Erectile Dysfunction

Erectile dysfunction (ED) is the inability to get or keep a firm erection sufficient for sexual intercourse.

In an erection, impulses from the brain and local nerves cause the muscles of the corpora cavernosa, two chambers in the penis, to relax and allow blood to flow in through the arteries and fill the spaces. The engorged chambers expand the penis and the tunica albuginea, a membrane covering the two chambers, helps to sustain the erection. The erection ends when muscles in the penis contract to stop the inflow of blood and open the veins for blood outflow.

Causes of Erectile Dysfunction

These diverse factors can contribute to the development of erectile dysfunction, highlighting the multifaceted nature of this condition.

Treatment options may include :

• Lifestyle changes such as quitting smoking, reducing alcohol consumption, losing excess weight, and increasing physical activity may help some men regain sexual function.
  

• Trans-urethral agents involving the delivery of a pellet of Prostaglandin E1 Alprostadil into the urethra.
  

• Cutting back on or replacing medicines that could be causing ED.
  

• Psychotherapy: techniques that decrease anxiety associated with intercourse can be taught together with the help of the partner.
  

• Oral or locally injected drugs

  • Oral drugs called phosphodiesterase (PDE) inhibitors enhance the eff ects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow in the penis. Men who take nitrate-based drugs such as nitroglycerin pills for heart problems should not use any of these drugs because the combination can cause a sudden drop in blood pressure.
    

  • Drugs such as prostaglandin E1, papaverine hydrochloride, and phentolamine, are injected into the shaft of the penis to relax the smooth muscles of the corpora cavernosa, causing it to become engorged with blood. Patients using such medications should be warned about persistent erection, known as priapism, which requires emergency treatment.

• Oral therapy: Sildenafil (Viagra) may be prescribed. The medication enhances the ability to attain and maintain an erection in up to 60% of trial subjects. Patients will be advised to comply strictly with the prescription recommendations, especially for persons with heart problems
  

• Vacuum erection devices: mechanical vacuum devices cause an erection by creating a partial vacuum, which draws blood into the corpora cavernosa, engorging and expanding the penis. An elastic ring is moved from the end of the cylinder to the base of the penis as the cylinder is removed to maintain the erection.

• External suction devices: involving the use of suction devices to pull blood into the penis so as to attain and maintain an erection for intercourse.
  

• Surgery

• Penile implant. Implanted devices, known as prostheses, can restore erection in many men with ED. The implants may be malleable implants or inflatable implants. Once a man has either a malleable or inflatable implant, he must use the device to have an erection. Possible problems with implants include mechanical breakdown and infection, although the incidents of mechanical problems have decreased in recent years because of technological advances.

• Vascular surgery. Surgery may be performed to repair arteries with discrete blockage because of an injury to the groin or fracture of the pelvis. Surgery to block off veins, called ligation, can reduce the leakage of blood that diminishes the rigidity of the penis during an erection.
  

Extracorporeal Shock Wave Therapy (ESWT)