Overview
Erectile dysfunction (ED) is when a man cannot achieve or maintain an erect penis enough to have sex.
It is not unusual at any age to occasionally not be able to achieve an erection. Various reasons can cause this, from stress, anxiety, tiredness, or excessive alcohol intake.
If it happens regularly, it can be an indicator of underlying health issues that require further investigation and potential treatment.
Key Facts
- An erection occurs when blood flow increases to the penis, resulting from sexual thoughts or direct contact with your penis.
- The resulting increased blood flow fills the penile arteries, which causes the penis to grow rigid.
- An erection ends when the muscles contract, the blood flow reduces and the blood in the penis flows through the penile veins.
- ED can occur because of problems at any stage of the erection process.
- Your doctor may prescribe medication to help you manage the symptoms of ED. You may need to try several medications before you find one that works.
Symptoms & Diagnosis
Symptoms
You may have ED if you regularly have the following:
- Difficulty in achieving an erection
- Trouble keeping an erection while having sex
- Overall reduced interest in sex
If you experience these symptoms regularly for over three months, speak with a doctor.
Diagnosis
Testing for ED can involve various steps, including a physical examination and taking your health and sexual history. Additional tests may be performed to determine if an underlying condition causes your symptoms.
Physical exam
A physical exam will include examining your testicles and penis, checking your blood pressure and listening to the heart and lungs. They may also conduct a rectal exam to check your prostate.
Psychosocial history
Your doctor will ask you questions about your symptoms, overall health history, and sexual history.
Some questions that you may be asked include:
- How long have you had this problem?
- In what circumstances does it happen?
- How often does it happen?
- Does it happen at every sexual attempt?
- Does it happen with all the sexual partners you’ve had?
Additional tests
Your doctor may require additional tests to help diagnose your ED. These can include:
- Ultrasound. This is used to check the blood vessels of the penis to see if there are any issues with the penile blood flow.
- Nocturnal penile tumescence (NPT) test. This portable, battery-powered device is worn on the thigh and used to check the quality of any nocturnal erections. Information taken is saved in the device for your doctor to review afterwards.
- Injection test. A medication is injected into your penis to stimulate an erection. This helps your doctor to check the firmness of the erection and how long it lasts.
- Urine tests. Taking a sample of your urine helps your doctor to check for diabetes or any other underlying health conditions.
- Blood tests. These tests can be used to investigate other health conditions that may affect you, such as heart disease, thyroid issues, and low testosterone levels.
These tests help your doctor check for any underlying health issues that may cause your ED and guide your treatment.
Causes & Prevention
Causes
There are many possible causes of ED. Some of the most common are:
- Diabetes
- Increased age
- Low testosterone levels or other hormone imbalances
- Obesity
- Kidney disease
- Cardiovascular disease
- Hypertension, or high blood pressure
- High cholesterol
- Stress
- Anxiety
- Depression
One or several of these can be factors causing ED, so it is vital to work with your doctor to rule out or treat any underlying health issues.
Treatments
Depending on the cause of your ED, treatment can include medication, counselling or lifestyle changes.
Medications
There are various medications that your doctor may prescribe. Working with your doctor, you may have to try several medications before you find one that works for you. The following oral medications stimulate blood flow to your penis to help treat ED:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Avanafil (Stendra)
- Vardenafil (Levitra, Staxyn)
Alternatively, your doctor may prescribe Alprostadil (Caverject, Edex, MUSE) which can be administered in two ways: as a penile suppository or as a self-injection at the base or side of the penis.
Testosterone therapy (TRT) may also be recommended if you have low testosterone levels.
Counselling
If you have some mental health issues, this can impact your sex drive and cause ED. As a result, speaking with a counsellor may help you. This support will help address the following:
- Your feelings around sex
- Subconscious conflicts that could be affecting your sexual well-being
- Any significant stress or anxiety factors
Conclusion
It is important to remember that ED is a common condition and can be medically addressed to overcome the symptoms in many cases. Your treatment plan will depend on your symptoms and their severity and will be agreed upon by the doctor.
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