What is Erectile Dysfunction (Impotence) |
Urologist, Jaslok Hospital, 25 years of experience
What is Erectile Dysfunction (Impotence)?
Impotence or erectile dysfunction occurs when a man is not able to attain or maintain an erection of the penis satisfactorily for sexual intercourse. Although it is common for a man to have some problems with erection from time to time, erectile dysfunction that happens routinely is not normal and needs to be treated.
Erectile dysfunction is a common problem that can occur due to many causes such as inadequate blood flow to the penis, diabetes, obesity, smoking, alcohol consumption, stress, etc. Many men find it embarrassing to talk about erectile dysfunction but with the timely diagnosis and treatment erectile dysfunction can be totally reversed and hence it is important to consult the doctor. Healthy sex life can help improve the quality of life, boost self-confidence, and prevent strained relationships between couples.
Let us explain in detail erectile dysfunction (impotence) in this article.
- What are the causes of Erectile Dysfunction ( Impotence )?
- What are the types of Erectile Dysfunction ( Impotence )
- What are the risk factors for Erectile Dysfunction ( Impotence )
- What are the symptoms of Erectile Dysfunction ( Impotence )
- What is the diagnosis of Erectile Dysfunction ( Impotence )
- What are the treatments for Erectile Dysfunction ( Impotence )
- What are the complications of Erectile Dysfunction ( Impotence )?
- How to prevent Erectile Dysfunction ( Impotence )?
What are the causes of Erectile Dysfunction (Impotence)?
Erection is a neurovascular process that requires adequate blood supply and nerve supply to the penis. During sexual arousal, the nerves send signals (impulses) that cause an increase in blood flow to the penis. This blood gets accumulated in two hollow chambers known as corpora cavernosa and causes the penis to expand and become stiff. Any restriction to the blood flow of the penis or blockage of the nerve impulses can cause erectile dysfunction.
The common causes of erectile dysfunction are:
General diseases
- High blood pressure. ( Know more about- What is Hypertension? )
- Atherosclerosis means the hardening and narrowing of arteries
- Heart diseases
- Diabetes
- Tuberculosis
- Dyslipidemia is elevated cholesterol in the body
- Kidney diseases ( Know more about- What is Acute Kidney Failure ? )
Local diseases
- Syphilis
- Priapism- painful persistent erection of the penis
- Addictions to tobacco, alcohol, narcotic drugs, and side effect of certain medications such as antidepressants
- Injury to the head, spinal cord, or vertebrae
- Surgeries that involve the penis area or spinal cord
- Advancing age (> 50 years)
- Obesity
- Cancer treatments near the pelvic area
- Multiple sclerosis, is a condition in which the nerves are damaged
- Parkinson’s disease in which the central nervous system gets affected
- Peyronie’s disease means the development of scar tissue inside the penis
Psychological causes:
-
- Depression ( Know more about- What is Depression ? )
- Anxiety
- Fear of being unable to satisfy your partner
- Disliking the act of sexual intercourse
- Sleep disorders and fatigue
- Stress at home or work
What are the types of Erectile Dysfunction ( Impotence )?
- Primary impotence- A condition where a man has never been able to achieve an erection spontaneously. This can be due to some abnormality in the structure of the penis or due to a trapped nerve
- Secondary impotence- Where a man has been able to have successful erections in the past but presently is unable to have successful erections
- Situational impotence- This means that a man can have an erection in certain situations such as during masturbation but is unable to have a successful erection with his partner
- Partial impotence- A man achieves a partial erection
- Total impotence- A man has never had and will never be able to attain an erection
What are the risk factors for Erectile Dysfunction ( Impotence )?
The risk factors for erectile dysfunction include the following:
- Psychological conditions such as stress or anxiety
- Long-term consumption of alcohol and tobacco
- Obesity
- Prostate surgery or radiation treatments for cancer ( Know more about- What is Prostate surgery? )
- Conditions such as diabetes, high blood pressure, high levels of cholesterol
- Nerve injuries
- Medications such as antidepressants, antihypertensive drugs, antihistaminic, etc.
- Hormonal disorders such as hypogonadism, hypothyroidism
What are the symptoms of Erectile Dysfunction ( Impotence )?
The signs and symptoms of impotence (erectile dysfunction) may include:
- Decreased sexual desire. ( Know more about- Home Remedies for Increasing Sexual Desire )
- Trouble attaining an erection.
- Difficulty in sustaining an erection during sex.
Some other signs of erectile dysfunction are:
- Delayed ejaculation
- Premature ejaculation
- Unable to orgasm even after ample stimulation
- Decreased sexual desire
- Low self-esteem
If you are experiencing the symptoms mentioned above, then you should talk to a doctor as a specialist can diagnose and treat it accurately.
What is the diagnosis of Erectile dysfunction (Impotence)?
Diagnosis of Erectile Dysfunction includes:
- History taking– The doctor will inquire about any past or present illnesses commonly seen in erectile dysfunction, history of any medications, surgeries in the past, and personal habits such as smoking, alcohol consumption, etc. The doctor will also take a detailed sexual history and inquire about erection function, ejaculation, orgasms, etc.
- Physical examination- This includes-Examination of the penis and testicles. If the penis lacks sensitivity, a nervous system problem could be the cause of erectile dysfunction.
- Measurement of blood pressure for hypertension and pulse check to see if there is any problem related to blood circulation.
- Examination of the body to check for extra hair or breast development can point to hormonal problems
- Based on the man’s age and family history, the doctor might do a rectal examination to check the prostate for enlargement.
- Blood tests to check for signs of diabetes, heart diseases, low testosterone levels, chronic kidney diseases, and high cholesterol. The doctor may also ask for a urine test to check for diabetes.
- Ultrasound (Color Doppler)- in this test the technician passes a handheld device known as a transducer over the penis and checks the blood flow to the penis.
- Psychological examination for the diagnosis of depression, anxiety, fatigue, and other emotional and mental disturbances
- Nocturnal penile tumescence (NPT) – In this test, a plastic ring-like device is worn around the penis at night to check for erections during sleep. Each night, during sleep a man experiences about 3-5 erections, and hence if erections at night are detected by the NPT test it shows that the man is physically able to have erections and that the cause of erectile dysfunction would most probably be related to a psychological problem.
- Injection testis- also known as an intracavernosal injection. A doctor will inject medicine into the penis to cause an erection and evaluate how full the penis becomes and how long the erection lasts.
What are the treatments for Erectile Dysfunction (Impotence)?
Based on the cause and severity of erectile dysfunction as well as other underlying health conditions, various treatment options are available. These treatments include-
Oral medications :
- Sildenafil (Viagra)
- Tadalafil (Adcirca, Cialis)
- Vardenafil (Levitra, Staxyn)
- Avanafil (Stendra)
These medications enhance the release of nitric acid in the body, which causes relaxation of the muscles in the penis and consequently increases the blood flow, resulting in an erection. The common side effects seen with these medications include flushing of the face, nasal congestion, visual disturbances, headache, backache, and indigestion. These medications are NOT to be taken with nitrates (commonly prescribed for chest pain), alpha-blockers, or if you have heart failure or hypotension as these medications can cause a decrease in blood pressure. Hence it is important to consult the doctor before taking any medicines for erectile dysfunction.
Penile injections such as Alprostadil self-injection:
In this method, alprostadil is injected into the base or side of the penis by a fine needle and this helps sustain an erection for about an hour. Self-injection lessons must be first given by experienced healthcare professionals. The success rate with this method of treatment is as high as 85%. Alprostadil can also be mixed with two or more drugs known as “bimix” or “trimix” combinations which are stronger than alprostadil alone and have become the standard treatment for erectile dysfunction. The common side effects of this method include mild bleeding and prolonged erection (priapism).
Alprostadil urethral suppository ( Intraurethral therapy):
This method involves placing Alprostadil in the penile urethra. Erection starts within 10 minutes and lasts for about 30-60 minutes. Side effects include a burning feeling in the penis and minor bleeding. Intraurethral therapy is not as effective as penile injections
Testosterone therapy:
In men with low testosterone levels, (most commonly older men) this method is useful. Testosterone therapy must not be given if a man has a normal testosterone level for his age group, increasing the risk of prostate cancer.
Penile Pump (Vacuum erection device) :
This technique uses a hollow tube and a pump which can be hand-powered or battery-powered. The tube is placed on the penis and the pump is used to suck out air present inside the tube and create a vacuum that pulls blood into the penis. A ring is then slipped onto the base of the penis which holds the blood in the penis and keeps it hard for about 30-40 minutes. Bruising of the penis can be a possible side effect of this method.
Penile implants are also known as penile prostheses are devices placed surgically into both sides of the penis. These devices make the penis stiff and cause an erection.
There are 2 types of penile implants:
- Semi-rigid or bendable implants- These are the simplest type of implants made of silicone. The silicone provides the firmness required for penetration during sex and allows manipulation into erect or non-erect positions
- Inflatable implants- One pump and two cylinders are placed in the erection chambers i.e., the corpora cavernosa of the penis which causes erection by releasing saline solution.
The most common cause of penile implant failure is an infection that occurs in less than 2% of men.
Psychological counseling:
For depression, anxiety, or other mental and emotional disturbances the hardening.
Lifestyle changes such as:
- Quitting/ limiting alcohol consumption and smoking
- Following a healthy diet
- Regular exercise
- Adequate sleep and reducing stress
- Treating underlying disorders such as diabetes, hypertension, and high cholesterol
What are the complications of Erectile Dysthe function (Impotence)?
Untreated Erectile Dysfunction can lead to:
- Unsatisfactory sexual life
- Self-esteem.
- Stress, anxiety, and depression
- Strained relationships with the partner
- Inability to get his partner pregnant
How to prevent Erectile Dysfunction (Impotence)?
Erectile dysfunction can be easily prevented by:
- Management of diabetes, hypertension, or other underlying chronic health conditions
- Limiting smoking, alcohol consumption.
- Regular exercise and following a healthy diet. A healthy diet consists of increased whole-grain foods, fruits, vegetables, and low-fat foods and decreasing salt intake.
- Reducing stress. Relaxation processes such as meditation and yoga can help reduce stress drastically. the Counseling and visiting a psychiatrist for depression, anxiety, and other mental health problems.
We hope that we have answered your questions regarding erectile dysfunction (impotence) through this article.
For more information on erectile dysfunction ( impotence ), kindly contact a Urologist.
We only aim to give you information through this article. We do not recommend medication, or treatment in any way. Only a doctor can give you the best advice.
