Erectile Dysfunction: Symptoms, Causes, Treatments and Side Effects

Since the 1990s, erectile dysfunction (ED) has been recognized as a common disease. Higher rates of reporting, diagnosis, and treatment of ED have been driven by effective treatments, direct to consumer advertising, and screening by physicians.

What is erectile dysfunction?

Erectile dysfunction or disorder (ED) is the inability to achieve and maintain an erection for satisfactory sexual intercourse. Erectile dysfunction or erectile disorders are the preferred medical term as opposed to impotence. There are no signal criteria defining how consistent the problem has to be and for what duration it must be present to considered ED. The diagnostic and statistical manual of mental disorder-5 specifies duration of at least six or more months in its definition of ED.

Signs and symptoms:

Erectile dysfunction is characterized by the regular or repeated inability to achieve or maintain an erection of sufficient rigidity to accomplish sexual intercourse. It is defined as the persistent or recurrent inability to get or maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least six month.

Psychological impact:

Erectile dysfunction often has an impact on the emotional well being of both men and their partners. Many men do not go for the treatment due to feelings of embarrassment. About 80% of treat cases of ED go untreated.

Causes of erectile dysfunction:

Causes of or contributors to ED include the following:

• Prescription medicine (SSRIs, beta blockers, alpha-2 adrenergic receptor agonists, thiazides, hormone modulators, and 5 alpha reductive inhibitors).
• Neurogenic disorders (E.g: diabetic neuropathy, temporal lobe epilepsy, multiple sclerosis, Parkinson’s, multiple system atrophy)
• Cavernosal problems (Example: peyronie’s disease)
• Hyperprolactinemia (E.g causes to a prolactinoma)
• Psychologic due to: performance anxiety, stress, and mental disorders.
• Surgery (e.g radical prostatectomy)
• Aging: it is four times more common in male aged in their 60s than those in their 40s.
• Kidney disorder or failure
• Poor Lifestyle or bed habits, particularly smoking, which is a key risk factor for Erectile Dysfunctions as it promotes arterial narrowing.

Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood circulation. Erectile Dysfunction is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation, although the prostate gland itself is not necessary to get and maintain an erection. As far as inguinal hernia surgery is concerned, in most cases and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of people with preoperative sexual  dysfunction, while, in most cases, it does not affect people with a preoperative or man sexual life. Erectile Dysfunction can also be connected with bicycling due to both neurological and vascular problems due to compression. The increased risk appears to be about 1.7 fold.

Concerns that use of pornography it is one of the primary cause ED, have little support in epidemiological studies, according expert data.

Pathophysiology:

Penile erection is overseen by two mechanisms: the reflex erection, which is accomplished by straightforwardly contacting the penile shaft, and the psychogenic erection, which is accomplished by erotic or emotional stimuli. The previous includes the peripheral nerves and the lower portions of the spinal cord, while the last includes the limbic system of the mind. In the two cases, an intact neural system is needed for a fruitful and complete erection. Stimulation of the penile shaft by the sensory system prompts the emission of nitric oxide (NO), which causes the unwinding of the smooth muscles of the corpora cavernosa (the primary erectile tissue to the penis), and accordingly penile erection. Moreover, satisfactory degrees of testosterone (created by the testes) and an intact pituitary gland are needed for the advancement of a sound erectile system. As can be perceived from the mechanisms of an ordinary erection, barrenness may create because of hormonal inadequacy, issues of the neural system, absence of satisfactory penile blood flexibly or psychological issues. Spinal cord injury causes sexual brokenness, including ED. Restriction of blood flow can emerge from impaired endothelial capacity due to the typical causes related with coronary artery illness, however can likewise be brought about by prolonged exposure to bright light.

Diagnosis:

In many cases, the diagnosis can be made based on the person’s history of symptoms. In different cases, a physical examination and laboratory investigations are done to preclude more serious causes such as hypogonadism or prolactinoma. One of the first steps is to distinguish among physiological and psychological ED. Determining whether involuntary are present is important in eliminating the possibility of psychogenic causes for ED. Obtaining full erections occasionally, such as nocturnal penile tumescence when asleep (that is the point at which the mind and psychological issues, assuming any, are less present), tends to suggest that the physical structures are functionally working. Similarly, performance with manual stimulation, as well as any performance anxiety or acute situational ED, may indicate a psychogenic component to ED. Another factor leading to ED is diabetes mellitus, a notable cause of neuropathy). ED is also related to generally poor physical wellbeing, poor dietary habits, obesity, and most specifically cardiovascular disease, such as coronary artery disease and peripheral vascular disease screening for cardiovascular risk factors, such as dyslipidemia, hypertension, smoking and alcoholism is useful. In some cases, the simple search for a previously undetected groin hernia can demonstrate useful since it can affect sexual functions in men and is relatively easily curable. The flow diagnostic and statistical manual of mental disease (DSM-IV) lists ED:

• Ultrasonography: Penile ultrasonography with Doppler can be utilized to analyze the erect penis. Most instances of ED of organic causes are identified with changes in blood flow in the corpora cavernosa, spoke to by occlusive artery disease (in which less blood is permitted to enter the penis), frequently of atherosclerotic origin, or because of failure of the Veno-occlusive mechanism (in which an excess of blood circulates back out of the penis). Before the Doppler sonogram, the penis should be examined in B mode, to identify possible tumors, fibrotic plaques, calcifications, or hematomas, and to assess the presence of the cavernous arteries, which can be tortuous or atheromatous.
• Other workup methods:

1. Penile nerves function: Tests such as the bulbocavernosus reflex test are utilized to ascertain whether there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which promptly makes the anus contract if nerve work is typical. Physician measure the latency among squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger in the anus.
2. Nocturnal penile tumescence (NPT): It is typical for a man to have five to six erections during sleep, particularly during rapid eye movement (REM). Their nonattendance may show an issue with nerve capacity or blood supply in the penis. There are two methods for estimating changes in penile rigidity and circumference during nighttime erection: snap gauge and strain gauge. A critical extent of men who have no sexual dysfunction nonetheless don’t have ordinary nighttime erections.
3. Penile biothesiometry: This test utilized electromagnetic vibration to evaluate sensitivity and nerve function of the glans and shaft of the penis. Dynamic infusion cavernosometry (DICC) Technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.
4. Corpus cavernosometry: Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is imbued under tension into the corpus cavernosum with a butterfly needle, and the flow rate required of venous spillage. The spilling veins might be visualized by infusing a mixture of saline and x-ray contrast medium and playing out a cavernosogram. Digital subtraction angiography (DSA), the pictures are procured digitally.
5. Magnetic resonance angiography (MRA): This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to give nitty gritty images of the blood vessels. The specialist may infuse into the patient’s bloodstream a contrast agent, which causes vascular tissues to stand out against different tissues, so that data about supply and vascular anomalies is easier to gather.

Treatment of erectile dysfunction:

Treatment depends on the underlying reason. When all is said in done, work out, especially of the aerobic type, is viable for forestalling ED during midlife. Counseling can be utilized if the underlying reason is psychological, including how to lower stress or anxiety identified with sex. Medications by mouth and vacuum erection gadgets are first-line treatments, trailed by injections of medications into the penis, just as penile implants. Vascular reconstructive surgeries are advantageous in specific gatherings. Treatments, other than medical procedure, don’t fix the underlying physiological issue, yet are utilized varying before sex.

Medications for erectile dysfunction:

The PDE5 inhibitors like:

• Sildenafil (viagra),
• Vardenafil (levitra)
• Tadalafil (cialis) etc.

Are prescription drugs which are taken by mouth. Starting in 2018, sildenafil is accessible in the US without a prescription. Also, a cream combining alprostadil with the saturation enhancer DDAIP has been affirmed in Canada as a first line treatment for ED. Penile injections, then again, can include one of the accompanying medications:

• Papaverine
• Phentolamine
• Prostaglandin E1 etc.

In addition to injection, there is an alprostadil suppository that can be inserted into the urethra. Once inserted, an erection can begin within 10 minutes and last up to an hour. Medications to treat ED may cause a side effect called priapism.

Testosterone: men with low levels of testosterone can experience ED. Taking testosterone may help keep up an erection. Men with type 2 diabetes are twice as prone to have lower levels of testosterone, and are three times bound to experience ED than non-diabetic men.

Pumps:

a vacuum erection device assists draw with blooding into the penis by applying negative pressure. This sort of device is once in a while alluded to as penis pump and may be utilized only before sexual intercourse. Several kinds of FDA approved vacuum therapy devices are available under prescription. At the point when pharmacological methods fail, a planned external vacuum pump can be utilized to attain erection, with a separate compression ring fitted to the base of the penis to maintain it. These pumps should be distinguished from other penis pumps (provided without compression rings) which, rather than being utilized for temporary treatment of impotence, are claimed to increase penis length whenever utilized habitually, or vibrate as an aid to masturbation. All the more drastically, inflatable or unbending penile implants may be fitted surgically.

Surgery:

Regularly, if all else fails, if other treatments have failed, the most well-known strategy is prosthetic implants which include the insertion of artificial rods into the penis. A few sources show that vascular reconstructive surgeries are viable choices for certain people.

Alternative medicine:

The food and drug administration (FDA) doesn’t prescribe alternative therapies to treat sexual dysfunction. Numerous products are advertised as “herbal Viagra” or “natural” sexual enhancement products, however no clinical trials or scientific studies uphold the adequacy of these products for the treatment of ED, and synthetic chemical compounds like sildenafil have been found as adulterants in huge numbers of these products. The FDA has cautioned consumers that any sexual enhancement item that claims to work just as remedy products is probably going to contain such impurity.

How side effects of erectile dysfunction medicine affect a patient:

ED drugs that you take by oral, through an injection, or as a pellet in the urethra can have side effects, including a lasting erection known as przepis. Go to a health care provider right away if an erection lasts 3 hours or longer.

A small number of male have skin allergy, abdominal pain, fever, blood in stool, vision or hearing loss etc after taking oral ED medicines. Go to your health care provider  as soon as possible if you develop these problems.