Erectile dysfunction (ED) is a condition in which a man is unable to maintain an erection or even have one. It is a common clinical condition, especially in old age.
The majority of males have experienced failure in erection during coitus at least once, but this doesn’t indicate the presence of any serious illness.
It may be due to stress or any circumstantial cause.
ED is when they are unable to perform desired erection at all times.
ED can be cured in most cases, its treatment depends on the primary cause, it can be physical or even psychological.
TREATMENT
Lifestyle choices
- Balanced diet
- Regular exercise
- Fitness (weight loss)
- Proper sleep cycle
- Cardiovascular health
- Reduce smoking
- Lower alcohol consumption
- Say no to drugs
Balanced diet
A diet that includes natural products such as fruits, green vegetables, and whole grains.
Avoid– Processed food products, red meat
Regular exercise
Exercise has proved to reverse ED efficiently. Daily walking is associated with a low risk of ED according to a Harvard study, it reduces the risk of ED to below 41%. 1
Fitness
The link between obesity and ED is yet to be discovered deeper in the technical aspect. However, studies report that obesity can cause inflammation and low levels of testosterone in plasma, leading to endothelial dysfunction and hypogonadism, which can in turn cause Erectile dysfunction. 2
Proper sleep cycle
Proper assessment of the sleep cycle may help in treating ED. Obstructive sleep apnea (OSA) is considered to be one of the major factors of ED. Better sleep reduces stress and maintains good physiological health thereby reducing the chances of ED. 3
Cardiovascular health
Cardiovascular health roughly means the health of the heart and blood vessels. The blood pressure and blood sugar level have to be checked from regularly to keep a tab on cardiovascular health.
Major cardiovascular diseases affect vascular endothelial function which in turn impairs penile erection and causes erectile dysfunction as blood won’t easily travel to the penis due to a damaged vascular system.
Reduce smoking
Prevention of smoking can lower the chances of ED by many folds. Smoking causes spasms in penile arteries affecting the blood flow. It affects the production of Nitric oxide, a molecule produced by the body that helps achieve an erection by dilating the blood vessels by increasing reactive oxygen species. Thus affecting smooth muscles, and resulting in failure of erection.
SUMMARY
Smoking damages the blood vessel dilation process due to which blood does not easily travel to the penis. Hence, erectile dysfunction occurs.
Lower alcohol consumption
Chronic alcohol consumption leads to vascular damage and the risk of erectile dysfunction. A study conducted on this matter presented a J-shaped relationship between alcohol and ED, meaning moderate consumption can be allowed but chronic doses may lead to ED. 4
Say no to drugs
Studies were conducted to analyze the relationship between drugs such as cannabis and ED. It showed that ED was more common (almost double) in the case of cannabis consumers compared to non-consumers.
The penis muscles have cannabinoid receptors that interact with the cannabinoid released from drugs such as marijuana. 5
Smoking is known to cause negative effects on blood flow. Smoking tobacco along with marijuana can cause a much worse effect on erections as both are known to disturb your normal body functions.
Psychological treatments
ED can also be caused by –
- Stress
- Sexual trauma
- Mental distress
- Weaker libido
- Depressed mood
- Low self-esteem
- Performance anxiety
Treatment:
- Psychotherapy
- Couple counseling
- Anxiety reduction procedures
- Cognitive-behavioral intervention
- Guided sexual stimulation techniques
Treatment may include both psychological and clinical methods. Sex therapy combined with medical assistance can cure psychogenic ED.
Clinical treatments
- Oral medications
There are many medications available now, which focus on increasing blood towards the penis and aid in an erection.
It includes the following drugs such as:
- Sildenafil citrate (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
- Apomorphine sublingual
Sildenafil citrate is a phosphodiester type-5 inhibitor (PDE5), it is broadly accepted by patients and prescribed by doctors, because of its efficient action on ED and good safety profile.
Tadalafil and Vardenafil are new oral administrations that, surprisingly, have a higher potency than Sildenafil. They are also phosphodiester type-5 inhibitors.
These drugs are very efficient and widely acceptable. They have fewer side effects making them more admissible.
Apomorphine sublingual is administered in case of moderate levels of ED. It is an agonist of dopamine D1 and D2 receptors. But it has a few drawbacks, its working ability is lesser than other mentioned drugs, and also side effects have been seen in its usage.
Oral pills are a widely acceptable form of medication, as they can be easily administered. Scientists have been searching for effective drugs, we have come a long way, starting with herbal remedies to more clinically oriented modern-day drugs.
- Penile injections
When other therapies fail to show effect or the patient is reluctant for oral medications, penile injections solve the purpose.
Intracavernosal injections (ICI) are used for improving penile functions. It improves RI indices of penile arteries.
ICI agents mainly include alprostadil, combination therapy is also used these days. Though, their compositions are not standardized yet
Intracavernosal injections have a fine efficacy profile but have moderate side effects.
Along with ICI therapy, oral alpha-blocker may be used to increase its efficiency.
- Testosterone therapy
Testosterone replacement therapy (TRT), can play an important role in restoring normal testosterone levels in the blood.
This therapy can be used in males suffering from hypogonadism. Testosterone helps to improve weaker libido.
Testosterone therapy alone is less efficient in the treatment of ED, rather it should be paired with oral medications of phosphodiester type-5 inhibitors, to get desired results.
- Intraurethral alprostadil
When phosphodiester type-5 inhibitors cannot be used for the treatment or the patient is not responding to oral drugs, intraurethral alprostadil is the prime solution for treatment.
It works fast, and has fewer side effects this therapy does not possess problems like fibrosis.
Therefore, it is widely accepted by the patients and is preferred over intracavernosal injections as it has a higher safety profile and easy administration.
This treatment becomes more effective if it’s coupled with Sildenafil medications.
This can be used for treating ED of any origin, it has proved effective regardless of the underlying cause of erectile dysfunction.
- Erectile Pumps
This is not a treatment, but a device that helps in maintaining an erection during coitus.
- Vacuum Erection devices
Patients with special cases like post-prostate surgery can prefer this treatment.
Penile rehabilitation seems possible with these devices. It can be a preferred method when oral drugs cannot be used.
These devices regulate penile blood flow and cause erection due to penile swelling.
- Penile implants
This method can be used when other conventional methods prove unsatisfactory.
In spite of having better performance, this method is generally not preferred by patients as it can be very invasive.
This method can treat diseases like Peyronie’s disease or any other penile injuries.
They provide a permanent solution for ED, and need not be planned earlier for intercourse like oral drugs.
- Surgery
Penile vascular surgery is a bypass surgery for the treatment of ED, due to damage to penile arteries.
It is not advisable in old age, due to the hardening of arteries.
By opting for surgery as an option for treatment one can avoid long oral drugs, which can have side effects.
Venous surgery in ED has not shown impressive results. But can still serve well the patients of organic venous occlusive dysfunction.
Higher studies and research is required in this field of treatment for better results in the future.
