Erectile Dysfunction (Impotence): Causes, Symptoms, Diagnosis and Treatment

Erectile dysfunction (ED), also known as impotence, is a condition in which a man is unable to get and maintain an erection that is sufficient for sexual intercourse. It is one of the most common sexual health related problem faced by men. Approximately, one in ten adult men will suffer from ED at some point during his lifetime.

Erectile dysfunction can occur at any age, but it is more common in men older than 40 years. Studies show that about half of the men aged between 40 and 70 will experience ED at least once in their lives. The older you are, the more likely you are to develop ED.

What causes erectile dysfunction?

Causes of erectile dysfunction can be psychological or physical. Psychological causes of impotence include anxiety, depression and chronic stress. But in most cases, erectile dysfunction is caused due to physical problems, accounting for nearly 90 percent of all cases of ED.

Physical causes of erectile dysfunction can be categorized into four main types. They include:

1. Vasculogenic conditions

Any condition that affects the blood flow either by weakening or causing a blockage in these blood vessels. These include:

  • Arteriosclerosis. This is one of the most common causes of erectile dysfunction. It happens when fatty substances, called plaques, clog the arteries and restrict the blood flow to vital areas, including the penis.
  • Diabetes. Diabetes can cause impotence because it can damage the nerves that control an erection. Poorly managed diabetes can lead to chronic erectile dysfunction.
  • High Blood Pressure. It is also a common cause of erectile dysfunction. It happens when high blood pressure causes damage to your arteries, making them thicker. This can affect the blood flow to your penis.
  • Kidney disease. A condition characterized by a gradual loss of kidney function over time. Men with kidney disease find that they are unable to sustain an erection for as long as they are used to. Eventually, they lose the ability to achieve an erection at all.

2. Neurogenic conditions

Any condition that affects the nervous system. These include:

  • Parkinson’s disease. A progressive neurological condition caused by damage to nerve cells in the brain. Since Parkinson’s disease impacts the central nervous system, men with Parkinson’s disease may find themselves unable to attain or maintain an erection.
  • Multiple sclerosis. A chronic inflammatory disease of the central nervous system. This inflammation prevents the nerve fibres from working correctly. This causes a range of symptoms which include muscle weakness, dizziness, visual changes, and erectile dysfunction.
  • Stroke. A brain injury such as stroke can cause impotence because they interrupt the transfer of nerve impulses from the brain to the penis.
  • Spinal cord injury. An injury to the spinal cord can affect nerve impulses or blood supply to the penis which then results in erectile dysfunction. The extent of the impotence will depend upon the severity of the injury. The greater the injury the more severe the extent of the impotence.

3. Anatomical conditions

Any condition which affect the tissue or structure of the penis. Examples of these include:

  • Hypospadias: Hypospadias is an abnormality of the penis that is present at birth. This can cause problems with passing urine and also with erections.
  • Peyronie’s disease: Peyronie’s disease is a disorder in which scar tissue, called plaque, forms under the skin of the penis. These plaques can cause the penis to bend during erections, making sexual intercourse difficult and occasionally painful. This condition is usually caused by an accident or injury to the penis.
  • Chordee: Chordee is a congenital condition in which the head of the penis curves downwards (or sometimes upwards) which is especially noticeable during an erection. This is caused by a too short fibrous urethra which pulls the penis downwards thereby preventing a normal erection.

4. Hormonal conditions

This is a rare cause of erectile dysfunction. It usually caused by a hormonal imbalance. There are a number of hormonal imbalances which can result in impotence. Obesity is a common reason for men to have a hormonal imbalance, because high percentages of body fat can cause the creation of excess estrogen in the body. Other causes of hormonal imbalance include pituitary gland problems, hyperthyroidism (over active thyroid), and hypothyroidism (under active thyroid).

Other causes of erectile dysfunction include:

  • Smoking.
  • Excess alcohol consumption.
  • Lack of physical exercise.
  • Some prescription medications like antihistamines and high blood pressure drugs.

Symptoms of erectile dysfunction

The main symptom of erectile dysfunction is an inability to maintain and sustain an erection for sexual activity. An inability to get an erection does not mean that this occurs all of the time. You may find that you are able to achieve an erection during masturbation or when you first wake up in the morning. But, the problem occurs when you are with your partner. That is the situation when you develop impotence or erectile dysfunction.

There are numerous reasons for this to happen. For instance, some men are worried about the risk of a pregnancy especially if this is something which they are totally unprepared for. They may not be ready or even interested in becoming a father so tense up before the sexual act which impairs their ability to perform.

If you find that you are unable to get an erection when you are with your partner then chances are there is a psychological cause. But, if you are unable to achieve an erection at any time then there may be an underlying physical cause.

Diagnosis of erectile dysfunction

Because there are a variety of causes for ED, your doctor may use different tests to diagnose the condition and determine its cause. Only after the cause of ED is determined can it be effectively treated. Tests for underlying conditions might include:

Psychological exam. Your doctor might ask questions to screen for depression and other possible psychological causes of erectile dysfunction.

Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.

Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.

Urine tests. Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.

Ultrasound. This test is usually performed by a specialist in an office. It involves using a wandlike device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems.

Treatments for erectile dysfunction

Your treatment for erectile dysfunction (impotence) will depend on the cause and severity of your condition. Some of the treatments available for ED include:

Lifestyle changes. In some cases, ED can be treated by making a few lifestyle changes. These include stopping smoking (if you are a smoker), reducing alcohol consumption, taking regular exercise and losing weight.

Medications. Medicines, such as Sildenafil (Viagra), Tadalafil (Adcirca, Cialis), Vardenafil (Levitra, Staxyn), and Avanafil (Stendra), are often used to treat erectile dysfunction. They work by increasing blood flow and allows you to get an erection in response to sexual stimulation.

Counselling. Counselling can help if the erectile dysfunction is caused by psychological factors. Counselling can also benefit a man who has lost sexual confidence, even though his erectile dysfunction is caused by physical factors. It may be provided by your doctor, a psychologist or a psychiatrist. Your partner may also be involved.

Hormone therapy. Some men have erectile dysfunction that might be complicated by low levels of hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies. This treatment is available as a cream or gel, topical solution, injectable form and pellet form placed under the skin.

Mechanical aids. Mechanical aids, such as vacuum pump and penis constriction rings, serve as erectile aids for some men. A vacuum pump is a cylinder device that is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is then maintained by placing an elastic ring around the base of the penis. This can be useful when a man is able to get an erection, but has difficulty maintaining it.

Surgery. If you have tried other forms of treatment for erectile dysfunction such as lifestyle changes, medication, or even a vacuum pump but nothing appears to have worked then surgery is an option. Surgical treatments include:

  • Vascular surgery – a surgical procedure to restore penile blood flow that has been reduced by correcting a blockage or leakage in blood flow to the penis. This surgery can enable some men to get or maintain an erection.
  • Penis implant – a device that is surgically implanted into the penis. It can enable erections through a mechanism of squeezing on a specific part of the device. Penile prosthetic implants are expensive and generally used only as a last resort, if other treatments have not worked.

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