Erectile Dysfunction : Patient Information

Who is at risk for Erectile Dysfunction?

The risk of having ED increases with age. ED is more common after 40 years of age. Common risk factors for ED are-

• Diabetes
• Hypertension
• Smoking
• Obesity
• Dyslipidemia
• Nerve damage to the penis or the pelvic area
• Pelvic surgery
• Radiation therapy to the pelvic area
• Low levels of testosterone
• Neurologic diseases
• Pre-existing psychological causes

Psychogenic  Erectile Dysfunction

Various conditions are commonly described to cause ED but in India, psychogenic ED appears to be quite common.  As a rule, a psychological cause for the ED is more likely than a physical cause if there are times when you can get a good erection, even though most of the time you cannot (For example, if you can get an erection by masturbating, or wake up in the morning with an erection).

 Few noteworthy points are-

• If you can achieve an erection on some occasions and not others, the cause is likely to be psychological.
• There are many possible psychological causes, including work stress or sexual boredom or conflicts with a partner, which may lead to temporary sexual dysfunction with that partner.
• It is acceptable to have lesser erection occasionally depending on your physical and mental stress level.
• You should not get stressed out about occasional decreased erections as that may cause performance anxiety and loss of confidence leading to erectile dysfunction.
• If you get too stressed about initial decreased performance then it may become a long-term problem. 
• Previous erectile failure for one of these reasons may cause anxiety and so the problem can repeat itself
• If you have an episode where you can’t have sexual intercourse, you may get anxious that it will happen again. This anxiety can be enough to stop you getting an erection next time, leading to more anxiety.
• Don’t read and self diagnose on the Internet
• Don’t be self conscious and anxious about size of penis. Ordinarily, size of penis is sufficient for satisfactory sexual relationships. 
• If ED is due to a physical problem, the decline in sexual function is usually gradual.
• Commonly the best treatment is to have realistic expectation that occasional decrease erection or having performance anxiety in the early days of a relationship is natural and not take too much stress about it.

In many cases a consultation with a Psychiatrist may also be important to treat various associated issues especially in long standing ED. Psychological conditions associated with ED include:

• Anxiety
• Depression
• Feelings of self-inadequacy
• Low self esteem
• Inability to describe emotions
• Stress

How is erectile dysfunction diagnosed?

History and examination to find out any underlying cause. SHIM (Sexual Health Inventory of Men) score is important to diagnose and to judge the severity of ED. 

Investigations

• Blood sugar, HBA1C, Thyroid profile, Lipid profile
• Serum Testosterone (between 8-11am). If less – check LH/FSH/prolactin
• Serum PSA – if clinically indicated
• Kidney and liver  function test
• Cardiology evaluation if heart disease is suspected
• Penile Doppler- if indicated after clinical examination

 Treatment

• Adjusting patients  and partner’s needs and expectations
• Lifestyle changes to decrease stress
• Addressing predisposing factors like smoking, obesity, metabolic syndrome, diabetes and heart disease
• Psychosexual counselling if the psychological distress is severe or there is  an underlying Psychiatric disturbance

Medications-

They work by increasing the blood flow to your penis when you are sexually aroused. Commonly used are –

1. sildenafil (Viagra®) 
2. tadalafil (Cialis®)
3. vardenafil (Levitra®). 

You have to take a dose before you plan to have intercourse. These tablets work only if you are sexually aroused.

If you are taking nitrates then these medicines should not be taken. Patients with serious heart  conditions are also not allowed to take these medicines. 

Vacuum devices – applied at the base of penis before intercourse. Should not be kept applied for more than 30 min. Not widely popular in India.  

Shockwave therapy- Not a standard option,  it is still experimental

Penile implants – They are surgically implanted into the penis In refractory cases if the conservative treatments fail or in cases where medical treatment is unlikely to work