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Erectile Dysfunction

What is erectile dysfunction?

Erectile dysfunction (ED) refers to the inability to achieve erections sufficient for sexual intercourse. It can also be an in consistency or an ability to sustain only brief erections. Incidence increases with age.

Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence of events includes generation of nerve impulses in the brain, spinal column and area around the penis, and response in muscles, fibrous tissues as well as vasculature in and around the corpora cavernosa.

What are the causes of erectile dysfunction?

Causes of ED include the following:

  • Diseases: Disorders that cause injury to the nerves or impair blood flow in the penis such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease and neurologic disease
  • Lifestyle choices: Smoking, obesity and sedentary lifestyle
  • Surgery: Cancer surgeries that involve the removal of the prostate and bladder can injure nerves and arteries near the penis, causing ED.
  • Medications
  • Psychological factors: Stress, anxiety, guilt, depression, low self-esteem and fear of sexual failure
  • Hormones: Hormonal abnormalities, such low levels of testosterone

How is erectile dysfunction diagnosed?

When you present to the clinic with erectile dysfunction, your doctor will review your complete history, and perform a thorough physical and psychosocial examination. Blood and urine tests for blood count, urinalysis, lipid profile, diabetes, thyroid function and measurements of creatinine and testosterone may be ordered.

How is erectile dysfunction treated?

Erectile dysfunction can be treated with non-surgical and surgical methods. Some conservative treatment measures include:

  • Lifestyle changes: Abstinence from smoking, weight loss and increased physical activity
  • Medication changes: Cutting back on drugs with harmful side effects
  • Psychotherapy: Techniques to decrease anxiety associated with intercourse
  • Drug therapy: Medication can be taken orally, injected directly into the penis or inserted into the urethra at the tip of the penis.
  • Vacuum devices: Mechanical vacuum devices cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it.

The surgical treatment for ED usually has one of three goals:

  • To implant a device that can make the penis erect
  • To reconstruct arteries and increase blood flow to the penis
  • To occlude off veins that allow blood to leak from the penile tissues

The most common surgery performed for ED is penile prosthesis implant surgery. Implanted devices, known as prostheses, can restore erection in many men with ED.

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