Erectile Dysfunction - Let's Talk

Erectile dysfunction is a disorder in which a person is not able to have an erection sufficient enough for intercourse. This term is synonymous with impotence.  A common myth is that a person with erectile dysfunction cannot have children. This belief prevents many people from getting married. The fact is that the ability to have children depends on the quality of semen and the sperm count in it.  Erection is the mechanism by which semen is deposited in the vagina. A person with erectile dysfunction can easily have children if he is not having any other disease.

Most of the studies have shown that the incidence of erectile dysfunction is around 20 %. And most of the cases are treatable.  Majority of the patients are devoid of treatment because they don’t seek medical assistance.  People are either shy or they think that they cannot be treated, there are a cluster of people who consider this as degenerative process and accept this as a part of their ageing.

Whom shall I approach?

This problem can only be handled if patients seek medical assistance or open up enough to talk about it. The best person to talk about this is a Urologist. In absence of Urologist your primary care provider or your family doctor can guide you.

What are the organic causes of erectile dysfunction?

Most of the time erectile dysfunction is psychogenic, which means the cause is due to excessive stress, performance related anxiety or lack of self-confidence. This can be easily treated. Other times there may be an underlying disease (Organic).

Erectile dysfunction can be due to disease of arteries,  veins , or nerves. Other times hormonal abnormalities play an important role in disease process.  Diabetes, hypertension, heart diseases,  trauma,  smoking, physical inactivity and various medications are important precipitating factors.

What are the tests required?

Your urologist will first take a detailed sexual, medical and psychosocial history and this will include interviewing your partner.

• A detailed examination of cardiovascular system, nervous system and genitalia are required. A cluster of laboratory tests are often required to identify the cause or any other treatable abnormality.
• Vascular Evaluation is done  to look for blood flow to the penis, its retention and return. This can be done using Combined Intracavernous Injection and Stimulation (CIS ) testing;
• Penile Doppler and Duplex ultrasonography are other tests used for this purpose.
• Penile Angiography may be required if erectile dysfunction developed after injury or any trauma.
• Psychophysiologic Evaluation is done to monitor rigidity of penis, tests like Nocturnal penile tumescence (NPT) monitoring.
• Neurological evaluation and hormonal evaluation may be required in selected cases.

What are the ways in which erectile dysfunction is treated?

• The goal of treatment aims at maintaining a healthy relationship and not just a rigid erection. Counseling plays a major role. The next step is to help patients identify the risk factors associated with disease and how to modify them.
• The first line of oral medications directed to treat this disease are called phosphodiesterase type 5 inhibitors. The commonly used drugs are Sildenafil and Tadalafil. Intracavernosal injection, intraurethral drugs and transdermal drugs form the second line of treatment.
• Vacuum erection device therapy are the next line of therapy especially those with prompt venous drainage; this device mechanically creates a negative pressure over the penis,  a mechanical ring further blocks the return of blood from the organ. The erection lasts till the ring is in place.
• Penile prosthesis or implant surgery and Penile Revascularization Surgery are the last resort options for treatment of erectile dysfunction. Most of the times  a combination of modalities are helpful.

Recent studies have reported that erectile dysfunction can be an early marker for cardiovascular diseases, this is because any systemic disease which will affect blood vessel of  heart tend to also affect the blood vessel supplying penis. Hence  all erectile dysfunction patients must be evaluated lest an underlying cardiovascular disease might  be missed.