What is Erectile Dysfunction?

The sexual condition, erectile dysfunction is also referred to as ‘impotency’ and is marked by symptoms like:

• Inability to achieve optimal erection necessary to perform sexual intercourse
• Lack of capacity to maintain normal erection throughout the act of intercourse

It is imperative to keep in mind that occasional episodes of erectile difficulty are physiological even in young healthy males. The prevalence of ED in general population is 5 to 15%; however, with advancing age, the risk of ED increases significantly (up to 47% in males over 75 years of age). Research and clinical data indicates that excessive physical exertion, mental pressure, excitement or nervousness can significantly affect sexual performance and may lead to transient ED, but most cases resolve with lifestyle modification and nutritional changes.

According to the latest estimates reported by National Kidney and Urologic Diseases (2), more than 30 million Americans are currently living with moderate to severe ED that warrants pharmacological or surgical management.

 

What Causes Physiological Erection?

Erection is a product of optimal hormonal, nervous and vascular symphony that allows maximum engorgement of penile sinuses and vessels with blood. The process of erection can be summarized in 3 steps:

• Relaxation of penile tissues (especially corpora cavernosa) in response to sexual thoughts or stimuli. This phase requires active involvement of parasympathetic nervous system.
• Accelerated inflow of blood to the inguinal region.
• Accumulation of blood in the sinuses leading to rigidity and erection of penis.

Physiologically, the erection ends after ejaculation (or contraction of penile tissue) that allows the release of accumulated blood from the cavernous sinuses. However, any pathology or disease condition that promotes premature contraction of cavernous tissues or loss of blood pooling can present as erectile dysfunction or other sexual disorders.

 

What Causes Erectile Dysfunction?

 

1. Systemic Disorders:

As discussed above, any disease condition that affects the health of blood vessels can aggravate the risk of ED. In most cases, ED is one of the earliest manifestations of vascular damage due to uncontrolled and chronic systemic disorders; such as:

• Diabetes
• Hypertension
• Advanced atherosclerosis
• Cardiovascular dysfunction
• Damage to inguinal region due to traumatic injury, surgery etc.

2. Mental Health Issues:

A lot of individuals are under the impression that erectile dysfunction is always a complication of long term systemic health issues, which is not true. In fact more than 50 to 55% cases of ED are due to psychological or psycho-social issues that needs to be addressed before initiating pharmacological management:

Most frequently reported psychological causes of erectile dysfunction are stress, anxiety and mood disorders, degenerative brain disorders and psychological issues (such as schizophrenia, paranoia, phobias, obsessive compulsive disorder etc.)

Some rather common causes of ED (that are often ignored by individuals and physicians) are:

• Unemployment: Stress and emotional pressure can greatly affect a man’s capacity to get sexually stimulated. In a time like now, when economy is ever falling and job market is uncertain, men are at a much higher risk of developing depression which may affect their performance in bed.
• Marital Discord or Conflicts With the Partner: Negative relationships and unnecessary conflicts affects your emotional status negatively. It can affect the libido (sexual desires), stamina and orgasms. In severe cases, erectile dysfunction and premature ejaculation is also reported.
• Self-Esteem: Individual must feel good about his appearance to be able to perform well in the bed. Poor self-esteem or poor image of the self affects the sexual performance and may lead to erectile dysfunction due to anxiety, stress and emotional pressure.

3. Lifestyle or Habits that May Worsen or Cause Erectile Dysfunction:

A healthy adult male requires physical as well as mental energy to achieve and maintain normal erection.  Healthcare providers believe that a healthy lifestyle can play a vital role in maintaining normal sexual relations. Poor habits and health choices on the other hand can worsen or deteriorate sexual health. Some statistically significant lifestyle choices include:

• Excessive alcohol consumption
• Chronic history of smoking
• Use of illicit drugs
• Use of pharmacological prescription drugs
• Chronic exposure to heavy metals or reactive oxygen species (such as radiations)

 

How to Manage Erectile Dysfunction?

• Mild to moderate cases of erectile dysfunction responds fairly well to oral over-the-counter agents like phosphodiesterase inhibitors (Viagra or sildenafil or similar agents).
• Most cases of Ed due to systemic dysfunction are hard to manage with pharmacological regimens alone and may require the use of assistive devices or penile pumps.
• If the cause of erectile dysfunction is a pharmacological or anti-psychotic drug, dose modification is usually helpful. Alternatively, you can always ask your healthcare professional to choose other therapeutic or pharmacological options for the management of symptoms. Ideal antidepressants that are least likely associated with sexual dysfunction are nefazodone, bupropion, mirtazapine and reboxetine.
• Addition of drugs like 5-phosphodiesterase inhibitors or mianserin and/or mirtazapine to the pharmacological regimen with your doctor’s advice is also recommended by investigators (4).

Other popular options include:

• Surgical implants
• Psychotherapy/ behavioral counseling
• Stress/ anxiety alleviating remedies
• Hypnotherapy

To conclude, poorly addressed erectile issues can significantly affect the quality of life and may compromise the integrity of relationships. It is therefore highly recommended to speak to your primary care provider for early assessment and prompt management of systemic or mental health issues that are contributing to ED.

 

References:

1. Selvin, E., Burnett, A. L., & Platz, E. A. (2007). Prevalence and risk factors for erectile dysfunction in the US. The American journal of medicine, 120(2), 151-157.
2. http://kidney.niddk.nih.gov/KUDiseases/pubs/ED/index.aspx
3. 3. Andersson, K. E. (2011). Mechanisms of penile erection and basis for pharmacological treatment of erectile dysfunction. Pharmacological reviews, 63(4), 811-859.
4. Taylor, M. J., Rudkin, L., Bullemor-Day, P., Lubin, J., Chukwujekwu, C., & Hawton, K. (2013). Strategies for managing sexual dysfunction induced by antidepressant medication. Cochrane Database Syst Rev, 5.