Erectile dysfunction is the inability to produce or maintain an erection that is sufficiently rigid to enable vaginal penetration and thus successful sexual intercourse. Typically, if this happens regularly (75% of the time) over a significant period of time (several weeks to months), the term erectile dysfunction is applied. If this is the case, it is also possible to use the word impotence.
Erectile dysfunction can occur in various ways. It is completely impossible for some people to grow an erection. Some may develop an erection that is not sufficiently rigid to allow for adequate intercourse.
There are several causes of erectile dysfunction, including some medications (prescription and non-prescription), psychological factors, and hormone, nerve, or blood vessel disorders supplying the penis.
Other male sexual function issues include a lack of sexual drive or desire (libido), ejaculation problems (ejaculatory dysfunction), and a lack of pleasurable sensation (orgasm) during intercourse.
A common problem is an erectile dysfunction. It is important for men who experience erectile dysfunction to discuss it with their doctor because the disorder can have a negative impact on relationships and self-esteem; serious underlying factors need to be excluded, and there is an effective treatment.
Sexual dysfunction associated with cancer
Upon diagnosis and treatment, between 10% and 88% of patients diagnosed with cancer experience sexual difficulties. The prevalence varies depending on the place and type of cancer and the types of treatment used. Chemotherapy, weight changes, hair loss or surgical disfigurement, hormonal changes, and cancer treatments that directly affect the pelvic region may influence sexuality.
In many patients with prostate and testicular cancer, sexual problems are found. They are also reported for cancer patients who do not directly affect sex organs, including lung cancer (48% of patients), Hodgkin’s disease (50%), and laryngeal (60%) and head and neck cancer (39-74%).
Risk factors for male sexual dysfunction
The erectile dysfunction predisposing factors are as follows:
- Medical conditions such as diabetes mellitus and cardiovascular disease;
- Neurological conditions including or arising from dementia, multiple sclerosis, stroke, or spinal cord or back injury;
- Pelvic trauma, prostate surgery, previous priapism, prolonged bike riding (> 4 hours/week, depending on seat and posture);
- Depression and stress;
- High blood pressure;
- Increased cholesterol;
- Certain drugs (some antidepressants, particularly SSRIs; diuretics; and others);
- Alcohol and recreational drugs such as cocaine and heroin may initially stimulate sexual excitement, but it has been shown that long-term use leads to erectile dysfunction.
If during the middle age a man has the risk factors for cardiovascular disease (smoking, obesity, high cholesterol), he is at an increased risk of developing erectile dysfunction.
It was shown that exercise has a protective effect.
Progression of male sexual dysfunction
Approximately one-third of people with erectile dysfunction note that it gets worse over time without medication. About a third of men find that without treatment, erectile dysfunction improves.
After treatment, nearly half of men with extreme erectile dysfunction remain impotent in the longer term.
Depending on the cause of erectile dysfunction these figures vary. Even if men choose not to follow erectile dysfunction treatment, it is important for a doctor to investigate them, as erectile dysfunction may indicate an increased risk of cardiovascular disease.
Symptoms of male sexual dysfunction
Temporary erection failure is very common and will hopefully be resolved. The impact on relationships and self-esteem can be devastating if ongoing erectile dysfunction develops. People with erectile dysfunction are likely to experience severe psychological distress. Sexual self-consciousness is believed to lead to:
- Increased appearance-related anxieties;
- Interferes with attention, focus, and concentration;
- Impairs physical performance; and
- Reduces awareness of our physiological arousals leading to sexual dysfunction.
It helps with the successful treatment of erectile dysfunction.
Although studies are minimal, male sexual dysfunction has been shown to have a negative impact on female partners ‘ sexual function as well. A study comparing women’s sexual activity with erectile dysfunction partners with those without found that sexual excitement, lubrication, orgasm, satisfaction, pain, and total score were significantly lower in those with erectile dysfunction partners. A significant proportion of men with erectile dysfunction received treatment later in that study. Upon diagnosis, there was a significant increase in sexual excitement, lubrication, orgasm, pleasure, and pain. It was concluded that male erection status affects female sexual function, which may improve after male sexual dysfunction treatment.
Discussing erectile dysfunction with your doctor is important, so you can rule out any serious underlying factors and discuss treatment options. Most men are ashamed to talk to their doctor or even their wife about this problem. To effectively manage this common problem, open communication with your doctor and in your relationship is crucial.
Effective erectile dysfunction treatment is available, allowing the return to a fulfilling sex life for most men. Based on the drug used, the side effects of erectile dysfunction treatment differ. Some may disrupt the sexual activity’s spontaneity. For example, it is typically necessary to take PDE-5 inhibitors one hour before sex. Side effects can include eye disturbances, indigestion, vasodilatation, diarrhea, and blue tinge.
Certain treatments such as penile injections can cause pain at the site of the injection or an erection that won’t go down. It is necessary to discuss treatment options carefully with your doctor to determine which one is best for you.
Clinical examination of male sexual dysfunction
Following a detailed discussion of the history and risk factors of erectile dysfunction, your doctor will examine the testicles and penis to help determine the cause of erectile dysfunction. Your doctor will check your area’s reflexes and pulses to see if blood vessels or nerve problems contribute to erectile dysfunction. In order to help diagnose erectile dysfunction, your doctor will order tests if necessary.
How is male sexual dysfunction diagnosed?
Diagnosis is based on information provided to the doctor about the history of erectile dysfunction (how quickly it happened, how often it happens, etc.), risk factors evaluation, and whether erections often occur overnight while a man sleeps. It is common for a man during REM sleep to have 3-5 full erections overnight.
The doctor can arrange nocturnal penile tumescence (NPT) tests to decide whether normal erections occur overnight (nocturnal erections). This means wearing a computer in your own home overnight. The monitor’s data is then analyzed to determine how often erections occurred, how long they lasted, and how rigid and broad the penis was during erections. If NPT testing is natural, it is generally psychological that causes erectile dysfunction. If not, it may be appropriate to further check the blood flow in the genital area to see if blockage or leakage occurs.
A blood test of hormone levels such as testosterone, prolactin, and the thyroid-stimulating hormone may also be arranged by the doctor to see if these lead to erectile dysfunction.
Prognosis of male sexual dysfunction
Erectile dysfunction can be effectively treated for the vast majority of men.
It is important that you discuss it with your doctor if you have erectile dysfunction. It is important to exclude serious underlying causes. There are plenty of treatment options available, and your doctor will help you decide which one is right for you.
Through medication and/or therapy, certain causes of erectile dysfunction such as hormonal problems or anxiety can be completely cured. Even if it is difficult to cure the underlying cause, a medicine may still permit a sufficient erection. Ignoring the problem seems not to make it better, and the relationships and self-esteem may have a significant impact.
How is male sexual dysfunction treated?
A doctor needs to check that there is no underlying cardiovascular disease before starting treatment for erectile dysfunction and does other tests to determine the cause of erectile dysfunction.
Drugs known as inhibitors of phosphodiesterase-5 (PDE-5) are the most common treatment for erectile dysfunction. These include tadalafil (Tadacip), Vilitra (vardenafil), and sildenafil citrate (Cenforce). In about 75% of men with erectile dysfunction, these are successful. These are tablets taken approximately an hour before sex, lasting between 4 and 36 hours. Sexual stimulation is needed before an erection takes place. The PDE-5 inhibitors cause blood vessel dilation in the penis to allow erection to occur and help stay stiff. PDE-5 inhibitors should not be used by people who use nitrate medicine (e.g. GTN spray or angina sublingual tablets).
If testosterone levels are found to be poor, testosterone replacement therapy will first treat erectile dysfunction.
If PDE-5 inhibitors are inadequate or do not work, other therapies include injections into the penis base that cause blood to flow into the penis and a relatively immediate erection that lasts about an hour. Alprostadil (Caverject and Erectile dysfunction) and Invicorp (VIP and phentolamine) are injected drugs. Alprostadil can also be injected into the penis opening as a gel. If your wife is pregnant, this is not acceptable.
Using a pump mechanism to create negative pressure around the penis, vacuum erection systems enable it to get erect. To help maintain the erection, an elastic brace is then positioned around the base of the penis.
Penile prostheses may be regarded as a last resort. There are available malleable rods and inflatable models. The choice requires surgery to implant the tool, which means that there are more complications than other treatments.
Surgery used to be common to repair blocked or damaged blood vessels, but it is not very successful for long-term erectile function unless it is performed to correct traumatic vascular damage in young men.
Erectile dysfunction suffered by obese men has been shown to significantly improve with weight loss and exercise. Many changes in lifestyle that enhance erectile dysfunction include reducing alcohol consumption, recreational drugs, and cigarettes.
When anxiety or depression triggers erectile dysfunction, psychotherapy can be an effective treatment alone or in conjunction with certain medications (e.g. antidepressants). Counselors in sex therapy are specialized in this field.
When men are found to take a drug known to cause erectile dysfunction, their doctor can recommend an alternative therapy that is equally effective.