Let’s Talk: Erectile dysfunction

Erectile dysfunction (ED) is a common problem where a man finds it difficult to get or keep an erection. Also known as impotence. Unfortunately, even though it is often seen as a taboo subject, most men will experience ED at some point in their life. ED can cause relationship problems, embarrassment and low self-esteem, stress and anxiety, and fertility issues for a couple.

Causes of ED are complex. In order to obtain an erection, a man needs to have healthy blood vessels, nerves, male hormones and a desire to have sex.

There are many physical as well psychological causes for ED.

The medical causes can include:

• Diabetes Mellitus
• Heart disease
• High blood pressure
• High Cholesterol
• Parkinson’s disease
• Multiple Sclerosis
• Sleep disorders
• Treatment for prostate cancer or in large prostate
• Surgeries or injuries that affect the pelvis or spinal-cord
• Certain prescription medications
• Low testosterone.

Case study, a patient in his 20s, newly diagnosed diabetic who is suffering with ED in silence. This has been bothering him and he has no idea that this could be related to his diabetes. He is treated with Viagra. Once he understands the cause, he is able to overcome his psychological fears which are making the problem worse. It causes low self-esteem and paranoia about sexual failure. He is much more relaxed and it is no longer a problem.

The lifestyle causes:

• Alcoholism
• Substance abuse
• Smoking
• Obesity

The brain plays a key role in triggering a number of physical events which cause an erection.

Psychological causes play a key role:

• Depression, anxiety and other mental health conditions
• Stress
• Relationship Problems
• Low self-esteem and paranoia about sexual failure

These are estimated to cause between 10% and 20% of ED cases alone.

To diagnose ED there will need to be:

• A full medical history taken including a medical and sexual past history, any prescription or non-prescription drug use
• Physical examination, as bodily features can give clues to the cause
• Laboratory tests can also be key for diagnosing ED
• Further tests such as monitoring nocturnal erection (nocturnal penile tumescence) can help to rule out some causes
• Psychological examination can reveal any psychological factors

Poorly controlled diabetes can lead to damage of nerves and blood vessels caused by poor long term blood sugar control. Erectile dysfunction can also be the first sign of coronary artery disease where plaque builds up in the arteries.

Try to cut down on the cigarette smoking, limit alcohol and stop any illicit drug use.

Regular exercise, a balanced healthy diet, adequate sleep and stress management will all help.

Treating ED

Medications:

There are a number of oral medications that can be prescribed to help improve blood flow to the penis. These include well-known brand names such as:

• Viagra

• Cialis

• Levitra

These medications can affect the heart and interact with other medications. Please consult your doctor before taking.

Alternative treatments include:

Vacuum constriction devices. A pump creates a vacuum that will draw blood into the penis making it erect. A rubber ring will need to placed around the bottom of the penis to keep it erect.

Alprostadil is a form of hormone medication that stimulates blood flow to penis and may be given by two different methods: Intracavernous injection therapy where alprostadil is given by injection into the penis. Intraurethral application where a pellet of alprostadil is inserted into the urethra via a urethral stick.

Psychosexual Therapy

Any underlying psychological factors can be addressed.

Cognitive Behavioural Therapy (CBT) is often used in addressing ED as it is a proactive and actionable therapy targeted at helping you change the way you think and behave. It can be used to address any performance anxiety, low self-esteem, and loss of sexual arousal.

Erectile Dysfunction Moving Forward

There are frequent advances in this field. Better medications, implants, vacuum devices and suppositories have all increased options for men suffering with ED.

Men are renowned for not wanting to talk about feelings, weaknesses or struggles. Erectile dysfunction is a medical condition like any other and needs to be discussed openly. No taboos, no stigma; let’s talk.