What is erectile dysfunction?
Erectile dysfunction (ED) is the inability to maintain or get an erection sufficient to permit satisfactory sexual performance. For a successful erection, one needs: a coordinated equilibrium between neurological, vascular and tissue components – therefore healthy vasculature, healthy nerves, healthy penile anatomy & good hormones are needed for good erections.
How common is erectile dysfunction?
Erectile dysfunction is a very common condition men suffer with. It is estimated that 52% of males between the age of 40 and 70 years suffer from erectile dysfunction. It is said that 39% of men have cardiovascular (heart) disease, 50% of males have diabetes. 91% of patients with erectile dysfunction (ED) have metabolic syndrome (which is defined as men having central obesity, high blood pressure, high triglycerides, low HDL and insulin resistance).
What assessment should men with ED have?
When a man suffers from ED, it is very important for him to consult with a medical professional (especially someone that holds a key interest in this area). A thorough history will be taken by the doctor to assess his lifestyle, identify or rule out certain causes & assess morning erection frequency. Sleep apnea is important to exclude – and men at risk will be referred for further testing. Some men will be asked to complete an IIEF-5 questionnaire. A thorough examination will also be done. Risk stratification is an important part of the assessment of men suffering from ED. Blood tests will also be done to assess some of the causes or contributors to ED.
What are the contributing factors of Erectile Dysfunction (ED)?
The following are contributing factors to ED: uncontrolled chronic conditions, low testosterone (better known as hypogonadism), family history of heart disease, medication use especially those used for hypertension. The relationship that the man finds himself in is also very important (how good or bad that relationship is). Lack of physical activity can also play a major role.
What are the causes of Erectile Dysfunction (ED)?
| VASCULOGENIC | Cardiovascular disease (Hypertension, peripheral vascular disease, coronary artery disease) |
| Diabetes | |
| Hyperlipidaemia | |
| Smoking | |
| Major pelvic surgeries (radical prostatectomy) or radiotherapy (pelvis or retroperitoneum) | |
| Obesity | |
| NEUROGENIC | |
| CENTRAL CAUSES | Degenerative causes (Multiple Sclerosus, Parkingson’s disease, etc) |
| Spinal cord trauma or disease | |
| Stroke | |
| Central Nervous System Tumours | |
| Epilepsy | |
| PERIPHERAL CAUSES | Diabetes type 1 and 2 |
| Chronic renal failure | |
| Polyneuropathy | |
| Surgery (major pelvic or retroperitoneal surgery eg radical prostatectomy, colorectal surgery, etc) | |
| Urethral surgery (strictures, urethroplasty, etc) | |
| ANATOMICAL OR STRUCTURAL | Hypospadias, epispadias |
| Micropenis | |
| Peyronie’s disease | |
| Penile cancer | |
| Phimosis | |
| HORMONAL | Hypogonadism |
| Hyperprolactinaemia | |
| Hyper- or hypothyroidism | |
| Hyper- or hypocortisolism | |
| Multiple endocrine disorders | |
| DRUG-INDUCED | Anti-hypertensives (thiazide diuretics, etc) |
| Anti-depressants (SSRIs, etc) | |
| Anti-psychotics (neuroleptics, etc) | |
| Anti-androgens | |
| Recreational drug use (Cocaine, heroin, alcohol, anabolic steroids, marijuana, tobacco, etc) | |
| Cancer treatment | |
| PSYCHOGENIC | Generalised type (eg: lack of arousability, disorders of sexual intimacy, depression) |
| Situational type (eg: partner-related, performance-related issues/ anxiety) | |
| TRAUMA | Penis fractures |
| Pelvic fractures | |
| OTHER | Haemochromatosis |
| Liver disease | |
| Sleep apnoea | |
| Respiratory disease | |
What is the treatment of Erectile Dysfunction (ED)?
It is important to understand that ED is a couple problem, therefore it is very important to involve the partner as much as possible. It is important to treat any contributing or causative factors. Chronic illnesses need to be adequately managed and any medication that is contributing to ED needs to be changed. PDEF5-I are commonly used to aid erections. Physical exercise is important – aerobic exercise (running, cycling, swimming, walking, boxing and cross-fit) of 40minutes 4 times per week is shown to improve erectile function.