blood vessels if you drink too much alcohol daily which can result in erectile dysfunction. Therefore alcohol intake should be limited.
• Erection can be reduced with stress therefore you should be able to minimize your stress level. You can use relaxation techniques like yoga and meditation.
• The blood vessels can be increased with regular exercises and it can also help you to reduce your stress.

8.2. Erectile Dysfunction May be a Sign of Heart Disease:

There can be increased risks of heart disease with erectile dysfunction. You can be able to predict the risk of heart disease if you have erectile dysfunction type 2 as compared to blood pressure or high cholesterol. But still ED is being treated as a lifestyle or recreational issue and it is not being taken as predictor of serious heart disease.

There has been decrease in the deaths due to stroke and heart diseases in people about 75 years but still there is need of screening for the patients of erectile dysfunction with heart disease or diabetes. This issue is ignored because of word erection for the patients as they expect that they might not have positive response.

ED can be very stressful but it can not be life threatening. ED is the difficulty in maintaining erection for sex and it can be early sign of heart disease. You can be able to find signs and symptoms of heart problems by understating connection between heart problems and erectile dysfunctions. It is important for you to get treatment of heart problems due to erectile dysfunction. The right treatment of heart disease can help you with erectile dysfunction.

Erectile dysfunction and heart disease can meet with clogged arteries with each other.

The hardening of arteries is known as atherosclerosis in which plaque of arteries builds up in different body parts. The arteries become hard and narrow providing limited blood flow. The blood supplying arteries to the penis are smaller as compared to the arteries blood supplying to the heart and these symptoms can show up as erectile dysfunction. There can be heart disease with atherosclerosis in arteries which can supply blood to the heart. There can be increased risks of stroke, aneurysm and peripheral artery disease with atherosclerosis.

a) Certain men are at increased risk:

There can be increased risks heart diseases and atherosclerosis with erectile dysfunction.

• There can be increased risks of ED in men with diabetes and heart problems.
• ED at younger age can be sing of heart disease especially men under age of 50 years but it can not be sign of heart disease in men over 70 years.
• You can have increased risks of erectile dysfunction and heart disease if you are obese or overweight.
• There can be atherosclerosis with high level of low density lipoprotein cholesterol.
• You can have atherosclerosis with smoking which can affect your erection directly.
• There can be damage to arteries lining with high blood pressure which can lead to atherosclerosis.
• You can have erectile dysfunction if you have heart disease in your family.
• Depression can be major cause of erectile dysfunction.

b) Treatment for erectile dysfunction caused by heart disease:

You can be able to keep your heart healthy by making simple healthy lifestyle changes like walking, exercising, losing weight and eating balanced diet.

8.3. Erectile Dysfunction, Heart Disease and Other Vascular Diseases:

The narrowing of arteries can be due to atheroma which is in the form of plaques and fatty patches and is developed in the lining of the arteries. This plaque is normally formed over many years in different places in the body but it is common in brain, legs, heart and penis. These plaques can become triggers and cause narrowing of many arteries causing erectile dysfunction problems and symptoms.

There can be increased risks of atheroma due to certain risk factors due to which conditions can become worse. You can be able to prevent atheroma related conditions due to risk factors from getting worse.

• There can be atheroma problem due to smoking and it can also lead to the erectile dysfunction. The young smokers are at greater risks of developing erectile dysfunction as compared to the middle aged smokers. It is good for you to stop smoking.
• It is important for you to keep on checking blood pressure because there can be risks of erectile dysfunction due to high blood pressure.
• You should be able to lose your weight if you are overweight because it can also lead to ED.
• High cholesterol should be avoided.
• It is important for you to take some moderate physical activity at least 30 minutes daily like walking, swimming, dancing and cycling.
• You should eat healthy diet and avoid alcohol excess.
• The blood sugar level should be controlled if you have diabetes because it can cause problems.

It can take several years for erectile dysfunction due to narrowing of arteries before any problems or symptoms due to coronary narrowing arteries or some other arteries. Therefore we can say that erectile dysfunction can be an early warning of the heart disease or some other cardiovascular diseases. The narrowing of arteries can be prevented easily if you take care about your lifestyle. Little changes in your lifestyle can help you to get rid of this problem.

There can be increased risks of heart attack in men if they have erectile dysfunction problem. These men are twice as likely to have heart problems, 20 percent more likely to have heart failure problems and 10 percent can have stroke problem mainly due to erectile dysfunction. It is important for you to consult with your doctor in this situation who cans advice you about the ways through which you can be able to modify risk factors. This advice can also help you to prevent heart diseases and other cardiovascular diseases from developing.

9. What to Expect at Your Doctor Visit?

The doctor can diagnose and treat Ed easily in one visit but it is important for you to have follow up visits so that you can discuss about the results. It will also make sure that you have understood your condition.

Your partner can also be involved in this treatment. It is important for you to consult with urologist or endocrinologist although doctor might be able to diagnose and treat your erectile dysfunction effectively. The doctor will confirm the diagnosis of ED to access the severity of your problem. The treatable conditions will be identified according to the erectile problems. The basic assessment will help men to find the treatments while testing can also be done.

The physical examination will be performed by the doctor to check blood flow circulation, rectal exam, penis exam and neurologist exam. The doctor can ask you about your medical history and other questions like:

• Were you able to achieve and maintain your erection in the past?
• Have you any problem in achieving and maintain erection?
• Is there erection during sleep?
• How long you are having erection difficulty?
• What kind of medications you are taking?
• Do you smoke and in what quantity?
• What is your daily alcohol intake?
• Do you have surgery recently?
• Have you used vascular surgery or other treatments for blood vessels?
• Are you feeling depressed?
• Do you have stress feelings or worried about something?
• Is there decrease in your energy level?
• Do you have good sleep?
• What kind of symptoms do you have?
• Is there any change in sensation in your penis?
• Do you have urination problems?

Tests that may be done include:

• Blood tests
• Nocturnal penile tumescence (NPT)
• Neurological (nerve) testing
• Penile ultrasound
• Rigidity monitoring
• Psychometric testing
• Urine analysis

The treatment can be according to the type and cause of ED. There are different treatment options available to you including injection, oral medications, vacuum devices, medicines inserted in urethra and surgery. If you have erection difficulties then Viagra, Cialis and Levitra are prescribed by the doctors for ED due to psychological and physical problems. These drugs are called PDE5 inhibitors.

You have to be careful about these drugs as there can be some side effects of these drugs as well especially if you have severe heart failure, uncontrolled diabetes, recent stroke, uncontrolled hypertension and low blood pressure. Skin patches, injections, vacuum devices and topical gels can be used if these pills don’t work. Herbs dietary supplements can also be used for sexual performance.

10. Disclaimer:

Above article is only for knowledge purpose. Please contact your healthcare provider before using any of above medicine or method. for any query or personal consultation according to your health condition, please contact your doctor.