Erectile Dysfunction: Causes, Symptoms, and Treatment

Posted on : June 9, 2021 by Clinic One on Sexual Health

Erectile dysfunction refers to a condition that relates to the inability of men to achieve desired sexual performance due to affliction in the male genital organ. In other words, it specifically refers to the inability of males to keep a firm and erect penis for proper sexual intercourse.

Even though it is not seen as a common condition, but the interest in the subject has been widely prevalent amongst our society and all through the ages since it could bring impotency among those who suffer.

Generally speaking, erectile dysfunction is experienced during times of stress which may be stemming from the emotional and relationship difficulties that affect two major components of male erection namely psychogenic and reflex erection.

Hence, erectile dysfunction is a medical condition that can range from mild, moderate to severe ailment and needs to be addressed by a health care professional.

Firstly, we need to understand how a penis (male reproductive organ) gets erected to reflect on this condition. Male erection is largely based upon the blood flow through penile arteries that fills up the chambers inside the penis making it rigid and erect.

Nevertheless, this increased blood flow occurs as a result of sexual and emotional excitement. Thus, impairment in any of these processes involved such as emotional, vascular, and psychological health and wellbeing may consequently lead to erectile dysfunction.

Therefore, male aging is considered as one of the major parameters that include the onset of this disease because emotional, vascular, and psychological health is down-regulated when people age.


Prevalence in Nepal and Worldwide

Few studies that have been aimed at discriminating the demographics involved for this condition of erectile dysfunction indicate the higher prevalence in the United States and eastern and southeastern Asian countries as compared to Europe and South America.

The main differences are accounted for cultural and socio-economic background of these regions evaluated but more studies are needed to identify exactly the nature of genetic influences from environmental impact.  


But on the other hand, the hesitancy in seeking professional help in the case of a psycho-sexual problem such as erectile dysfunction is contributing to the low rate of identification and thereby documentation of this condition in a country like Nepal.


This is in large part attributed to the socio-cultural background of a country like Nepal that regards the discussion on a psycho-sexual problem as taboo which consequently affects its proper diagnosis and treatment. 

Nevertheless, a hospital-based survey on psycho-sexual disorder with special emphasis on (erectile dysfunction) in diabetic patients with type-2 diabetes mellitus done by a teaching hospital in eastern Nepal reveals that 48% of male patients out of 100 type 2-diabetes patients aged above 50 and married had erectile dysfunction.

This surely is not enough sample size to certainly conclude about this condition but in correlation to the study conducted globally, Nepal certainly lies in the hotspot for the higher prevalence of this disease is the part of a cluster of south Asian country.


Causes of Erectile Dysfunction

Two major aspects of male erection namely reflex erection and psychogenic erection have been attributed to erectile dysfunction in males. While the reflex erection is achieved by direct stimulation of the penile shaft and is under the control of peripheral nerves along with the lower part of the spinal cord on the other hand psychogenic erection is due to the erotic and emotional stimuli and hence controlled by the limbic system of the brain.

While, erectile dysfunction was in the past thought to be pure psychogenic in origin, but new research and evidence point to the contrary and attributes almost 80% of the cases to have organic (endocrine and non-endocrine) origins. Here, endocrine factors are related to reduced serum testosterone levels (a male hormone produced in testes), while on the other hand, non-endocrine etiologies which are considered more commonly affect the blood supply and thereby are vasculogenic.

Nevertheless, neurogenic origins relating to nervous function during times of stress cannot be disregarded, which may have a psychological component to it, stemming from low-quality emotional and physiological relationships. But more importantly, cardiovascular events often act as an early marker for men who tend to be prone to erectile dysfunction.   

A list of many possible causes for erectile dysfunction in males can be attributed to one of these conditions listed here.

For example, cardiovascular disease, diabetes, hypertension or high blood pressure, high cholesterol levels and obesity, low testosterone levels or other hormonal imbalances, stress, anxiety, depression, relationship problem, long term use of certain medications such as those used for depression or high blood pressure, sleep disorder, prolonged drug use, alcohol use, tobacco use, certain health conditions such as Parkinson’s disease or multiple sclerosis, etc. 

Since many factors can be the cause of erectile dysfunction, hence it is wise to consult your physician to rule out some factors and hone into specific causes to get the appropriate treatment for your condition.


Who are at risk of erectile dysfunction?

One of the most valuable studies in elucidating the epidemiology of erectile dysfunction according to the age group and population demography has been given by Massachusetts Male Ageing Study (MMAS).

The results of the study conducted by (MMAS) suggest that older males are more prone to mild and moderate cases of this disease.

In other words, this condition is estimated to be prevalent amongst 52% of men aged (40-70) years, and the susceptibility is directly correlated to age, health status, and emotional function. 

Similarly, considering the total male population in general, it was estimated to be prevalent in over 150 million males worldwide in 1995 and the numbers were estimated to increase to 320 million in 2025 as per one of the studies carried out by Ahmed et al.

This is an obvious sign of poor lifestyle choices and unhealthy living which thereby affects the individual’s mental, and physical health leading to erectile dysfunction.

But to cut it short, it’s the older male from the age group (40-70) who are at greater risk of having this disease.


How is erectile dysfunction transmitted?

As erectile dysfunction in itself is not a contagious disease, but the sexually transmitted disease (STD’s) could lead to erectile dysfunction.

In other words, certain sexually transmitted diseases such as gonorrhea, chlamydia, untreated HIV, viral hepatitis could lead to infections in prostate glands and this, in turn, could lead to symptoms of erectile dysfunction in males.

If this is the case for you, managing your sexually transmitted infection (STI’s) along with treating your prostate gland will be necessary to resolve your erectile dysfunction. 

Symptoms of erectile dysfunction

Some tell-tale symptoms of erectile dysfunction in males include

  • Problems getting and/or keeping an erection
  • Decreased or unsatisfactory sexual life or desire
  • Unsuccessful attempts to pregnancy
  • Low self-esteem and depression


How to prevent erectile dysfunction?

Healthy living and managing your fitness level along with maintaining existing health conditions that may be involved in erectile dysfunction is certainly the best way to prevent erectile dysfunction.

While to name a few, here are few measures that could be noted to mitigate the ill effects of this disease.

  1. Firstly, it’s wise to work with a doctor to manage other health conditions that may be associated with your erectile dysfunction, for example, diabetes, heart problems, or other chronic health condition.
  2. A good place to start would also be to stop smoking, drinking alcohol, or using illegal drugs.
  3. Regular exercise and other forms of reducing mental stress such as yoga and meditation are very helpful.
  4. But if your mental health is not up to the mark and deteriorating it wise to get professional help especially for anxiety, depression, and so on.


When to see a doctor?

It will be advised for you to see a doctor if

  1. If you have worries about getting or keeping your erection.
  2. If you are having inadequacies in your sexual experiences such as premature or delayed ejaculation.
  3. If you have diabetes, heart problems, or other health condition that is linked to erectile dysfunction in any case or symptoms for it.


What are the treatments for erectile dysfunction?

It all starts with adopting healthy lifestyle habits to improve your fitness level so that, in turn, it could improve your vascular health and heart condition.

This is because the majority of erectile dysfunction cases are related to vascular health and therefore it is vital to keep your heart health in good shape.

Additionally, your doctor could point out the exact nature of the risk factor involved which might be very helpful in improving your condition related to erectile dysfunction.

These may include,

  1. Changing certain food habits
  2. Quitting smoking, alcohol use, or illegal drug use
  3. Improving your work-out routines or introducing one if you haven’t already
  4. Consulting a therapist to improve on your emotional and psychological problems if any, for example, depression, anxiety, relationship problems, or life stressors. These may well be getting in the way of your sexual health and specifically erectile dysfunction.

Nevertheless, some other ways of treating erectile dysfunction with medication and more as advised by your physician, when changing lifestyle choices do not work are listed below.

  • Testosterone Therapy (when your blood tests for low testosterone)
  • Penile Injections 
  • Intra-urethral medication 
  • Vacuum Erection Devices
  • Penile Implants
  • Bypass surgery to penile artery damage in the case of a younger male with a case history of pelvic trauma.
  • Oral drugs such as Viagra, Levitra, Cialis, are recommended for use before a couple of hours of having sex.


References:

  1. Ahmed, A. Alnaama, K. Shams and M. Salem (2011), Prevalence and risk factors of erectile dysfunction among patients attending primary health care centers in Qatar, Eastern Mediterranean Health Journal, Volume 11
  2. Alana Biggers (M.D, MPH) (2019) Everything you need to know about erectile dysfunction (ED), Health line magazine
  3. Faisal A Yafi et. al. (2016), Erectile Dysfunction, Journal: Nat Rev Dis Primers (2: 16003)
  4. Shakya DR et al (2020), Psycho-sexual disorders in clinical diabetes mellitus patients of a teaching hospital of eastern Nepal, Journal of Diabetes and Endocrinology Association of Nepal 4 (2), pp (19-23)
  5. Urology Care Foundation (2018) Article, Erectile Dysfunction

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