There are several problems that may affect men at different stages of life. Of all the sexual problems that men experience, erectile dysfunction is the most common. Erectile dysfunction describes several problems, ranging from being able to retain an erection for only a short time to the inability to get an erection at all. It is quite normal for men to experience this at some point in their lives.
Causes of Erectile Dysfunction
One of the commonest causes of erectile dysfunction is a condition known as “venous leakage”. Although blood flows into the penis in the usual way during an erection, it then leaks out again so that your penis droops and becomes flaccid. This is because the “locking system” that normally keeps blood inside the penis stops working effectively. The problem of venous leakage can be counteracted by the man wearing a medically designed ring that fits around the base of the penis.
Erectile problems can be psychological in origin. For example, if you are worried about your sexual performance, or are harbouring feelings of inadequacy, guilt, or resentment, these may manifest themselves as an inability to get or keep a erection. This form may be quite easy to diagnose because you will be able to have an erection sometimes, but just not with a partner. Sex therapy is usually the best treatment for this problem.
Illness and Ageing
Various illnesses can affect erectile function as well as certain medications. Impotence is more likely to strike in later life, although fortunately this is not inevitable. As you get older, your levels of the male sex hormone testosterone decline and one side-effect may be less powerful erections. This isn’t necessarily a problem; you simply need to find what gives you the best erection, usually plenty of direct friction in genital area. You also like to consider taking a hormone treatment.
Erectile Dysfunction Treatments
A comprehensive assessment of the sexual dysfunction is vital for the formulation of a treatment of plan. In some patients, sexual desire, arousal, orgasm and ejaculation are still intact. The management of ED is based on the cause of the problem. It also depends on the patient and partner’s wish and outcome goal. Hence, a holistic approach is recommended for the treatment of sexual dysfunction.
To determine the appropriate treatment the doctor would have to take medical history and conduct a physical examination. As part of medical history, the doctor would have to ask questions about
- Diseases, injuries or medical conditions the patient or his family members have had
- Medications being taken
- Life style i.e. alcohol consumption, smoking, level of stress
- Relationship with partner
Through different approaches, e.g. consultation with sexologist, medical treatment and surgery may have to be combined, for optimal results treatment of ED can be, five types viz. Professional counselling, hormonal treatments, pharmacological therapy, external devices and penile implants.
As impotence can sometimes result from a combination of psychological and physical factors, counselling may help to reduce anxiety and overcome the condition. This therapy is sometimes used in combination with other treatments as directed by the doctor.
A small percentage of impotence is caused by abnormal levels of sex hormones like estrogens.
Pharmacological therapy could be by way of oral medication, urethral inserts and injectables.
Yohimbine (Yocon 5.4 mg): This is a natural product derived from the bark of the Yohimbine tree of South America. It acts on the nervous system and may increase the male libido. It is effective in approximately 25-35% of patients but continuous medication for 6 to 8 weeks before assessment of its efficacy is essential. Uncommon side effects include mild dizziness, nervousness and rare headache and nausea.
Trazadone: Trazadone is an anti-depressant, which in lower dosages of about 100 mg at bedtime can promote normal erections. Possible side effects include drowsiness, nausea and difficulty in urinating.
Sildenafil Citrate (Viagra): Viagra has revolutionised treatment of ED and brought the topic of impotence itself into sharp focus. Introduced in 1998, it is effective in 75-80% of all men with ED, 40% of men who are impotent due to radical prostectomies and prostate cancer and most men with psychogenic impotence. Over 3.5 million prescriptions of 30 million tablets are dispensed in the first months of its approval. The efficacy and tolerability profile of the drug makes it the first line of therapy for ED and has earned it the acronym Pfizer Raiser!
This treatment involves the insertion of a hollow plastic applicator, which contains a suppository of the drug alprostadil (dose range of 125 mcg to 1000 mcg) about 1 inch into urethra of the penis. This medicated urethral system for erection (MUSE) was the second medication approved by the FDA for dysfunction. It is effective in about 40% of males with ED. Major side effect is irritation of the urethra and penile discomfort. A small toothpick like applicator holds the tiny pellet of the drug in the urethra when inserted. Massages of the penis within five to 10 minutes cause an erectile effect.
The vascoactive drugs available for injection therapy include Prostaglandin E-1, Papaverine and Regitine. The drugs are injected using small gauge needle at the base of the penis, directly into the corpora cavernosa. Pain sensation is minimal at this point. This causes relaxation of arterial and cavernosal smooth muscle, with increased penile arterial flow. Erections usually occur within 5 to 15 minutes and may last an hour or longer. There are extremely effective and work in more than 95% of patients. Major complications include penile discomfort, rare priapism and even rarer injury to the urethra.
External compression devices are used to trap blood within the penis maintaining an erection. There are two main groups of compression devices: simple constricting devices to be used by those men who get erections but easily lose them, and vacuum compression devices that helps get an erection and sustain it.
Simple compression devices are usually rubber or silicone winged rings supplied with an applier, the revive rings, a slip tube, or the actis device. They are placed at the base of the erect penis and trap the erection. They should not be left in place more than 30 minutes and should not be used by patients with bleeding problems.
External vacuum erection devices (VEDS) are effective in approximately 75% of patients. It takes a great deal of practice and perseverance to learn their use, but when mastered, they can be used quickly and effectively. It involves placing a plastic cylinder over the shaft of the penis pressing against the base of the pelvis to get a seal and using a vacuum pump to produce a vacuum in the cylinder, drawing blood into the penis and allowing an erection to form. A compressor band is slipped over the base of penis holding the blood within the penis, the vacuum is released and the cylinder removed. There have been no significant problems related to vacuum compression devices if used properly, and if constriction band is not allowed to remain in place more than 30 minutes. Most of the vacuum producing components are mechanical; however, there are battery operated devices as well.
Penile implants are implanted in those patients in whom all other therapies are ineffective or sub-optimal or in which the patient is not willing to utilize other treatment modalities. Patient satisfaction is approximately 98%. The different penile prosthesis includes semi-rigid malleable devices, self contained inflatable devices, and multi-component inflatable devices. Multi-component devices give the best quality functions with the best cosmetic flaccid state.
Surgery is necessary for all penile implants. The procedure takes anywhere between 40 minutes to one and half hour and is done under general, spinal or local anaesthesia. Most devices are functional after 6 weeks when the pain and swelling of the surgery have disappeared and the incisions are healed.
Quite a few herbal extracts have been examined by modern sexologists with varied results. These herbs include:
Chase Berry – 0.5% standardised extract has been tried at 350 to 500 mg daily. This is found to be lower prolactin levels that may interfere with hormonal balance and sexual performance.
Panax Ginseng: 5 mg ginsenoside extract, 1 to 3 times daily, has been evaluated. This is advised for 2-week cycles, breaking for 2 weeks in between. It increases testosterone levels and sperm count. This has been traditionally used as virility aid. It is advised to start with smaller dose and work up 3 times a day.
Ginko Biloba: Standardised extract, 24% ginko flavonglycosides, 80 mg thrice daily has been tried. It increases blood and oxygen levels in the brain and recent researches show promise in increased penile blood flow.
Role of physical medicine in ED is slowly gaining acceptance. Kegal exercises increase blood flow and muscle tone. Regular exercise, both aerobic and weight training, supports the cardiovascular system, increase overall energy and promotes relaxation while at rest. These in turn tell favourably on one’s sexual prowess.