Erectile Dysfunction: A Common, Yet Treatable Problem | Urban Reproductive Health
Erectile dysfunction is a common medical condition that affects more than 30 million men every year. The causes of erectile dysfunction also referred to as impotence or ED, vary, but there are revolutionary new diagnostic techniques and treatments that make this condition highly manageable. Understanding the causes, symptoms, and treatment options for erectile dysfunction is the first step in tackling this all-to-common problem.
What is Erectile Dysfunction?
Erectile dysfunction is the inability to achieve an erection that is firm enough for sexual activity. Erectile dysfunction can either be acute or chronic and can be triggered by one-off events like stress or anxiety or ongoing conditions like heart disease or blood disorders. While most men will experience an episode of ED from time to time, regular occurrences of ED can indicate a more serious health problem. There is a direct link between ED and heart disease.
Symptoms of Erectile Dysfunction
The most common symptom of ED is an inability to achieve an erection. In some men, this presents itself as trouble to initially attain an erection, despite being otherwise aroused. It can also present itself as an inability to maintain an erection. The person may initially achieve an erection, but lose it after several minutes. Another common symptom of ED is a lack of normal sexual arousal and a reduced desire for sexual activity.
Social Stigma of Impotence
Many sufferers of ED go years without treatment due to the stigma of the condition. ED can affect daily living, making physical or emotional intimacy difficult or impossible. Men who have experienced episodes of ED in the past may experience anxiety when attempting sexual activity, making the condition worse. There is a certain degree of embarrassment that comes along with impotence, as the condition is taboo in most societies. This can make the sufferer even less likely to seek treatment for the condition and reluctant to talk to doctors about what has been happening.
There is a certain expectation of men and masculinity in society–that men are to be sexual conquerors, having encounters with many women and generally being sexual beings first. Even married men are expected to be viral, sexually aggressive, and potent. A diagnosis of ED can be so devastating that some men will never discuss it or attempt to seek help for it. The reality is that there are simple and effective treatments for ED and many men suffer needlessly without treatment.
ED Can Cause Relationship Strain
Because there is such a social stigma about ED, many men withdraw from their partners and refuse to talk about it. In many cases, the partners of ED sufferers blame themselves for the condition, causing stress in the relationship. Many men who suffer from ED withdraw from any physical contact, even non-sexual contact. This can make the tension and anxiety worse, effectively worsening the incidences of ED.
Another reason that there is such a “hush” over the issue of ED is that it is viewed as an “old man’s” disease. While the condition mainly affects men 40 and older, ED can happy for any man of any age. When men start to experience the condition in their 20s and 30s, there is an added level of shame that makes it less likely that they will seek help for it.
Underlying Causes of Erectile Dysfunction
Sedentary Lifestyle and Obesity
One of the major risk factors for ED is obesity. When men are overweight, the body starts to turn testosterone into estrogen. This testosterone is necessary for gaining an erection, so a lack of it makes it difficult to achieve. An unhealthy diet and lack of exercise is often a direct cause of erectile dysfunction. Most men who lose weight will start to notice stronger and more consistent erections.
Heart Disease and High Blood Pressure
Erectile dysfunction is one of the most direct signs of heart disease. A diagnosis of erectile dysfunction is often a trigger for doctors to order a complete cardiology workup. For men who are diagnosed with ED, most are also diagnosed with heart disease within five years. There is also a direct correlation between ED and high blood pressure.
Smoking decreases the level of blood flow through the body. This includes the blood flow needed for an erection. With decreased blood flow to the penis, achieving or maintaining an erection becomes difficult if not impossible. Fortunately, quitting smoking can help to reverse the problem.
Medication Side Effects
There are quite a few medications that can cause problems with erections, including prescription drugs for acid reflux, high blood pressure, antihistamines, and opioid-based medications. It is helpful to talk to your doctor about your medication usage if you find that erectile dysfunction is a problem.
An unhealthy prostate can lead to problems with erectile dysfunction. Chronic inflammation of the prostate gland can lead to problems getting and keeping an erection. In addition, some of the most common medications for prostate cancer can also affect the ability to maintain an erection as they often slow blood flow to the area.
Low testosterone or “low T” is often the culprit when it comes to impotence. Low T can cause hair loss, insomnia, ED, and decreased sex drive. Low T occurs in nearly one in four men and is quite common in men older than 40. Fortunately, low T is easily diagnosed with a blood test and can be treated with simple medications. Simple injections of testosterone or oral medication can bring back normal function and ease the symptoms of ED.
Mental Health and Performance Anxiety
Erectile dysfunction can be a vicious cycle of suffering from the condition, then having anxiety about a recurrence of the problem. If you are under stress, either about the ED or any other situation, it can exacerbate the problem. Depression, anger, grief, relationship difficulties, and jitters can lead to an episode of ED. If your mood is, in fact, the culprit, simply taking a few moments to center yourself can often solve the problem.
Diagnosing Erectile Dysfunction/Talking to Your Doctor
The first step in getting treatment for ED is to talk to your doctor about your symptoms. There are treatments available for ED, but they depend on what is causing the issue. Getting an erection requires the coordination of several body functions—the heart, the brain, and blood vessels all act in concert, so getting to the heart of the problem will require in-depth inspection.
Medical and Sexual History
Your doctor will want to have a clear picture of what is going on in your body. He will ask about past surgeries, medication use, and present symptoms. Your doctor will also ask about your sexual history. He will want to know if you get erections and how frequently you experience ED. It is vital that you are completely honest with your doctor and disclose any information that can help in your treatment plan.
Your doctor will want to examine your chest for evidence of enlarged breast growth. He may also check for hair loss. These are often signs of a hormonal problem and can explain the ED. He may also check your pulse, blood pressure and check for blood flow in your wrists and ankles. Finally, he may examine your penis and testicles to ensure that they are functioning properly and have working nerves.
Blood and Urine Tests
The doctor will likely take blood and urine samples and check your testosterone levels and examine your blood for the presence of kidney disease, diabetes, high cholesterol, and heart disease. The doctor may also check your thyroid levels. Underactive thyroids can often lead to impotence.
Overnight Erection Test
Most men have several erections during their sleep, so doctors may monitor you overnight to find out if you are having involuntary erections. For the overnight test, you will place a device over your penis that will monitor your erections. This device will measure the number and strength of your erections. An alternative test places a plastic ring around the penis. If the ring breaks, it means that you have had a successful erection. If the test shows that you have had erections, the doctor may determine that your ED is being caused by a non-physical reason.
Another testing method is the intracavernosal test. During this test, the urologist injects a medical stimulant into the base of the penis which will trigger an erection in men with healthy blood flow. If no erection occurs, the doctor will likely attribute it to a blood flow issue. The injection test is usually ordered as part of a complete diagnostic workup and is one of the best tools that doctors use to diagnose the severity of the ED.
Ultrasounds are also highly effective in diagnosing and treating ED. During the ultrasound exam, the urologist will use a handheld ultrasound device to measure the level of blood flow in the penis. He will move a wand around the entire penis, checking the images of the blood vessels on the ultrasound screen. This is a highly effective test that usually helps to quickly diagnose me who are suffering from ED symptoms.
Mental Health Exam
If the urologist has ruled out physical factors to explain your ED, he may explore any mental health issues you may be experiencing. He may ask about your history of depression, anxiety, or stress. If you are involved in a relationship, he may talk to both you and your partner together to get to the root of any issues that may be causing or contributing to the ED.
What to Ask Your Doctor About ED
While the doctor will likely ask you a number of questions to get to the root of the problem, there are several questions you can ask to get a better picture of the condition.
-What is causing my ED?
-Are my ED symptoms temporary or permanent?
-Is this condition treatable?
-What treatment options are available to me?
-Are there any lifestyle changes or at-home treatments that will work?
-Will I need to see a specialist or can I receive treatment with my primary physician
-Will my insurance cover the treatments and medications?
The doctor may follow up with a series of questions that may seem intrusive. These questions are designed to get to the bottom of the issue and find the best possible treatment for the problem. There are several treatments available, and the right treatment plan depends on the severity of your condition, your overall health, and the anticipated duration of the ED.
Common questions typically include:
-Do you ever get erections?
-Does your erection get firm enough for sexual activity?
-If you get a firm enough erection to start sex, do you lose it during the act?
-Do you wake up with an erection?
-Can you get an erection by masturbation?
The doctor may also ask about lifestyle issues like whether you smoke, drink alcohol, or use recreational drugs. They may also ask about your sexual relationship with your partner.
Treatment for Erectile Dysfunction
The treatment your doctor recommends will depend heavily on what is causing your ED symptoms. If your ED is caused by stress, anxiety, or depression, your doctor will likely refer you to a counselor who will help you to work through these issues.
Your doctor may prescribe medication to treat the condition. The most common medications for ED include Cialis, Viagra, Stendra, and Levitra. You can take these medications between 35 minutes and 36 hours before sex, and doctors recommend you take these no more than once per day.
These pills are highly effective for the overwhelming majority of men. If you have an erection that lasts for more than four hours, contact your doctor as this can be a serious condition.
Side effects of these medications include
-Temporary blue and green vision
There are several harmful drug interactions with ED medications, so it is vital that you tell your doctor exactly what drugs you are taking. Erectile dysfunction can be harmful when taken with beta-blockers, nitrates for chest pain, blood pressure, and prostate medication. In addition, some depression and anxiety medications can make ED worse or affect heart function, so those medications should be avoided.
Injections and Suppositories
If pills are not effective, your doctor may prescribe injections to help treat the ED. The most common drug is Alprostadil, which boosts blood flow to the penis and causes an erection within a few minutes. You can either inject the medication into the side of the penis or insert a small suppository into the penis and wait for it to dissolve.
These devices work by boosting blood flow in the penis. These pumps are highly effective and are often the first-choice remedy for men who have suffered from ED for years. Some men use them as needed, while others use them for rehabilitation and use them daily to increase regular blood flow on an ongoing basis. Other alternatives include rubber rings that constrict the base of the penis and prevent blood from escaping.
When your doctor has explored all other options including therapy, oral medication, and devices, he may suggest surgery. There are several procedures used to correct ED, including implants, prosthesis, or vascular reconstructive surgery.
There are two types of implants that are commonly prescribed for patients whose ED has not responded to other treatments. Malleable implants are flexible rods that are surgically inserted into the penis, just beneath the skin. You can then bend these rods into the best shape for sexual activity. These rods are not painful and are removable if no longer needed.
Inflatable implants are surgically inserted into the scrotum and you use an external pump to create an erection. Implants will also add to the width and length of the penis. These methods are less frequently used as they increase the chances of developing an infection. They may also auto inflate, break down or shift. In addition, implants make it more difficult for you to undergo surgery for enlarged prostate or bladder cancer.
Vascular reconstruction is a preferred method in the treatment of ED in that it is more effective than oral medications without the risks of implants. With vascular reconstruction, doctors can repair broken blood vessels and open blockages that stop blood flow.
Natural Remedies for Erectile Dysfunction
While there are medical interventions that have been proven successful in treating ED, some people swear by natural remedies to help alleviate the symptoms. These remedies include:
-Exercise and Weight Loss
There is a direct correlation between weight and ED. Losing even a few pounds can make all of the difference in the condition. Hitting the gym might be just what the doctor ordered when it comes to beating ED.
This diet is high in vegetables, fruits, whole grains, and fruit. The Mediterranean diet is good for the heart and is thought to help aid in curing ED.
Some men swear by a regular course of acupuncture to cure ED. The ancient Eastern medical practice has been known to treat a variety of conditions, from infertility to depression, migraines, and ED.
Ginseng and green tea have long been touted for their healing properties, and many men turn to them to help ease the symptoms of erectile dysfunction.
Future and Experimental Treatment for ED
In addition to the current proven treatments and home remedies, there are several treatments in the works that show promise in the fight against ED.
Several clinical trials are in the works that are testing out the effectiveness of stem cell treatments for ED. In these treatments, doctors inject human and animal stem cells into the penis to help aid in blood flow. Results for this investigational therapy have been promising and test subjects have reported favorable results.
The first few penis transplants have been a success, with the first one performed on a soldier who has been severely injured in combat. After a three-hour reconstructive surgery at Johns Hopkins medical center, the soldier was able to regain normal function.
Finally, shockwave therapy has been found to be effective in treating ED. Patients receive a low-intensity shock that energizes the blood vessels and encourages new blood vessel growth. While results have been mixed with shockwave therapy, it is still in the experimental stage and not yet approved for the widespread treatment of ED.
Erectile dysfunction is a common condition that affects millions of men each year. The condition can be caused by a number of factors, from simple issues with require easy fixes to more complex ones that require in-depth solutions. The first step in dealing with erectile dysfunction is to talk to your doctor about what is happening. From there, he will recommend a course of treatment that will put you back on track to fulfilling and healthy sex life.
Calvin Winters is a retired personal trainer and nutritionist who has a deep passion for health and wellness. Calvin is the lead team manager and in charge of all content and business operations. Calvin earned a Bachelor of Science degree from U.C. Berkeley and a Master’s degree from Stanford University. In Calvin’s free time he loves to go deep-sea fishing and spend time outdoors.
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