The prevalence of erectile dysfunction (ED) among men is growing due to stress and changing lifestyle habits. Erectile dysfunction is a common complaint in men with aging. But, what is concerning more is that adults younger than 40 also experience ED. According to research, around 14% of healthy men under age 40 have complaints of erectile dysfunction. The prevalence increases up to 50% in men over age 50. Many men don’t share their symptoms as they feel embarrassed, which can worsen the condition.
What is erectile dysfunction (ED)?
If a man frequently has a problem getting or maintaining an erection enough for sexual intercourse, it can be due to erectile dysfunction. Although ED is a fairly common problem men face from time to time, if you frequently encounter it, talk to your healthcare provider for proper guidance. As sometimes, erectile dysfunction occurs due to underlying health conditions.
What are the symptoms of erectile dysfunction?
As the name suggests, people with erectile dysfunction have problems with erections. A person with erectile dysfunction may experience the following symptoms:
- Difficulty in getting an erection at the start
- An inability to maintain an erection for enough time for sexual intercourse
- Immediately loss of erection after penetration
- Dissatisfying sexual intercourse
- Loss of interest in sexual activities
- Decrease in self-esteem
- Emotional distress includes anger, irritability, sadness, or even feeling less masculine.
What are the causes of erectile dysfunction?
Several factors contribute to a healthy erection, such as nerves, blood vessels, hormones, and psychological health, and when any problem with these factors can lead to erectile dysfunction.
There are times when men may experience difficulties with their erection, which are:
- Physical factors:
- Age; developing erections and keeping them firm might be strenuous as you get older
- Too much workload
- Excessive alcohol consumption
- Relationship difficulties
- Tobacco overuse
- Illicit drug abuse. Marijuana, cocaine, and opiate overuse can increase the chances of erectile dysfunction.
- Difficulty in falling and maintaining sleep
- Psychological factors: The brain plays a crucial role in sexual excitement and erection events. Therefore, the following psychological issues can trigger erectile dysfunction:
- Chronic stress and anxiety
- Poor communication with partner
- Low self-esteem
- Guilt about sexual performance
- Medical issues: Various medical conditions can lead to erectile dysfunction, such as:
- Low testosterone levels
- High cholesterol levels
- High blood pressure levels
- Atherosclerosis or clogged cardiac vessels
- Cardiovascular diseases
- Chronic kidney disease
- Multiple sclerosis
- Enlarged prostate
- Prostate cancer and its treatment after-affects
- Surgery or trauma in the pelvic area
- Peyronie’s disease, in which scar tissues develop inside the penis
- Certain medications, such as antidepressants, tranquilizers, antiandrogens, hormone therapy, anti-seizure pills, chemotherapy, and blood pressure drugs, can cause ED.
Which factors increase the risk of erectile dysfunction?
Erectile dysfunction can occur in any man at any age due to various factors. The following are some factors that increase the chances of ED:
- Smoking constricts the blood vessels and can cause erectile dysfunction over time.
- Excessive alcohol drinking
- Stress, excess worrisome, and depression
- Chronic health conditions, such as diabetes and cardiovascular diseases
- Radiotherapy treatment for prostate cancer or nearby organs
- Prostate cancer
- Surgery of the men’s reproductive area can damage blood and nerve supply that can cause ED.
- Long-term illicit drugs use
- Various medications can cause ED as a side effect, such as antihistaminics, antidepressants, muscle relaxants, antihypertensive, diuretics, and pain killers (NSAIDs).
How can a doctor diagnose erectile dysfunction?
The doctor may perform the following test to diagnose ED:
- Thorough questionnaire about your symptoms, frequency, medical history, psychological condition, drug abuse, drinking or smoking habits, and relationship problems.
- Physical examination: The doctor may carefully inspect the nerve supply of your penis and testicles.
- Blood test: A doctor can send your blood sample to a lab to investigate hormone levels (testosterone and prolactin), heart disease, diabetes, the presence of illegal drugs, and other health condition.
- Urinalysis: Through urine tests, a doctor can know about testosterone levels, medical conditions, and kidney ailments.
- Lipid profile: High cholesterol levels can indicate atherosclerosis, which may affect penis blood circulation.
- Liver and kidney function test: They can detect any abnormalities in kidney or liver functions that can cause ED.
- Duplex ultrasound: It provides better imaging to confirm ED. A doctor performs an ultrasound to check the blood flow and analyze atherosclerosis, tissue scarring, or a venous leak. A doctor can perform a duplex ultrasound in both conditions while the penis is erect and soft.
- Penile biothesiometry: The electromagnetic vibrations during this test can determine sensitivity and nerve functioning.
What are the treatment modalities of erectile dysfunction?
The doctor may prescribe an appropriate treatment based on your symptoms and severity of ED, which includes:
- Psychological counseling: The doctor may help you overcome stress, depression, and abnormal sexual behaviors.
- Lifestyle modifications: Regular exercise, quitting smoking, treatment of drug overuse, and limiting alcohol consumption can improve the ED.
- Medications: A doctor may prescribe various drugs to help ED.
- Penile injection therapy: Intracavernosal injections may be effective in various erection issues caused by nerves and blood vessel conditions.
- Hormone replacement therapy: Over-the-counter hormone replacement as topical gels, creams, pellets, and patches, can be effective in ED, but you should use them after a doctor’s recommendation.
- Mechanical devices: The doctor may prescribe various aids, such as penile constriction rings or a vacuum device, to help maintain an erection.
- Surgery: The doctors may suggest surgical intervention when other treatments are not improving the condition. Surgically-placed penile implants (inflatable or malleable) can improve ED.
Adapting a healthy lifestyle, regular exercises, a positive mental approach, and maintaining chronic health conditions may prevent and improve erectile dysfunction. But, if you are facing frequent encounters, talk to your healthcare provider.
Dr. Mayank Gupta, Director & Senior Consultant – Urology & Kidney Transplant, Dharamshila Narayana Superspeciality Hospital, Delhi