GET TO KNOW MORE ON ERECTILE DYSFUNCTION!!

Do you know that erectile dysfunction is a very common disorder, and the incidence and prevalence is high worldwide? This condition remains disturbing for men and their partners who endure suffering as a result of the problem.

GET TO KNOW MORE ON ERECTILE DYSFUNCTION!!

Written by Bukola |Published: 22 |09|2022

WHAT IS ERECTILE DYSFUNCTION (ED)?

Erectile dysfunction is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.

It can be classified according to its cause as organic, psychogenic, and mixed erectile dysfunction. However, the European Association of Urology (EAU) Guidelines on male sexual dysfunction (European Association of Urology, 2017) suggests that the terms 'primary organic' or 'primary psychogenic' are used instead, as most cases of erectile dysfunction are actually of mixed aetiology (BSSM, 2017; European Association of Urology, 2017).

 

ITS PREVALENCE ARE?

In 1995, over 100 million men worldwide were estimated to have experienced erectile dysfunction. It is predicted that this figure will rise to 322 million by 2025 [Rajendran, 2014]. Erectile dysfunction can occur at any age, but the incidence and prevalence increase with age. The age adjusted risk of erectile dysfunction was higher for men with lower education, diabetes, heart disease, and hypertension [Johannes, 2000]. The increased incidence and prevalence of erectile dysfunction in older men is due to chronic disease, comorbid conditions, and age-related changes [Mola, 2015].

It was initially thought that erectile dysfunction was a disease of old age; however, available evidence suggests a growing incidence in men younger than 40 years of age (Nguyen, 2017). Erectile dysfunction in younger men was initially thought to be entirely psychogenic in nature. However, several studies have identified organic causes in at least 15–20% of younger men [Papagiannopoulos, 2015].

WHAT CAUSES ED?

Erectile dysfunction is a symptom and not a disease (European Association of Urology, 2017). It may have an organic and/or a psychogenic cause. It can also be caused by certain drugs.

1). ORGANIC CAUSES OF ERECTILE DYSFUNCTION ARE:

a). Vasculogenic Cause (the most common cause- a disorder or dysfunction of the blood vessels) [Randrup, 2015] such as:— cardiovascular disease (CVD), hypertension, hyperlipidaemia (High lipid level), diabetes mellitus, smoking, and major pelvic surgery (radical prostatectomy, radiotherapy (pelvis or retroperitoneum).

b). Neurogenic (disorder of the nervous system) cause- (central) such as:— degenerative disorders ( multiple sclerosis, Parkinson’s disease, and multiple atrophy), stroke, spinal cord trauma or diseases, and central nervous system tumours.

c). Neurogenic Cause- (peripheral) such as:- diabetes mellitus, chronic renal failure, polyneuropathy, major surgery of the pelvis or retroperitoneum, and urethral surgery (e.g: urethral stricture and urethroplasty).

d). Anatomical or structural cause such as— Peyronie's disease, penile cancer, prostate cancer, congenital curvature of the penis, micropenis, hypospadias, epispadias, and phimosis.

e). Hormonal cause such as:- hypogonadism, hyperprolactinaemia, hyperthyroidism- High thyroid levels, hypothyroidism- low thyroid levels, Cushing's disease, panhypopituitarism and multiple endocrine disorders.

2). PSYCHOGENIC (MENTAL) CAUSES OF ERECTILE DYSFUNCTION ARE:

a). Generalized cause — for example due to lack of arousability and disorders of sexual intimacy.

b). Situational cause — for example due to partner-or performance-related issues, stress, and mental health issues (including depression, anxiety, and schizophrenia).

3). DRUGS ASSOCIATED WITH ERECTILE DYSFUNCTION INCLUDE:

a). Antihypertensives — beta-blockers, verapamil, methyldopa, and clonidine.

b). Diuretics — spironolactone and thiazides.

c). Antidepressants — tricyclics, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors.

d). Antiarrhythmic drugs — digoxin, amiodarone.

e). Antipsychotics — chlorpromazine, haloperidol.

f). Hormones and hormone-modifying drugs — antiandrogens (flutamide, cyproterone acetate), luteinising hormone releasing hormone agonists (leuprorelin, goserelin), corticosteroids, and 5-alpha reductase inhibitors (e.g finasteride).

g). Histamine (H2)-antagonists — cimetidine, ranitidine.

h). Recreational drugs — alcohol, heroin, cocaine, marijuana, methadone, synthetic drugs, anabolic steroids.

(BSSM, 2017; BMJ, 2017; European Association of Urology, 2017).

 

There is some evidence that long-distance cycling (for example more than 3 hours a week) can cause erectile dysfunction, possibly due to nerve damage caused by contact with the saddle [Muneer, 2014; BMJ, 2017], but further research is needed to confirm this [Michiels, 2015].

 

WHAT ARE THE RISK FACTORS?

The risk factors for erectile dysfunction are similar to those for Cardiovascular Disease (CVD) which include: obesity, diabetes mellitus, and dyslipidaemia (the imbalance of lipids such as cholesterol, low-density lipoprotein cholesterol, triglycerides, and high-density lipoprotein (HDL)), metabolic syndrome, hypertension, endothelial dysfunction, and lifestyle factors (such as lack of exercise and smoking) (BSSM, 2017; BMJ, 2017; European Association of Urology, 2017).

The link between erectile dysfunction and CVD probably involves endothelial dysfunction and small vessel atherosclerosis, resulting in disorders of penile and coronary circulation. Since penile arteries are smaller than coronary arteries, the same level of endothelial dysfunction causes a more significant reduction of blood flow in erectile tissues compared with that in coronary circulation (Muneer, 2014).

Erectile dysfunction not only shares risk factors with CVD but is also, in itself, an independent marker of increased risk for cardiovascular disease (CVD). The increased risk is probably independent of conventional cardiovascular risk factors (such as age, weight, hypertension, diabetes, hyperlipidaemia, and cigarette smoking) (Fang, 2015; European Association of Urology, 2017].

Erectile dysfunction significantly increases the risk of cardiovascular disease, coronary artery disease (CAD), stroke, and all-cause mortality (BSSM, 2017; Balon, 2017). This could be because these conditions share the same risk factors and pathophysiological mechanisms, such as endothelial dysfunction, chronic inflammation, vascular structural alterations, dysfunctional nitrous oxide pathways, and abnormal peripheral sympathetic activity [Rajendran, 2014].

WHAT ARE THE COMPLICATIONS?

Erectile dysfunction can affect the physical, emotional, and psychosocial health of the sufferer. Complications include:

Anxiety

Depression

Lack of sexual confidence.

Low self-esteem.

Interpersonal difficulties.

Relationship difficulties.

Impaired quality of life of the sufferer and that of their partner and family.

TREATMENT AND MANAGEMENT

Erectile dysfunction usually responds well to a combination of lifestyle changes and drug treatment.

 (PLEASE REFER TO YOUR PRIMARY CARE PROVIDER FOR FURTHER ADVICE, DIAGNOSIS AND TREATMENT).

 

LIFESTYLE CHANGES THAT MAY HELP

Addressing lifestyle issues can help men with ED. Engaging in physical activities can reduce the risk for ED relative to those who remain sedentary; exercise and weight loss are shown to improve erectile function.

The potential benefits of lifestyle changes (e.g. weight loss, smoking cessation and reduction in alcohol consumption) may be particularly important in individuals with erectile dysfunction and specific comorbid cardiovascular or metabolic diseases, such as diabetes or hypertension. As well as improving erectile function, lifestyle changes would also benefit overall cardiovascular and metabolic health.

If you cycle more than 3 hours per week, try a trial period without cycling to see if this improves your erectile function; or try using a properly fitted bicycle seat and riding with the seat in a suitable position, as it may help prevent impairment of erectile function.

 

 

PLEASE REFER TO YOUR PRIMARY CARE PROVIDER FOR FURTHER ADVICE, DIAGNOSIS AND TREATMENT.

 

 

Additional information on erectile dysfunction is available on:

NHS website has useful information on ED

The British Association of Urological Surgeons (BAUS) has produced an information leaflet on ED

Advice and support is also available on the Sexual Dysfunction Association (SDA) website (www.sda.uk.net).

REFERENCES

  • Balon, R. (2017) Burden of Sexual Dysfunction. Burden of Sexual Dysfunction 43(1), 49-55.
  • BMJ (2017) Erectile dysfunction. BMJ Best Practice. http://www.bestpractice.bmj.com
  • BSSM (2017) British Society for Sexual Medicine Guidelines on the management of erectile dysfunction in men. The Journal of Sexual Medicine, 1-28.
  • European Association of Urology (2017) Guidelines on male sexual dysfunction. European Association of Urology. http://www.uroweb.org 
  • Fang, S.C.,  Rosen, R.C.,  Vita, J.A. et al. (2015) Changes in erectile dysfunction over time in relation to Framingham cardiovascular risk in the Boston Area Community Health (BACH) Survey. The Journal of Sexual Medicine 12(1), 100-108.
  • Michiels, M. and and Van der Aa, F. (2014) Bicycle riding and the bedroom: can riding a bicycle cause erectile dysfunction? Urology 85(4), 725-730.
  • Mola, J.R. (2015) Erectile Dysfunction in the Older Adult Male. Urologic Nursing 35(2), 87-93. [Abstract]
  • Muneer, A.,  Kalsi, J.,  Nazareth, I. et al. (2014) Erectile dysfunction. British Medical Journal 348. [Abstract]
  • Nguyen, H.M.T.,  Gabrielson, A.T. and and Hellstrom, W.J.G (2017) Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors. Sexual Medicine Reviews 5(4), 508-520. [Abstract]
  • NICE (2015a) Type 1 diabetes in adults: diagnosis and management (NICE guideline). NICE guidelines [NG17]. National Institute for Health and Care Excellence. https://www.nice.org.uk [Free Full-text]
  • NICE Internal Clinical Guidelines Team (2015b) Type 2 diabetes in adults: management (full guideline). Clinical Guideline Update (NG28). National Institute for Health and Care Excellence. https://www.nice.org.uk [Free Full-text]
  • Papagiannopoulos, D., Khare, N. and and Nehra, A. (2015) Evaluation of young men with organic erectile dysfunction. Asian Journal of Andrology 17(1), 11-16. [Abstract] [Free Full-text]
  • Rajendran, R. and and Cummings, M. (2014) Erectile dysfunction: assessment and management in primary care. Prescriber 25(12), 25-30. [Free Full-text]