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Erectile Dysfunction

Erectile Dysfunction Treatment

WHAT IS ERECTILE DYSFUNCTION?

ED is the inability to get a hard penis on sexual arousal or inability to maintain the hardness till completion of sexual intercourse .

 Erectile dysfunction (ED) is a common multifactorial Dysfunction affecting 40% of men over age of 40 years and 70% above 70 years. With increasing incidences of life style diseases like Hypertension, Diabetes, Cardiac Problem, Obesity, Sedentary life style and drug abuse, incidences of ED are increasing day by day.

It is traditionally divided in two types: Psychological and Physical. Most of cases have a mixed bag of causes .

 Not discussing your problem with right person or taking advice from a quack can be disastrous.

Causes of Erectile Dysfunction;-

Most common cause is Reduced Blood Flow to penis at the time of arousal. It is just like your heart beat: when you do the exercise, more blood flow is required by heart. Similarly, erection needs 10-15 times more blood flow into penis. If it is impaired due to any reason, you are likely to have ED

  1. Stress
  2. Anxiety
  3. Depression
  4. Obesity
  5. Smoking & Tobacco chewing
  6. Lack of exercise
  7. Alcohol abuse
  8. Diabetes
  9. Heart diseases
  10.  High blood pressure
  11.  Neurological diseases
  12.  Vascular diseases
  13.  High cholesterol
  14.  Relationship problems
  15. Medicines used to treat many physical problems

 

As ED is a multifactorial disorder, it is important to  find out the possible factors contributing to ED in every case.

Investigations:-

  1. For Assessment of Blood Flow : - Combined intracavernosal injection of Vasoactive substance and Stimulation test, Rigidometry, Penile Perfusion Index and Penile Doppler are helpful.
  2. For Psychological Factors: - Careful history taking, Questionnaires for different problems are recommended.
  3. For Neurological Factors: - SSEP in Dorsal Nerve of penis is suggested.
  4. For Hormonal Factors:- Blood test is done to determine sex hormone level.
  5. Other Blood Biochemistry:- Like Liver Function Test, Kidney Function Test, Blood Sugar Test are very important.
  6. NPT:- Sometimes we need to find out presence or absence of erection, Its duration; or differentiate psychological type from physical ED. This test is very helpful to differentiate the two conditions. This test is done overnight when an instrument is strapped on your thigh with sensors attached to penis. It records all overnight penile activity; the data once obtained are transferred to a computer and analyzed.

 

TREATMENT OF ERECTILE DYSFUNCTION

Counseling:-

In many cases, counseling alone may be quite helpful especially in case where ED is present with one partner but absent with another. It is called Situational ED. Ideally, it should be couple sex counseling. If you are patient enough to wait, it can be quite rewarding.

Medicines:-

There are many medicines available to improve blood flow into penis; the testosterone supplement is also recommended in appropriate cases

Intrapenile Injection:-

Vasoactive substance is injected by a very thin needle ,to be followed by penile stimulation. You can get it injected from the doctor or take in prefilled syringes to be injected by you or your partner before initiating sex

Caution:-  After taking injection, if hardness persists even after 4 hours despite stoppage of sexual stimulation, it can be dangerous and result in Priapism . You should apply ice packs on penis or climb up and down two or three flight of stairs a couple of times. A few pushups may be helpful as well. If the hardness doesn’t subside, rush to an appropriate doctor..   

Vacuum Erection Device (VED):-

In this method, a plastic cylinder is fitted over the penis; and controlled negative pressure created. This pressure helps in retention of blood in the penis. Thereby erections is achieved. A ring is fixed at the base of penis to maintain it for a maximum of 30 minutes. You should remove the ring before 30 minutes, otherwise ischemic changes may damage your penis.

Penile Prosthesis:-

If medicines are contraindicated, or have intolerable side effects, or do not work; If intrapenile inj. are not accepted, or had resulted in priapism- in such  cases penile prosthesis is recommended. This is a very effective, safe , permanent and irreversible mode of treatment. It stays for 12-15 years. You need to stay in hospital for 4-7 days and get training about how to operate the device. You may find a minor change in the size but overall satisfactions level, as reported by the couples, is very good after surgery.

 

 

 

 

 

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