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A. Erectile dysfunction (ED) is a common male sexual disorder. It is the inability to get or keep an erection that allows for satisfying sexual activity. It can happen occasionally or regularly, with or without any clear reason.
Some men with ED are not able to get an erection at all.
ED is not a life-threatening disorder, but it can have a negative impact on your quality of life and that of your partner.
A. Getting an erection is a process that includes physical, hormonal, and psychological elements. The penis is made of soft, spongy, elastic tissue that fills with blood to make it grow in size and become rigid. Around the spongy tissue and the prostate, there are nerves that send signals so that the blood vessels supply the blood. These signals are controlled by the male hormone testosterone.
A. ED is a common condition in men of all ages and ethnicities.
The risk of having ED increases with age.
One in ten men will suffer from impotence and in diabetic men it is as common as 30%.
A. Risk factors for ED and cardiovascular disease (CVD) are similar. The most cases of ED result from a vascular
disturbance of the endothelium. Risk factors are such as:
Psychological risk factors for ED
Several psychological conditions have been associated with ED. These include:
Social ideas of how men and women are supposed to interact can also contribute to ED. These can include unrealistic expectations about love and sexuality, and inappropriate male and female role models.
ED is sometimes the cause and sometimes the result of unsatisfying or dysfunctional relationships. It is often difficult to find out which started first.
Cardiovascular disease and ED
ED and cardiovascular disease share common risk factors, like obesity, smoking, high cholesterol, high blood pressure, and lack of exercise.
ED can be an early sign of heart disease because problems with blood flow affect erectile function.
This is why men who experience ED should go to the doctor to get checked for heart disease.
Urinary symptoms and ED
ED is often associated with urinary symptoms, such as urinary frequency, nocturia, and urgency. Often these symptoms are related to benign prostatic enlargement (BPE). It is unclear if the urinary symptoms cause ED, but generally ED gets worse when urinary symptoms worsen.
A. Erectile dysfunction (ED) is a problem that needs to be diagnosed correctly, to find what causes it so that you get the appropriate treatment.
Discussing ED with your family doctor or urologist may be uncomfortable, but it is important to do so. Together you can discuss which treatment is right for you.
Medical history
Your doctor will take a medical history to understand your general state of health. As part of the medical history your doctor will ask about any other conditions you may have. Your doctor may ask you:
Sexual history
Your doctor will also ask you questions about your sex life, which could be very personal but are necessary for proper diagnosis and treatment. Some of the questions could be:
Your doctor will ask you to describe the firmness and duration of your morning erections, and sexually stimulated ones.
The doctor will also ask if you have problems with arousal, ejaculation, and orgasm.
If you have a sexual partner, it may be useful to attend this consultation together.
Questionnaires
Your doctor may ask you to fill out questionnaires, which are used to asses different aspects of your sexual health. The most common are:
Physical examination
The doctor will perform a complete physical examination, to check for abnormalities in the penis, scrotum, and testicles.
To check for heart disease the doctor will take your blood pressure, measure your heart rate, and order a blood test to check your level of cholesterol.
Your doctor will do a digital rectal examination to feel the size, shape, and consistency of the prostate, and if necessary, check the level of prostate specific antigen (PSA) in your blood.
To check for diabetes the doctor may order a test to measure the level of glucose in your blood. It could also be necessary to assess your testosterone levels in the morning. This is also done with a blood test.
Cardiac risk evaluation
Because of the relation between ED and heart disease the doctor generally does a cardiac risk evaluation as part of the diagnosis. Your doctor may refer you to a cardiologist for further evaluation.
Laboratory testing
Your doctor may order a laboratory tests to identify metabolic disorders underlying the ED.
Other tests
In some cases it may be necessary to do specific diagnostic tests. These may include:
These are not common tests during initial diagnosis of ED and are only necessary if your doctor needs additional information to assess your personal situation.
If necessary, your doctor may refer you to a neurologist, a psychiatrist, an andrologist, or an endocrinologist for further tests.
A. Erectile dysfunction (ED) is a common condition. Although it is not life threatening, it can negatively affect your quality of life. Because it can be related to other conditions, such as heart disease, it is important that you get the right treatment. There are various treatment options for ED:
Education and couple assessment
Lifestyle changes
Phosphodiesterase 5 inhibitors (PDE5I)
Topical therapies
Vacuum erection device
Shockwave therapy
Intracavernous injections
Penile Implants
A. An important part of treatment is understanding the condition and the consequences it may have on your intimate relationships. Your doctor will often recommend a combination of physical and psychological approaches to treat ED.
In the past doctors focused mainly on treating the physical aspect of ED. Nowadays, psychological and emotional aspects of the condition are also dealt with.
Treatment that includes psychological approaches has proved to be more effective than treating only the physical symptoms.
This approach has also shown to be effective in single patients, or in cases when the partner is not involved.
If you are in a committed relationship, it benefits your treatment if your partner agrees to the type of treatment, is aware of how it works, and you are able to talk about it.
Keep in mind that treatment is based on your individual situation and what may be helpful for others is not always helpful for you.
If you have other conditions that may be related to ED, your doctor will discuss referring you to a specialist for
assessment and further treatment.
Lifestyle advice
Improving your general health could help improve your symptoms. Your doctor will advise you to stop smoking, drink less alcohol, and exercise regularly.
Depending on your individual situation, your doctor may recommend that you adapt your diet. It is important to discuss this with the doctor first. As a general rule, try to have a varied diet which is low on sugar, salt, and fatty foods.
A. Kindly refer to the respective sections for further details.