Erection issues or when medics say a man has Erectile Dysfunction (ED), popularly called “impotence”, this
actually means that the man has one or more of the following symptoms:
- He is unable to have an erection
- He is unable to maintain his erection
- He has reduced sexual desire
- He has premature or delayed ejaculation
So what does it take to have a normal erection?
Achieving and sustaining an erection as well as getting the right amount of pleasure from sexual intercourse is via an integration of physiological processes involving the nervous system, hormones and blood supply to the penis, and any abnormality in these systems would have a significant impact on your erection.
So what causes Erectile Dysfunction?
It could either be physical or psychological, or sometimes both. For example, a minor physical condition that slows down your sexual response can lead to anxiety which then worsens it.
Physical Causes: These include:
· Diseases like renal failure, diabetes mellitus, liver cirrhosis, cancer and cancer treatment, hypertension,
high cholesterol levels, thyroid disease, obesity (especially around the waist).
· Neurological conditions like epilepsy, stroke,
any trauma to the brain and spine
· Malnutrition and zinc deficiency
· History of prolonged painful erections
· Anatomical defects of the penis like epispadias and peyronie’s disease
· Vascular conditions e.g heart conditions like myocardial infarction, vascular injury from prostate cancer treatment, pelvic blood vessel and nerve trauma from long term riding of bicycles.
· Use of medications like antihypertensives, antidepressants, antipsychotics, anti-ulcer medications, cholesterol lowering drugs, body building steroids, drugs for treating prostrate enlargement
· Haematological conditions e.g sickle cell anaemia, leukaemia
· Surgeries on the brain, spinal cord, bladder and prostate.
· Hormonal imbalance in prolactinoma, hypogonadism
Psychological Causes: These include:
· Widowers syndrome-This is a fairly common disorder, usually occurring after age 50, after a husband loses his spouse.
· Performance anxiety
· Relationship issues relating from poor communication or other concerns
· Post-traumatic stress disorder
Use of tobacco products
- Use of illicit drugs
Diagnosis and treatment
Erection problemss are managed by 2 mechanisms
1. Reflex erection: achieved by directly touching the penis
2. Psychogenic: visual or emotional erotic stimulation
There are really no formal tests to diagnose erectile dysfunction but tests can be carried out to exclude underlying diseases.
Laboratory tests to be carried out to exclude diseases include:
- Blood sugar test
- Cholesterol level test
- Liver function test
- Hormone profile (testosterone level, leutinizing
hormone levels, thyroid stimulating hormone, prolactin level).
- Transrectal ultrasound scan to evaluate the prostrate and pelvis
- Duplex ultrasound scan and Magnetic resonance angiography: to evaluate blood flow to the penis.
Possible ways to overcome erectile dysfunction includes:
1. Lifestyle modifications including exercise especially aerobics, quit smoking, weight loss if obese, and cut down on
2. Psychosocial counselling (preferably with your partner)
3. For men with premature ejaculation not caused by other health issues, reducing penis sensitivity using delay condoms or delay gels is a very quick solution.
4. See your health provider for review of your medication if you are currently being managed for another medical condition.
5. Use of medications for treating erectile dysfunction e.g. viagra, tadalis. These medicines should be used only on a doctors’ prescription
6. Hormone replacement therapy for men with hypogonadism and prolactinoma
7. There are also herbal remedies in the market but these herbals should be used with extreme caution bearing in mind that most of them have not been thoroughly researched to full understand their side effects. If you have
to use herbal remedies please ensure they are at least NAFDAC approved.
For a man, erectile dysfunction can be a very disturbing condition, but one that can be managed. Be totally
open to your doctor especially with your medical, social and sexual history so the right management plan can be made and you would be back to becoming the stud you used to be.
Written by Dr. T. Akinpelu. Follow him on twitter @akinpelutola
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