Erectile dysfunction: 4 causes, symptoms, risk factors and treatment options

In this post, we are going to be discussing erectile dysfunction, causes, symptoms, risk factors and treatment options

The story

The kissing and groping had been hot. He’d come back from work and stealthily walked into the kitchen, where she was doing the dishes, and hugged her from behind.

It was an innocent hug initially, and they were rocking from side to side while asking each other how their days were. Until she felt his bulge rubbing against her. Then his lips suddenly found hers as if by magic. And that was how the “hot kissing” started.

Next he swept her off her feet into the safety of his powerful arms, his biceps reflecting the light, and ferried her to their king-sized bed. One of the perks of living alone as a newly married couple was these spontaneous sexual adventures.

He hurriedly undressed her, his heart thumbing so loud she could hear them. She did the same to him, their lips still locked in a kiss. Then she guided him to lady town, where a soaking wetness awaited him.

A few thrusts, not even up to 2 minutes, and he went flaccid inside her, before he could even ejaculate himself. Frustrated, he pulled out, shame written all over his face.

What is Erectile Dysfunction?

Otherwise​ called Impotence, Erectile Dysfunction [ED] is defined as the inability to achieve erection– or doing so with great difficulty; and or the inability to sustain erection long enough to satisfy both partners.

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It is fairly common for one to loose erection during sex; there’s virtually no sexually active male who has not, at one point or the other, had an episode in which his penis failed to “rise up to the occasion.” Such occasional occurrences, however, are “normal” and are not considered clinically as ED. It is considered to be ED when it becomes habitual, the norm rather than the exception, occuring at least 60 to 100% of the times, and constituting a matter of grave concern to the individual.

Studies show that most men above the 40-year mark find it difficult to achieve and maintain an erection, or achieve the degree of turgidity they were used to in their youthful days, about as many as 50% of the times. Studies also show that older men are mostly unable to achieve full erection without direct, tactile stimulation of the penis.

It is important to note that, as in the case above, ED has nothing to do with how macho, or not, one looks; there are multiple factors that can lead to ED irrespective of one’s body habitus. Also, it has nothing to do with the size of the penis.

Physiology of Erectile Dysfunction?

Understanding the physiology of normal erection will​ help us understand the possible causes of ED, the risk factors, and how best to exploit this knowledge in both prevention and treatment.

Requirements For Erection

Penile erection is a complex physiological process requiring optimal functioning of the following;

  • the brain
  • intact system of nerves
  • patent blood vessels​
  • the optimal level of Testosterone
  • a normal penis

Mechanism Of Erection

Following exposure to an erotic stimulus, which may be psychic, visual, olfactory, auditory, or tactile, the nerves of the penis are stimulated to release some vasoactive substances [chemicals, like Nitric Oxide, that act on blood vessel smooth muscle].

These chemicals make the blood vessels to dilate, allowing blood from the body to rush into the flaccid penis, filling it up, stretching it taut, conferring turgidity to it. This is called tumescence; erection.

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Erection is sustained by two things:

  1. the pressure of the blood inside the penis occludes the channels through which blood can leave;
  2. and a muscle at the base of the penis [the ischiocavernosus] contracts, closing off​ the point through which blood can leave the penis and return to the body.

These two, acting in concert, keeps the blood sequestered inside the penis, thus sustaining erection.

Detumescence occurs, when the nerves stop producing vasoactive substances, and the ones that have been produced already are broken down, leading to the effect of those chemicals on the blood vessels being lost. Also, ejaculation makes the sympathetic nerve to relax the muscle closing off​ the base of the penis, allowing blood to flow back into the body, making the penis to become flaccid.

Symptoms of Erectile Dysfunction?

The symptoms of ED include the following;

  • inability to achieve an erection, or difficulty doing so.
  • inability to sustain an erection.
  • the decrease in the usual rigidity of one’s erection.

All lasting for at least 6 months.

erectile dysfunction
Erectile dysfunction Credit: VectorMine/shutterstock

Causes of Erectile Dysfunction?

For the purpose of convenience, and a better understanding of the uninitiated, I will classify the causes into the following;

Factors Affecting BLOOD VESSELS

  • Tobacco abuse [hardens and narrows blood vessels]
  • Atherosclerosis [clogs blood vessels]
  • Peripheral artery disease
  • Hypertension
  • Diabetes

Factors Affecting NERVES

  • Diabetes
  • Spinal cord injuries
  • Damage to nerves during Prostate surgery
  • Alcoholism
  • Multiple sclerosis

Factors Affecting the BRAIN

  • Stroke
  • Head injury
  • Depression
  • Anxiety
  • Stress

Factors Affecting Hormone Levels

  • Hyperthyroidism
  • Hypothyroidism
  • Liver disease
  • Hypogonadism [anything that reduces levels of male sex hormone]

Factors Affecting the PENIS

Drugs

  • Antihypertensives
  • Antihistamines
  • Antidepressants
  • Antipsychotics
  • Certain Anti-Ulcer medications

Note that this list of causes is not exhaustive.

Risk Factors

This includes the following.

  • Smoking
  • Obesity
  • Diabetes
  • Hypertension
  • Heart disease
  • Chronic illnesses
  • Drug abuse

Complications of Erectile Dysfunction?

ED is a serious condition with far-reaching complications, affecting both the individual, his partner, and their relationship. Some of these complications include;

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Complications On The Individual

  • Low self-esteem​
  • Anxiety
  • Depression
  • Suicide
  • Unsatisfactory sexual life

Complication Affecting His Partner

  • Sexual frustration

Complications Affecting The Relationship

  • Relationship problems, and ultimately a break-up.
  • Infertility.

Treatment of Erectile Dysfunction?

ED is treatable, and options for treatment abound. While some of the medications for treating ED are readily obtainable, self-diagnosis and self-medication is STRONGLY ADVISED AGAINST for the following reasons;

  1. Most cases of ED may have a potentially fatal underlying cause, and addressing the ED without first addressing the underlying problem may lead to fatal consequences. ED, for instance, is considered a serious indicator of heart disease, as it shares some risk factors with it. And as such, heart disease MUST BE RULED OUT FIRST in every person with ED!
  2. Some of the readily obtainable drugs have serious side effects, especially in people with cardiovascular disease, which is usually associated with ED. So such drugs should not be taken until a doctor has been seen, and such conditions ruled out.
  3. Each cause of ED has a treatment that is best suited for it. And without knowing the particular cause of one’s own case, one may be barking up the wrong tree, taking the wrong medications. In fact, in most cases, addressing the underlying cause may be enough to resolve the ED.

Treatment Options

This includes​ the following:

Life Style Modifications

  • Weight loss through regular exercise, and dietary discretion, is helpful, especially in obese patients.
  • Cessation of smoking, reduction in alcohol intake, and cessation of drug abuse, including the over-the-counter medications listed above, is also helpful.

Psychotherapy

Sexual counselling is invaluable, especially in cases where no organic cause can be identified.

Oral Medications

PDE-5 inhibitors are very useful in the treatment of ED. They help intensify and sustain erection by delaying the breaking down of the vasoactive substance c-GMP.

Examples include;

  • Sildenafil [Viagra]
  • Verdenafil
  • Injectables-This involves the use of Prostaglandin E1 analogues, like Alprostadil, which could be injected directly into the penis.
  • Hormone Replacement-Replacement of Testosterone is useful, especially in men with low levels of Testosterone. It can also be used as an adjunct if other measures fail.
  • Penile Pumps-This involves using an external vacuum device. It is in the form of a tube that the penis is inserted into, and vacuum pressure applied. This draws blood into the penis, achieving tumescence.
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Then a constriction device, in the form of a ring, is then slipped at the base of the penis to prevent blood from flowing back into the penis, in order to sustain an erection. Erection is sustained until the ring is removed.

Please note that there are rings specially​ made for this, and those rings are INCOMPLETE circles, are SLIPPED FORM THE SIDE, and are thus easy to remove. DO NOT USE A REGULAR RING! It could lead to penile gangrene and amputation! In fact don’t use any ring, unless it is prescribed by your physician. This is me watching my hands like Pontus Pilate!

Surgical Options

There are several surgical options, depending on the case. Some of them include the following;

  • Revascularization [in which the blood vessel are made patent again]
  • Placement of penile implants.

About the author

Doctor

Dr Chibuike Joseph Chukwudum is a doctor who Studied Medicine and Surgery at Nnamdi Azikiwe University Awka. He is the former Medical Officer at Oakland specialist hospital,obosi.He also previously worked at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State.