All you need to know about Erectile Dysfunction
Last updated date: 14-Feb-2022
12 mins read
Erectile dysfunction definition
Erectile dysfunction, which is also referred to as ED, is a health condition that can make men incapable of getting or keeping an erection strong enough in order to engage into sexual intercourse.
Erectile dysfunction can affect a man in the short-term as well as in the long-term. You might be diagnosed with erectile dysfunction if you:
- Are able to get an erection from time to time, but you cannot control it, in order to keep it firm;
- Are able to have an erection, but it is not enough in order to get and offer satisfactory intercourse;
- Are mostly incapable of having an erection when you want to.
Erectile dysfunction can be treated by both general practitioners and urologists. Even if erectile dysfunction is a common health condition, ageing is not a reason for its debut. Erectile dysfunction can actually point to a wide variety of other health problems.
Erectile dysfunction can often be referred to as impotence, but impotence is a term that does not have a medical value, therefore, it is not normally used by doctors, in order to avoid confusion.
Physiology of erection
In order to get an erection, there is a whole ongoing process, which involves different parts and organs of the body. Until the visible effect of erection,nerves endings have to release chemicals that are needed to increase blood flow to the genital organ. The penis has two chambers where blood flows into. These chambers are made of spongy muscle tissue (the corpus spongiosum).
While the penis is erecting, the spongy tissues are not contracting as they are relaxed and they form blood traps. The blood pressure from these chambers make the penis firm during erection. Moreover, during orgasm, men have a second set of nerves that are responsible for both the penis’ muscular contractions and the release of blood back to the body, in order to finish the erection.
Furthermore, the size of the masculine genital organ might increase or decrease due to exposure to cold or warmth and it is a normal reflex. This means that in some moments, the penis receives more blood than in others, based on the exposure to coldness or warmth.
Erectile dysfunction symptoms
The main symptom of ED, which is also the most bothersome one, is that the sexual functionality of the genital organ is considerably altered.
The effects of erectile dysfunction are reflected into the man’s daily life. These could powerfully affect the man’s daily activities and alter his motivation. Therefore, if you are experiencing erectile dysfunction, you might start to have a lower self-esteem, as you might consider yourself incapable of having a normal life.
After the self-esteem bar gets lower, there is another problem that men suffering from erectile dysfunction normally experience. Depression. Though depression and erectile dysfunction can work both ways, meaning that erectile dysfunction can cause depression and depression could also be a cause for erectile dysfunction, depression can seriously alter life quality. Therefore, life quality is affected beyond sexuality as it could also alter the social life and work.
Moreover, due to the feeling of inability in sexual life, there might appear tensions and distress. This could lead to serious relationship or even marriage problems.
When the inability of getting an erection happens frequently, either the general practitioner or the urologist can help you improve the situation.
Erectile dysfunction causes
There are many causes for erectile dysfunction. The most important and serious cause for erectile dysfunction could be related to heart conditions. Heart problems that could lead to erectile dysfunction could be high blood pressure or other cardiovascular conditions. Multiple studies show that men that suffer from erectile dysfunction are at high risk of getting a stroke, heart attack or even blood circulation problems in the legs. Also, erectile dysfunction can be related to emotional issues.
Other common causes for erectile dysfunction are related to age and unhealthy lifestyle. The men whose daily routine includes smoking and use of alcohol and drugs could be heavily affected by ED, as well as those men that are overweight and avoid exercising.
Moreover, erectile dysfunction and diabetes are strongly related, as diabetes can also be an important factor in the incidence of erectile dysfunction. Almost 75% of men who suffer from diabetes are also affected by erectile dysfunction, due to damaged peripheral blood vessels and nerves caused by poor blood sugar control.
The main diseases that can cause erectile dysfunction are:
- Chronic kidney disease;
- Heart disease;
- High blood pressure (hypertension);
- High cholesterol;
- Low testosterone;
- Metabolic syndrome;
- Multiple sclerosis (MS);
- Parkinson’s disease;
- Peyronie’s disease;
- Sleep disorders.
As you see, the causes of erectile dysfunction are divided into two main categories:
Physical Causes and Psychological Causes
The physical causes of erectile dysfunction are mostly due to heart problems. In order to keep the erection, the penis needs to trap more blood. The more blood the penis traps, the stronger the erection is. Therefore, the erection is strongly tied to blood flow, which can be altered by heart conditions, hardened arteries, smoking, or high blood sugar. Also, erectile dysfunction can be due to the inability of nerve signals to reach the penis. The penis’ nerves can be also altered on account of injury or surgery in the pelvic area, cancer treatments or radiation. Cancer treatment, radiation and other surgeries can affect the nerves of the penis, even if they were performed in upper parts of the body, such as the abdomen. Moreover, an external factor of erectile dysfunction is represented by drugs. Therefore, it is very important to talk to a specialist before the intake of any medicine.
Emotional causes of erectile dysfunction could also be many, and they could differ from person to person, but there are many causes in common between men that are experiencing erectile dysfunction.
Erectile dysfunction psychological problems are depression, anxiety, stress at work or stress at home, conflictual relationships, stress or fear from social, cultural or religious conflicts, or even low self esteem, so those who worry about their sex performance tend to be proner to erectile dysfunction.
How is erectile dysfunction diagnosed?
In order to correctly apply a diagnosis, the medical team will check your health history and will ask you multiple questions in regards to your environment, lifestyle, health and the actual symptoms.
Therefore it is very important to speak openly to your doctor. So, if the doctor asks questions that seem uncomfortable or questions for whose true answers you are not proud of, you must speak the truth.
The doctor can ask you questions like:
- Do you have any other health problems?
- Do you take any prescribed medicines, over-the-counter ones or supplements?
- Are you using recreational drugs?
- Are you a smoker?
- Do you drink alcohol? If yes, how much alcoholic drinks are you drinking and how often?
- Have you ever had surgical interventions in the pelvis area?
- Have you noticed urinary problems?
Afterwards, the doctor will start asking about the erectile dysfunction symptoms that you have noticed and about your life environment, in order to filter out or in possible external factors that cause your erectile dysfunction. Even if this questionnaire may feel like entering into your private life, it is very important to keep being honest, as it will help you solve the situation more effectively.
Questions that you can be asked by your doctor at this stage often include:
- When did the symptoms start? Was it gradually or all at once?
- Do you wake up with erections?
- Is your sex drive or arousal affected?
- Do you have erection problems during sexual intercourse?
- Is there, lately, something special happening in your life that has stressed you?
- Is your daily life stressful?
- Do you suffer from depression or a mental health problem?
- How is the relationship with your partner?
The next step is a physical exam. The doctor will perform a physical check of your overall health , but it will focus on the area affected by erectile dysfunction, therefore, the doctor will check your penis and testicles. Depending on your age, this physical check will also verify the heart and blood system. Moreover, based on your family medical history, a rectal exam will also be performed to test the prostate. These medical examinations are not painful.
Erectile dysfunction tests are always performed after the physical exam. This lab test will be based on a sample of your blood and a sample of your urine. The purpose of this test is to find out if you are suffering from other conditions that can cause erectile dysfunction.
Other tests that offer a more detailed perspective in regards to erectile dysfunction can be performed. These tests can be:
- Ultrasonography – it checks the blood flow
- Blood tests – it checks the testosterone level, as well as other hormones specific to men;
- Nocturnal penile tumescence (NPT) – it checks the erection during sleep;
- X-rays of the pelvic area, such as arteriography, MRI or CT scanning, but these are very rarely performed in case of erectile dysfunction. These tests are usually performed when there is a history of trauma or cancer.
Can erectile dysfunction be cured?
Depending on the cause of erectile dysfunction, it can be curable. Some causes of erectile dysfunction might be easier to cure than others. If the erectile dysfunction and its cause are correctly diagnosed and using an effective treatment, there are high chances of cure.
Erectile dysfunction treatment
Treating erectile dysfunction normally starts by improving the heart and vascular health. Moreover, if you start the erectile dysfunction treatment, you must adopt new and healthier food habits, stop smoking, drinking and the use of drugs and start working out as often as possible.
The doctor might suggest treating emotional problems as well. These emotional problems, such as depression, anxiety or other life stressors, could strongly influence erectile dysfunction.
At first, the doctor will try to apply to you one of the best known non-invasive treatments. These treatments are known to be safe and effective. Before starting, you should be totally aware of the possible side effects of the chosen treatment. The best erectile dysfunction treatment options are:
- Medicines, such as phosphodiesterase, type-5 inhibitors that are for oral intake or PDE5 inhibitors, such as Viagra, Levitra, Cialis or Stendra, that are also for oral intake and increase the blood flow and which represent the most known erectile dysfunction medication.
- Testosterone Therapy;
- Penile Injections;
- Intraurethral medication;
- Vacuum Erection Devices;
- Penile Implants.
PDE5 inhibitors are one type of the used medicine for erectile dysfunction and they should be taken about an hour to an hour and a half before having sex as they improve blood flow into the penis. The PDE5 inhibitors need normal nerve function, in order to be effective. More than a half of those that suffer from erectile dysfunction consider they have firm erections after intaking PDE5 inhibitors. Unfortunately, those who suffer from both erectile dysfunction and another disease, such as Diabetes or Cancer are less likely to find this treatment effective.
In some cases, a surgical intervention is performed in order to bypass the penile artery damage. This procedure is usually performed on younger men that have a history of severe pelvic trauma and it is not recommended for older men, as they have hardened arteries.
The side effects of treating erectile dysfunction with PDE5 inhibitors are usually short and they can be mild. The side effects of PDE5 inhibitors are related to their effects on the body tissues, as they are working to increase blood flow toward the penis and they might affect other vascular tissues, as well. Some of the side effects of this type of treatment are:
- Stuffy nose;
- Facial flushing;
- Muscle aches;
In extremely rare cases, Viagra can alter your vision, but just for a short time. Furthermore, the medicine Cialis can cause back pain, or aching muscles in the back area.
In case you are already using nitrates for treating a heart condition, you must not intake any PDE5 inhibitors, as it might be very harmful.
Testosterone therapy is applied, when it is discovered that the erectile dysfunction and the decreased sex drive are caused by low blood levels of testosterone. This therapy also includes PDE5 inhibitors, in order to fix erections.
The erection device is a plastic tube that covers the penis and it seals with the skin of the body. This pump creates a low-pressure vacuum around the erectile tissue, resulting in an erection. After the removal of the pump, an elastic ring is slipped to the base of the penis, which helps in trapping the blood and maintaining the erection for up to even 30 minutes. 75% of those who suffer from erectile dysfunction and try this method to get an erection succeed.
Erectile dysfunction surgery
The surgical intervention in case of erectile dysfunction consists of putting inflatable or flexible rods in the penis. The inflatable rods need a device that is filled with saline solution and a pump that is well hidden in the scrotum. Therefore, when the pump is pressed on, it pushes the saline solution to the rod and it inflates it, a process that results in an erection. The device can also be deflated. The resulting erection is suitable for intercourse. About 90% of those who had the surgery performed reported that they are satisfied, as the device mimics a natural erection that does not alter sensations nor orgasm.
This procedure is applicable to only those men who have tried other treatments and didn’t succeed.
Approximately 95% of penile implants are successfully performed.
Though the success rate of surgical intervention is high, tt risks of infection,bleeding or scar tissue formation after surgery still exist. Also, in very rare situations, mechanical failures can occur that need another surgical intervention in order to repair, remove or change the device.
Erectile dysfunction foods
Foods influence our daily life and health more than we think. Vegetables and fruits, for example, have different substances in their composition that help many different body processes. For example, for those who suffer from erectile dysfunction, the best foods and drinks they can consume are:
- Spinach – it boosts testosterone levels and it also increases folic acid levels which, if low, can cause erectile dysfunction;
- Coffee – it is scientifically proven that caffeine helps improving blood flow;
- Avocado – it is rich in Zinc and Vitamin E, which, respectively, increase testosterone levels and imporoves sperm quality; Chili peppers – they contain capsaicin, which can boost up sex drive;
- Chili peppers – they contain capsaicin, which can boost up the sex drive;
- Oatmeal – it contains an amino-acid, L-arginine, which is known to treat erectile dysfunction, as it helps the penile blood vessels loose and stimulate the erection.
Erectile dysfunction exercises
The first-line of treatment in case of erectile dysfunction consists of pelvic exercises, or Kegel exercises, which are considered to be very effective. The penis is surrounded by the ischiocavernosus and bulbocavernosus muscles in the pelvic area and they activate in case of erection.
The most useful exercises for erectile dysfunction are:
- Lie on your back on the floor and squeeze your anus muscle and hold them for 5 seconds. Repeat it 10 times per set, and do a minimum of 3 sets and no more than 5.
- Lie on the floor on one of your sides and put a large pillow between your knees. Squeeze the legs together and keep it for 5 seconds. Try to repeat it at least 8 times per set, and do a minimum of 3 sets and no more than 5.
- Sit in a chair and squeeze your penis’s muscles like trying to stop the urine flow. Hold for 5 seconds and release. Also, this exercise should be performed 10 times per set and a minimum of 3 sets and a maximum of 5 sets. If you want to check if you are correctly performing this exercise, you could try to squeeze the muscles of your penis during the urination. If you are able to hold the urine flow from coming out for a few seconds, you are doing it correctly.
It is important to know that during these exercises you should not hold your breath, you should keep your stomach muscles relaxed as well as the pelvic muscles between the squeezes.
Most of those who try out these exercises see the results after a full month of practice and they can also hold the squeezes longer than at the beginning.
Though erectile dysfunction could be very bothersome and affect a man’s perspectives, it could be treated. The most important thing is to diagnose it correctly , finding the real cause of erectile dysfunction. If the cause is well treated, erectile dysfunction is just a temporary inconvenience.