Erectile dysfunction
What is erectile dysfunction?
Erectile dysfunction is defined as the persistent lack or inability to achieve and maintain an erection that allows satisfactory sexual intercourse.
The erection allows the penis to maintain its normal function. Sexual stimulation and arousal cause the brain, nerves, heart, blood vessels, and hormones to work together to produce a rapid increase in blood flow to the penis. The blood is trapped in the two spongy chambers of the shaft of the penis. As the corpora cavernosa of the penis rapidly fill with blood, they expand and the penis increases in hardness and size. The result is an erection.
Although erectile dysfunction is a benign problem, it has a significant impact on the quality of life of the man and his partner.
Diagnosis
For many people, a physical exam and answers to various questions (medical history) is all that is needed for a doctor to diagnose erectile dysfunction and recommend treatment. However, if the patient has chronic conditions or the doctor suspects any pre-existing conditions, they may need to undergo additional tests or consult a specialist.
Tests to check for pre-existing conditions might include the following:
- Physical exam: This may include a thorough examination of the penis and testicles, and checking for nerve sensation.
- Blood tests: A blood sample may be sent to a lab to check for signs of heart disease, diabetes, low testosterone, and other health conditions.
- Urinalysis – Like blood tests, urinalysis is used to look for signs of diabetes and other pre-existing conditions.
- Ultrasound: This test is usually done by a specialist in an office. It involves the use of a rod-shaped device (transducer) that rests on the vessels that supply blood to the penis. This creates a video image that allows your doctor to see if you have problems with your blood flow.
Sometimes this test is done along with an injection of medication into the penis that stimulates blood flow and produces an erection. - Psychological examination: the doctor may ask questions to find out if the patient suffers from depression, or to detect other possible psychological causes of erectile dysfunction.
How is it treated?
Depending on the cause, severity of erectile dysfunction, and underlying health conditions, your doctor may suggest different types of treatment. Some of them are:
Oral medications: For many men, oral medications such as Sildenafil (Viagra), Tadalafil (Adcirca, Cialis), Vardenafil (Levitra, Staxyn), and Avanafil (Stendra) are an effective treatment for erectile dysfunction. All four medications enhance the effects of nitric oxide, a natural chemical produced by the body that relaxes the muscles of the penis. This increases blood circulation and allows an erection to be achieved in response to sexual stimulation.
Before taking any medications to treat erectile dysfunction, such as over-the-counter supplements and herbal remedies, it is important to consult with a specialist.
If medications aren’t effective or appropriate, your doctor may recommend another type of treatment. Some of them are:
Penis pump: A penile pump (vacuum erection device) is a hollow tube with a manual or battery-powered pump. The tube is placed over the penis, and then the pump is used to suck the air inside the tube out. This creates a vacuum that draws blood into the penis.
Once you have an erection, you slip a tension ring around the base of the penis to retain blood and keep it firm. Then you remove the vacuum device.
Penile implants: This treatment involves surgically placing devices on both sides of the penis. These implants consist of inflatable or malleable (flexible) rods. Inflatable devices allow you to control the timing and duration of an erection. The malleable rods keep your penis firm but flexible.
In general, penile implants are not considered necessary until other methods have been tried first. Implants have a high degree of satisfaction among those who have tried and failed with more conservative therapies.