Erectile Dysfunction

E

rectile dysfunction can be described as a total inability to achieve an erection, an intermittent disability or a tendency to maintain only brief erections.

Patterns of erectile dysfunction
In older men, erectile dysfunction usually has a physical cause, such as illness, injury or side effect of other drugs. Any disorder that causes nerve damage or impairs blood flow in the penis has the potential to cause erectile dysfunction. The incidence increases with age. Approximately 5% of men who are 40 years old and between 15 and 25% of men who are 60 years old experience erectile dysfunction. However, it is not an inevitable consequence of aging.

Erectile dysfunction is treatable at any age and the knowledge of this fact has been increasing. Many more men have sought medical help and have returned to having normal sexual activity thanks to the greater effectiveness of treatments against erectile dysfunction. Urologists are responsible for addressing the problem, generally.

Although erectile dysfunction is more common in men older than 65 years, as noted, this disorder can occur at any age. It is very important to emphasize that an occasional episode of erectile dysfunction is something perfectly normal that happens to most men. In fact, most of the cases should not be cause for concern. With increasing age, it is also normal to experience changes in erectile function. Erections may take longer to develop, not be as firm or require a more direct stimulation to occur. Men also notice that their orgasms are less intense, the volume of the ejaculate is smaller and the recovery time increases between erections.

When erectile dysfunction proves to have a pattern or becomes a persistent problem, it can deteriorate a man’s self-image and affect his sex life. It can also be a sign of an emotional or physical problem that requires treatment.

Treatments include;

• weight loss and increased exercise (this may reduced the risk of erectile dysfunction by up to 70%)
• treatment of any hormone abnormality (testosterone treatment is only indicated if your testosterone levels are low and may be harmful if your the levels are normal);
• lifestyle modification (e.g. reduce stress, stop smoking, reduce alcohol consumption & stop illicit drugs);
• treatment of any anatomical abnormality if present (e.g. circumcision, frenuloplasty, penile straightening);
• psychological support if necessary.

First line treatment will be medication with a phosphodiesterase inhibitor such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) or avanafil (Spedra). These drugs only work when used together with sexual stimulation and will have no effect on your sex drive. There is no evidence that these drugs are dangerous if you have underlying heart disease. However, they should not be used if you are taking nitrates (e.g. GTN, isosorbide) for angina

Other second Line Treatments

• Penile injections to produce erections
• Medicated urethral system for erection (MUSE)
• Vacuum erection assistance devices (VEDs)
• Vascular surgery/angioplasty
• Penile prostheses