Erectile Dysfunction (ED): Prevention and Treatment

Highlights:

• Erectile dysfunction affects up to 50% of males over the age of 40, and the condition is now increasingly affecting more men of younger ages than ever before.
• High blood pressure increases the likelihood of experiencing erectile dysfunction by 62%. 8–10% of patients diagnosed with high blood pressure have also been found to suffer from erectile dysfunction.
• Shockwave treatment is the latest form of treatment for erectile dysfunction. The treatment involves focusing low frequency sound waves onto the outer tissue of the penis, and has been found to help men sustain a longer erection after 3–4 rounds of treatment when compared to before they began treatment.

Although erectile dysfunction is a disorder or condition that is completely normal among men in their later years, there is now a growing trend of the condition occurring in men of all ages. In fact it is affecting more men of younger ages than ever before. Despite not placing one’s life in danger, this condition is a vital indicator of overall health, especially in terms of circulation disorders such as stroke and ischemic heart disease, which are both caused by decreased circulation. Moreover, erectile dysfunction could have a significant impact on a marriage, which may subsequently affect everyday family life.

• Around 5% of men under 40 experience the condition
• Around 50% of men over 40 experience the condition

The natural process of maintaining an erection involves neurovascular cooperation under the control of hormones. The penis becoming erect relies on the following four normal-functioning mechanisms:

1. Intact neuronal innervations
2. Intact arterial supply
3. Copora (appropriately responsive corporal smooth muscle)
4. Intact veno-occlusive mechanics

The penis is flaccid in its regular state and only becomes erect as a response to sexual stimulation.

Erectile dysfunction can be classified according to the following three levels:

1. Slight dysfunction, meaning successful sexual intercourse is possible on most occasions
2.  Moderate dysfunction, meaning successful sexual intercourse is possible around half the time
3. Severe dysfunction, meaning it is almost impossible to engage in successful sexual intercourse

If a man is always able to maintain an erection during sex, it is considered normal. Erectile Dysfunction tends to occur as a result of both physical and mental issues, with the main cause being found to be insufficient circulation of the penis. As such, medical staff need to inquire into the patient’s medical history and perform a number of additional tests before making a diagnosis.

1.  Age is a crucial and unavoidable risk factor. The risk of developing erectile dysfunction increases the older a man gets.
2. Social and economic factors have been found to play a role, with men of lower socioeconomic statuses having been found to be more at risk of developing the condition.
3. The following congenital health disorders can be contributing factors:
   • Coronary artery disease: it has been found that heart disease can increase a man’s risk of developing erectile dysfunction by up to 13.2%.
   • High blood pressure: this condition increases a person’s risk of developing erectile dysfunction by up to 62% when compared to men with normal blood pressure. 8–10% of males suffering from high blood pressure have also been found to experience erectile dysfunction.
   • Diabetes: this disease increases a man’s risk of developing erectile dysfunction by up to 74.2% when compared to non-diabetics.
     Males who suffer from all three of the above conditions at the same time are almost certain to experience erectile dysfunction.
4. There is increased risk in males who have previously undergone certain types of surgery, such as pelvic or urethral surgery, or who have been involved in an accident that affected the pelvis or spinal column.
5. Male hormone deficiencies can be contributing factors.
6. Taking some forms of medication can increase the risk.
7. Certain behaviors, including smoking, drinking alcohol, specific types of exercise and certain forms of sexual intercourse, are also risk factors.
8. Mental health issues, especially depression, can also increase the risk, with studies finding that between 50%-90% of men with depression also suffer from erectile dysfunction. 

Taking good care of both physical and mental health, including getting plenty of rest, exercising regularly, avoiding certain risk factor and regular health checkup, can help to prevent erectile dysfunction. 

Treatment may take the form of medication or devices aimed at assisting the user to maintain an erection, with the following four types of treatment the most widely used:

1. Phosphodiesterase type 5 enzyme inhibitors are the first port of call for patients without any limitations in terms of the medication they can take (unsuitable groups include men taking medication containing nitrates). Side effects common to these drugs include headaches, vision abnormalities, hot flushes and/or aches and pains.
2. Injecting the penis with medication is another common form of treatment, with alprostadil one such drug suitable for direct injection. This drug helps improve blood flow to the penis, which will help it become erect and be able to sustain an erection for 30–60 minutes at a time.
3.  Another option involves inserting medication into the penis via the urethral opening using the same type of medication mentioned above, although this time using small pellets of the drug rather than a liquid. Within 5–10 minutes after insertion, the medication is absorbed into the organ and results in an erection.
4. A penis enlargement pump treatment involves placing a device over the penis and pumping it full of air for around 2–3 minutes. This action forces blood up into the penis tissue, leading to an erection. Then when the penis is fully erect, the device can be removed before tying a rubber band around the base of the penis to help sustain the erection.
5. In some cases, penile prosthesis surgery may be considered.

The latest technology developed to treat erectile dysfunction is shockwave treatment, which involves focusing low intensity extracorporeal shockwaves onto the outside of the patient’s penis to stimulate the growth of new blood vessels. This increase in blood vessels means greater circulation to the penis which, in turn, leads to more efficiency in terms of maintaining and sustaining an erection. Moreover, this method has been found to be extremely safe owing to the complete lack of side effects resulting from its use.

• Each session lasts 30 minutes and must be undertaken regularly, meaning twice a week for at least 2–3 weeks.
• No anesthetic is required for this form of treatment.
• The patient will feel a slight knocking sensation on his penis during treatment. However, this is painless, and he will not require any time to recover once it is completed. The patient can then return to his daily activities straight away due to the complete lack of side effects.

• Those not wishing to take any medication for their condition
• Patients who have not responded well to medication or have experienced side effects resulting from their use
• Men who have responded well to treatment but are still looking for more certainty regarding their condition

It has been found that patients see an improvement in their situation after the 3rd or 4th session when compared to before they began treatment. In addition, their erections tend to become gradually more reliable as they undergo further sessions as directed by their physician. Nevertheless, the number of sessions required depends entirely on the severity of the condition, as well as other associated risk factors, including diabetes and stress. The patient’s doctor will ultimately be responsible for scheduling and analyzing the success of treatment. Shockwave treatment should only be carried out by medical professionals specializing in the field of sexual performance as they will also be responsible for diagnosing the cause of the disorder before considering which treatment will be of the utmost benefit to the patient.