Wednesday, December 1, 2021
Erectile dysfunction (ED) is a condition that is increasingly common in men as they get older, however it can occur at any age. The causes may be physical or psychological or even a combination of both.
In men with a psychological cause, the onset is quite sudden, with some pinpointing an exact day or specific incident that may have triggered the problem. Often these men tend to be in a younger age bracket and generally their morning erections are maintained. In contrast, a physical cause presents with ED that gradually gets worse and worse culminating in complete loss of sexual function. In these individuals, morning erections are absent from the start.
Male sexual arousal is a complicated process that involves signals from the brain, which in turn are communicated via nerves, regulated by hormones and affect blood vessels and muscles. An interruption to this process at any stage can result in ED.
The brain: higher centres in the brain are responsible for producing GNRH, a hormone that stimulates testosterone production and release. Falling testosterone levels lead to reduced sex drive and interferes with blood flow to the vital areas during an erection. Stress also acts at this level, with stress hormones interfering with the production of GNRH.
The nerves: neurological conditions such as Parkinsons disease and Multiple Sclerosis can affect the nerves needed to stimulate an erection.
Hormones: Testosterone levels fall as men get older which can affect sexual function. Some men may have a problem known as hypogonadism, whereby the testicles fail to produce testosterone. There are many causes, some of which are congenital (you are born with) or caused by certain prescribed drugs or recreational drugs such as marijuana.
Blood flow: this can be affected by high blood pressure, diabetes, high cholesterol, cardiovascular disease and smoking.
Muscles: Neurological conditions can affect the nerves that supply vital muscles that are needed for male sexual function.
Drugs: such as diuretics, antidepressants and recreational drugs including alcohol can cause ED.
Lifestyle changes are important, with weight loss, stopping smoking and reducing alcohol intake all having a significant part to play
Drug treatments such as Sildenafil have proven very effective with over two thirds of men reporting improvement in sexual function. Sildenafil has a very good safety profile and has been used to treat ED since 1998 with mainly only minor side effect reported.
Psychosexual counselling may be effective in treating psychological causes.
Vacuum erection devices may be useful for men who are unable to take Sildenafil. These pumps work by drawing blood into the penis which will make the penis hard and erect.
Prostaglandins (Alprostadil – brand names Caverject or Viridal) are metabolites that can improve blood flow, prostaglandin injection into the base of the penis to the side can help this condition if all other treatments have failed. This must be first performed under medical supervision to make sure it is done safely.