diease

Erectile Dysfunction


OVERVIEW OF Erectile Dysfunction :

It is defined as the difficulty in maintaining the penis in the erectile position or making the penis to stand erect that is required for  the sex.


CAUSES :

Stress

Depression

Consuming higher amount of fat and oil diet

Any type of cardiovascular disease

Diabetes

Hypertension or high blood pressure

High cholesterol

Obesity

Low tolerance levels or other hormone imbalances

Kidney diseases

Increase in age

Anxiety

Relationship problems

 Ingestion of the medications such  as those used to treat high blood pressure or depression

 Sleep disorders

 Drug abuse

Over consumption of alcohol

Using tobacco products

Certain health conditions such as Parkinson’s disease or Multiple scelerosis

Any damage to the pelvic area and the surrounding structures through injury or surgery

Peyronie’s  disease which causes  the development of the scar tissue in the penis

The following includes the risk factors:

Various risk factors can contribute to erectile dysfunction, including:

Medical conditions, particularly diabetes or heart conditions

Tobacco use which restricts blood flow to veins and arteries, can — over time — cause chronic health conditions that lead to erectile dysfunction

Being overweight, especially if you're obese

Certain medical treatments, such as prostate surgery or radiation treatment for cancer

Injuries, particularly if they damage the nerves or arteries that control erections

Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions

Psychological conditions, such as stress, anxiety or depression

Drug and alcohol use, especially if you're a long-term drug user or heavy drinker

 


PATHOPHYSIOLOGY :

The neurovascular events that ultimately occur result in the  inhibition of adrenergic tone and the release of the nonadrenergic , noncholinergics neurotransmitter, nitric oxide. Nitric oxide is believed to be released from the nonadrenergic, noncholinergic nerves and endothelial cells. It subsequently stimulates the guanylate cyclase enzyme system in penile smooth muscle. This results in increased levels of cyclic guanosine monophosphate (cGMP) and ultimately in smooth muscle relaxation, enhancement of arterial inflow, and veno-occlusion, producing adequate firmness for sexual activity. The release of the nitric oxide leads to the relaxation of the corpus cavernosum the main tissue which helps in the erection of the penis.


COMMON CLINICAL SIGNS AND SYMPTOMS :

Feeling hard to keep the penis in erectile dysfunction

Loss of sexual activity in the shorter duration of time

Feeling insecure


DIAGNOSTIC :

The main step is the discussing with the person’s history of symptoms. To rule out whether the erectile dysfunction is due to differentiate between the whether cause is due to physiological or pathological. Determining whether involuntary erections are present is important in eliminating the possibility of psychogenic causes for ED

Ultrasonography:

Penile ultrasonography or doppler can be used to examine the erection of the penis. Most causes of the erectile dysfunction of organic causes are mainly related to alteration sin the blood flow in the corpora cavernosa which can be represented as the occlusive artery disease in whoch only less amkunt of blood is made into enter the penis. The arteries supplying the penis is also viewed.

Penis nerves function:

Tests such as the bulbocavernous reflex test are used to ascertain to check whether there is enough nerve sensation to the penis. The physician squeezes the glans that is the head of the penis  which immediately tell the anus to contract if the nerve function is normal.

Nocturnal penile tumenescence:

 It is normal for the man to have 5-6 erections during the sleep especially during rapid eye movement.

Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge]

Penile biothesiometry:

This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis

             Dynamic infusion cavernosometry (DICC):

Technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.

            Corpus cavernosometry:

Cavernoscopy is the  measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage.

            Magnetic resonance angiography (MRA):

This is similar to the normal magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. The doctor may inject into the patient's bloodstream a contrast agent, which causes vascular tissues to stand out against other tissues, so that information about blood supply and vascular anomalies is easier to gather.


TREATMENT AND PROGNOSIS :

Kegel exercise:

There are numerous exercises the man carry out to reduce the effect of erectile dysfunction.

The easiest and the best way to treat erectile dysfunction without medications is by strengthening the pelvic floor muscles with the aid of Kegel exercises. These can be useful in pregnant women who is planning for normal delivery but they can also effective for men looking to regain full function of the penis.

The first step in doing this is to detect the pelvic floor muscle. This can be achieved by stopping midstream two or three times the next time when the urine is passed. The muscles that can be palpated during this exercises is called as the pelvic floor muscles and they are main concentration in the kegel exercises.

The main aim of the kegel disease is tightening and holding these muscles for 5 second and then releasing them. Try to do the exercise atleast for 10 and 20 repetitions each day. This may not be possible when we start the disease, but it becomes easier as the time passes.

The improvement can be noticed after 6 weeks.

Make sure you are breathing naturally throughout this process and avoid pushing down as if you are forcing urination. Instead, bring the muscles together in a squeezing motion.

Aerobic exercise, such a jog or even a brisk walk, can also help the blood to circulate better and can help the men who have circulation issues with erectile dysfunction.

  • Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis.

Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device.

The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.

If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it's made by a reputable manufacturer.

  • Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.

Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among those who have tried and failed more-conservative therapies. As with any surgery, there's a risk of complications, such as infection. Penile implant surgery is not recommended if you currently have a urinary tract infection.


PREVENTION :

  • Work with your doctor to manage diabetes, heart disease or other chronic health conditions.
  • See your doctor for regular checkups and medical screening tests.
  • Stop smoking, limit or avoid alcohol, and don't use illegal drugs.
  • Exercise regularly.
  • Take steps to reduce stress.
  • Get help for anxiety, depression or other mental health concerns.

 


Medicines used in the Treatment :

  • Sildenafil (Viagra)
  • Tadalafil 
  • Vardenafil 
  • Avanafil 


REFERENCE :

https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776

https://www.urologyhealth.org/urology-a-z/e/erectile-dysfunction-(ed)

https://www.healthline.com/health/erectile-dysfunction

https://www.webmd.com/erectile-dysfunction/default.htm