What is erectile dysfunction?

Erectile dysfunction (ED) is the medical term for more commonly used lay term of impotence although it encompasses other conditions of sexual function including premature ejaculation, absence of ejaculation and inability to have intercourse due to penile deformities. Inability to get and maintain an erection for satisfactory sexual intercourse or activity can be termed as ED.

How long do I need to wait before seeking advice?

This is variable according to the needs of the patient and his partner. If it is persistent for 3-6 months it is important to address the issue.

How common is this problem in men?

It is much more common than we think! Look at the Massachusetts male aging study which was a cross-sectional random sample community-based observational study of 1,290 men between ages 40 to 70 years (1987- 1989) in Boston.1 Erectile dysfunction was classified as mild, moderate or complete. The combined prevalence of minimal, moderate and complete erectile dysfunction was 52%. The study demonstrated that erectile dysfunction is increasingly prevalent with age. At age 40 there was an approximately 40% prevalence rate increasing to close to 70% in men age 70. The prevalence of moderate erectile dysfunction increased from 17% to about 34% with that of complete erectile dysfunction increasing from 5% to 15% as age increased from 40 to 70. Most men experience ED at some point, usually transient in their lives by the age 40.

What is the normal mechanism of erection?

The smooth musculature of erectile tissue (corpus cavernosum) and arteries supplying penis play a key role in erection. These cylindrical structures and corpus spongiosum (covering urethra) are held in place by a thick sheet of tissue called tunica albugenia. In non-arousal state the smooth muscles inside the cavernous bodies are contracted allowing only small amount of blood for nutrition of the tissues. During erectile process blood flow to the penis increases and blood gets trapped by compression of veins reducing the venous flow from penis. The erectile process involves psychological (Mind), neurological (nerves), endocrine (hormones), vascular (blood vessels) and male sexual organs. Sexual arousal occurs in the various parts of the brain following stimulation. There is a nerve net work called ‘autonomic nervous system’ (ANS) which is not under volitional control. This complex neural network involving ANS activates various events like erection, ejaculation and detumescence (subsidence of erection). The somatic nerves (skin and related muscles) have a role in initiation of arousal. Penile veins get compressed and arteries continue to pump the blood into the cavernous tissue.

What are the risk factors for the loss of erection?

The prevalence of erectile dysfunction increases sharply after the age of 60. Some of the causes are poorly understood. Sedentary life style, cigarette smoking, alcohol abuse, obesity, lack of exercise have been shown to be associated with erectile dysfunction. Diseases that affect the psychogenic, neurological, vascular and male genital organ factors could lead to erectile dysfunction.

Does erectile dysfunction indicate any illness in the body?

Erectile function in a normal man can be taken as an indicator of healthy vascular system particularly smaller arteries. Sudden or gradual loss of erectile function in an apparently healthy and sexually active man may sometimes point to other diseases. ED may manifest in patients with diabetes, heart and vascular diseases. Cardiovascular risk factors such as high total cholesterol levels, low high-density lipoprotein cholesterol levels, high blood pressure increase the risk of ED. Rarely testicular cancer and lymphomas may present with ED although other symptoms usually precede ED

How to prevent ED?

Regular exercise-jogging, running; avoid stress, smoking, excessive alcohol and drugs like marijuana and cocaine; watch your weight. In a nutshell take care of your body and health. Avoid or combat stress situations.

References:

1. Feldman HA, Goldstein I, Hatzichristou DG et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151:54-61.

One-Stop Urology Clinics

Mr Vinod Nargund holds regular One-Stop Urology Clinics at CREATE Urology, Harley Street, London. The One-Stop Urology Clinics include a complete assessment of specific areas of Urological and male reproductive health in only one visit, including One-Stop Prostate, One-stop Testes, One Stop haematuria and  One-Stop Erectile Dysfunction & Sexual Health, and One-Stop Male Infertility. Contact us to find out more.

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