Erectile dysfunction (ED) is defined as the persistent or recurrent difficulty in achieving or maintaining an erection sufficient for satisfactory sexual intercourse.

ED is one of the most common problems among men. It can be a temporary issue linked to stress or psychological factors. However, if it becomes a consistent problem, happening repeatedly for at least three months, it's important to consult a healthcare professional. (1)

What are the causes of erectile dysfunction?

The causes of erectile dysfunction range from physical causes to psychological causes: (2)(3)

Physical causes

• Cardiovascular diseases: Erection depends on good blood flow to the penis, but the presence of problems in the blood vessels, such as atherosclerosis or high bad cholesterol, reduces blood flow, making erection difficult.
  
• Diabetes: Diabetes may affect the nerves and blood vessels responsible for nourishing the penis, making erection difficult. Studies indicate that 50-75% of men with diabetes suffer from varying degrees of erectile dysfunction.
  
• High blood pressure: High blood pressure may affect blood flow to the penis, and some medications used to treat it may worsen the problem.
• ‍Obesity and lack of physical activity: Excess weight and lack of exercise increase the risk of chronic diseases, which are factors that may affect sexual ability.‍
• Hormonal problems:
  Testosterone (the male hormone) is essential for men's sexual health, and its decrease may lead to decreased sexual desire and sometimes erectile dysfunction, and other hormonal imbalances in the body may affect sexual performance.‍
• Medications and drugs: Erectile dysfunction may be a side effect of some medications, such as:
  
  • Some high blood pressure medications (such as diuretics and beta blockers).
  • Some antidepressants and sedatives.
  • Some antipsychotics and hormone therapies.‍
  
  
• Peyronie's disease: It is a condition in which scar tissue forms inside the penis, leading to curvature of the penis during erection, often accompanied by pain, and may cause erectile dysfunction.
  
• Other causes:
  
  • Smoking and alcohol.
  • Neurological diseases such as Parkinson's disease and multiple sclerosis.
  • Sleep problems and obstructive sleep apnea.
  • Surgeries or injuries in the pelvis or spine;

Psychological causes

• Psychological stress and constant tension: one of the most common factors that may negatively affect sexual performance, and in some cases fear of failure during the relationship may exacerbate the problem.
• Depression: directly affects sexual desire and a man's physical ability to have an erection.
• Marital disputes: lead to a decline in self-confidence, in addition to exacerbating feelings of tension and anxiety.

What is the treatment for erectile dysfunction?

The optimal method for treating erectile dysfunction is chosen depending on the condition and the cause of the problem, and generally includes: (4)

1. Treating the underlying cause:

• If erectile dysfunction is caused by health problems such as diabetes, high blood pressure, or hormonal disorders, it is important to have good control over the problems first to improve sexual ability.
• If the doctor finds that one of the medications the patient is using is the cause, it can be modified or replaced if necessary (never stop a medication without consulting).
• Improving lifestyle through weight loss, exercise, and quitting smoking helps significantly.
• Psychological counseling if the cause is excessive anxiety and stress.

2. Medication:

The basic and most used treatment for erectile dysfunction is oral tablets that work to enhance blood flow to the penis, namely:

• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra)
• Avanafil (Spedra)

It is necessary to consult a doctor before using them, especially if you suffer from heart disease or frequent low blood pressure or use nitrate medications (such as the medicine known as a tablet under the tongue for angina pectoris), for fear of a dangerous drop in blood pressure.

Other medications:

• In some cases, alprostadil injections can be used in the penis or small suppositories that are inserted into the urethra to stimulate an erection.
• If tests show that erectile dysfunction is caused by a deficiency in the hormone testosterone, the doctor may prescribe hormone replacement therapy, which is in the form of skin patches, topical gel, or intramuscular injections.

3. Mechanical devices (if medications fail):

If the medications fail, the doctor may recommend devices such as:

• Vacuum device: It draws blood into the penis through an air pump, with the placement of a rubber ring to maintain the erection.
• Constricting ring: It prevents blood from leaving quickly, which helps the erection last longer.
  

But it has disadvantages; it may cause coldness of the penis, minor bruises, or loss of some spontaneity during sexual intercourse, which may affect the sensory experience.

4. Surgery (a last resort):

If previous treatments are not successful, surgery can be resorted to, the most famous of which is:

Penile implant surgery:

• The implant is either semi-rigid, providing permanent stability, or inflatable, giving greater control over the erection.
• Achieves high satisfaction rates, more than 95% of men are satisfied with the results.
• Safe, and is usually done within one day.
  

The Department of Urology and Andrology specializes in providing consultations related to andrology and erectile dysfunction, get a consultation now.

References

1. Mayo Clinic - Erectile dysfunction
2. NIDDK - Symptoms & Causes of Erectile Dysfunction
3. Family.org - Erectile Dysfunction: Causes, Symptoms & Treatment Options
4. MSD Manual Consumer Version - Erectile Dysfunction (ED) - Men's Health Issues