Definition and Overview

Erectile dysfunction is a condition characterized by a man’s inability to achieve or maintain an erection. Also known as impotence, it renders the patient unable to have sexual intercourse. It is normal for some men to encounter some difficulty achieving an erection occasionally, but if the problem is chronic or ongoing, it is classified as a disorder.

The effects of erectile dysfunction are wide-ranging. Patients may experience embarrassment, low self-esteem, and problems with their relationships because of it. Thus, men with this condition are encouraged to consult a medical professional as there are medications and other types of treatment options that are available.

In some cases, the inability to have an erection also manifests as a symptom of an underlying health condition, making it all the more important to seek medical attention.

Causes of Condition

To understand how erectile dysfunction occurs, it is first important to understand how the male organ becomes sexually aroused. Erections occur when there is an increase in blood flow to the penile arteries filling up the corpora cavernosa, which are the two blood chambers in the penis. When this happens, the penis becomes firm. For the blood to flow into the penis, the muscles in it have to be relaxed, and when it contracts again, the blood flows out, signalling the end of the erection.

To achieve an erection, the male body goes through a complex process that involves several parts of the body, including the brain, the organs responsible for producing and regulating hormones, the nerves and blood vessels leading to it, and muscles in the male organ. For a successful erection, a man should have a healthy and properly working nervous system, healthy arteries leading to the penile chambers, and healthy muscles and a sufficient amount of nitric oxide in the penis.

Any problem that affects the said body parts can result in erectile dysfunction. This explains why there is a wide range of possible causes that have been linked with this condition. The cause can be physical, such as damaged penile arteries, or emotional, such as the inability to fully relax the penis muscle due to anxiety or stress.

The most common causes of erectile dysfunction include:

  • Age – Studies show that ED is more prevalent among men who are at least 60 years old
  • An underlying health problem
  • Metabolic syndrome
  • As a side effect of certain medications, such as antidepressants or some pain relievers
  • As a side effect of cancer therapy
  • Surgery
  • Injury to the pelvic area or spinal cord
  • Alcohol abuse
  • Recreational drugs abuse
  • Mental health problems, such as depression
  • Stress
  • Nerve compression
  • Excessive tobacco usage – The use of tobacco is known to restrict proper blood flow to the veins and arteries.

Meanwhile, underlying health conditions that have been shown to cause or increase a person’s risk for erectile dysfunction include:

  • Diabetes
  • Obesity
  • Hypertension – High blood pressure can cause the narrowing of blood vessels leading to the penis
  • Hormonal problems
  • High cholesterol
  • Heart disease
  • Atherosclerosis
  • Parkinson’s disease
  • Peyronie’s disease
  • Multiple sclerosis
  • Prostate cancer or enlarged prostate

Key Symptoms

Erectile dysfunction refers to an ongoing inability to achieve an erection or to maintain one long enough during sexual intercourse. Due to this, patients suffering from it may also experience reduced sexual desire.

The condition becomes easier to diagnose when the patient begins to experience psychological and emotional issues, such as:

  • Stress
  • Low self-esteem
  • Anxiety
  • Depression
  • Difficulty conceiving a child

Since erectile dysfunction is not only a condition but also a common symptom of many health problems, it is important to observe if the patient has other symptoms that may be related to it. These symptoms should be mentioned to the doctor during the consultation.

To diagnose ED, doctors use a variety of laboratory tests, such as:

  • Complete blood count
  • Urinalysis
  • Blood glucose testing
  • Testosterone testing
  • Thyroid testing to check for hypothyroidism or hyperthyroidism
  • Lipid profile to check LDL cholesterol levels and test for atherosclerosis
  • Blood hemoglobin A 1c testing to rule out diabetes mellitus
  • Liver function tests
  • Prostaglandin E1 injection test to measure the blood flow to the penis
  • Biothesiometry or direct vibrational stimulation to assess the nerve function in the penis
  • Nocturnal penile tumescence to monitor the penis during sleep
  • PSA level test to check for prostate cancer
  • X-rays or ultrasound (in cases where trauma or injury is involved)

Who to See and Types of Treatments Available

Erectile dysfunction is a treatable health issue, so men suffering from it are encouraged to seek medical help as soon as they experience the symptoms mentioned above. A family doctor is the best source of primary medical care, although patients may be referred to specialists when necessary. For example, if a man has ED as an effect of an existing heart problem, he will be referred to a cardiologist for treatment.

Currently, the existing treatment options for this condition include:

  • Oral medications – Oral medications for ED include Viagra, Levitra, Stendra, Staxyn, or Cialis; all of which are considered as PDE5 inhibitors.
  • Other medications – Intraurethral and intracavernosal medications are also available
  • Lifestyle changes – If ED is caused by excessive alcohol, tobacco, or recreational drugs use, the patient will be advised to make some lifestyle changes to resolve the problem.
  • Counseling – If a man is found to be having problems achieving an erection due to stress or depression, he may undergo counseling for stress management or as part of the treatment for depression.
  • Psychological therapy – Men can undergo cognitive behavioral therapy or CBT as a possible treatment for this dysfunction.
  • Surgery – If there are physical causes hindering a man from achieving an erection, surgical procedures may be an option.

  • Heidelbaugh JJ. Management of erectile dysfunction. Am Fam Physician. 2010;81:305-312.

  • Qaseem A, Snow V, Denberg TD, et al. Hormonal testing and pharmacologic treatment of erectile dysfunction: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2009;151:639-649.

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