By Dr. Nanah Sheriff Fofanah-Sesay, Virginia,USA.
Erectile Dysfunction (ED) is an emerging epidemic that is usually not openly discussed by those affected. The purpose of this article is to outline the causes, prevalence, diagnosis, prevention, and treatment of this disease.
According to the National Institute of Health (1992), ED is the persistent inability to attain and maintain a penile erection adequate for sexual performance.
Many factors account for the development and sustenance of ED. However, denial and lack of motivation to seek treatment until the disease is well advanced is a major contributing factor.
Other causes of ED include but are not limited to obesity, diabetes mellitus, hyperlipidemia, kidney disease, hypertension, spinal cord or nervous system disorders, any type of pelvic surgery, smoking, alcohol dependency, illegal drug use, certain prescriptions and over-the-counter drug use, sedentary life style and increased persistent stress (WebMD, 2015).
ED affects almost all men at one time or another in their lives. Its affects as many as 30 million American men, including 30-50 percent of men between the ages of 40 to 70 years (John Hopkins Medicine, 2015).
In a randomized-sample prospective study conducted by the Massachusetts Male Aging Study (MMAS) about health and aging in middle aged men addressing erectile dysfunction, the prevalence of ED (minimal, moderate, and complete) clearly increases with age.
Since the etiology of ED is multifaceted, several tests may be conducted to determine the underlying cause and to diagnose the condition. An effective work-up leading to the diagnosis of ED starts with a comprehensive history and physical including a detailed evaluation of the individual’s sexual history.
The history often comprised of probing questions such as what are the specific circumstances under which ED initially occurred?, what sexual techniques do you use?, are there problems in your current relationship?, do you have more than one sexual partner?, If you have more than one sexual partner, do you experience ED with one or both? (WebMD, 2015). The provider or urologist may also want to interview your sexual partner(s) since they may be able to offer insight about the underlying causes.
Diagnostic tests for ED include a complete blood count (CBC) to evaluate for anemia which can cause fatigue. Blood glucose is done to evaluate for diabetes which contributes to ED.
Liver and kidney function tests are done to evaluate impairment in these organs which can cause ED. Lipid profile is done to evaluate for arthrosclerosis or hardening of the arteries which can affect blood flow to the penis.
The thyroid function test (TFT) is done to evaluate overactive thyroid gland which contributes to ED by producing excess thyroid hormone. Blood hormone studies such as testosterone, prolactin, follicle-stimulating hormone, and luteinizing hormones in low levels can cause ED. A urinalysis can point to abnormalities in protein, glucose, and testosterone level which can individually or collectively cause ED (WebMD, 2015).
Further diagnostic tests include nocturnal penile tumescence (NPT), to evaluate a man’s erectile function while sleeping. The penile biothesiometry involves the use of electromagnetic vibration to determine sensitivity and nerve function.The vasoactive injection causes blood vessels to dilate or enlarge to allow blood to enter the penis.
The bulbocavernosus reflex involves squeezing the head of the penis, which should immediately cause the rectum to contract, if ED is present, there will be a delay in response time or absence of rectal contraction. The prostatic sensitive antigen (PSA) is a blood test done to determine prostate cancer which may complicate ED if not treated (WebMD, 2015).
Other diagnostic testing for ED include the dynamic infusion cavernosometry which involves pumping fluid in the penis at a predetermined rate to determine severity of venous leak in men who have venous leak. The cavernosography involves injecting a dye into the penis followed by taking radiographic pictures of the penis to visualize venous leak and an arteriography which involves injection of a dye in the arteries followed by taking radiographic pictures of the arteries to determine damage to the arteries (WebMD, 2015).
ED can be treated at any age; however, response to treatment is highly dependent on the individual’s general health and underlying cause of ED. Keep in mind that your openness to the provider regarding the acuity of the condition is a fundamental prerequisite to the resolution of the problem.
From a preventive point of view, life style modification may be all you need to attain a stronger erection or prevent ED. Other treatment modalities includes penis pump, penile implants, erectile dysfunction surgery and medications such as Viagra, Levitra, staxyn, Cialis, yohimbe bark supplements, and alprostadil.
In addition, hormonal therapy such as testosterone, bromocriptine, and cabergoline have been noted to be useful. Other therapies include testosterone replacement therapy, horny goat weed, and psychotherapy.
ED is an emerging disease affecting not only the individual with symptoms but his sexual partner as well. If your partner suffers from ED, communication about the condition is essential to successful diagnosis and treatment; it can also engage your partner to be empathetic.
This article is dedicated to all men who are suffering from ED.