Erectile dysfunction (ED) refers to the inability to achieve erection sufficient for sexual intercourse. It can also be an inconsistency or an ability to sustain only brief erections. Incidence increases with age.
Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence of events includes generation of nerve impulses in the brain, spinal column and area around the penis, and response in muscles, fibrous tissues as well as vasculature in and around the corpora cavernosa.
Causes of ED include the following:
- Diseases: Disorders that cause injury to the nerves or impair blood flow in the penis such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease and neurologic disease
- Lifestyle choices: Smoking, obesity and sedentary lifestyle
- Surgery: Cancer surgeries that involve the removal of the prostate and bladder can injure nerves and arteries near the penis, causing ED
- Medications: Antihypertensive drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants and drug used in management of peptic ulcer
- Psychological factors: Stress, anxiety, guilt, depression, low self-esteem and fear of sexual failure
- Hormones: Hormonal abnormalities, such low levels of testosterone
When you present to the clinic with erectile dysfunction, your doctor will review your complete history, and perform a thorough physical and psychosocial examination. Blood and urine tests for blood count, urinalysis, lipid profile, and measurements of creatinine, testosterone and liver enzymes may be ordered. Monitoring your erections during sleep and while waking (nocturnal penile tumescence) can help diagnose ED.
Erectile dysfunction can be treated with non-surgical and surgical methods.
Tablets are available that can increase blood flow to the penis, thus achieving an erection. Common side effects of this method include hot flushes and headaches. However, men who have had cardio-vascular problems should consult their doctor, as this method of treatment may not be appropriate.
Another popular form of treatment is penile injection. This involves injecting a substance into the base of the penis that dilates the blood vessels enabling them to fill with blood and thus creating an erection. This method is successful for most men, but it is essential for your doctor to work out an accurate dosage for you to prevent your erection lasting too long.
Other popular methods include the use of surgical implants to help create an erection. Implants are permanently surgically implanted into the penis under general anaesthetic; they can only be removed through another operation. There are two main types of implant, the Semi-Rigid implant or the Inflatable implant.
Inflatable implants involve the insertion of two cylinders into the penis and a reservoir of 60-100mls of saline deep behind the pubic bone. A pump and valve are inserted into the scrotum allowing the saline to be pumped into the penis, thus producing an erection. When an erection is no longer needed the valve can be released allowing the saline to drain back into the reservoir and the penis to become flaccid (soft).
Problems with Implants
As with all surgical procedures there are risks associated with the anaesthetic that your doctor will discuss with you.
The implants themselves carry a specific risk, associated with slight risk that your body will reject the implant or that the implant may become infected. Although these risks are minimal, the result is that the implants would need to be removed and it is unlikely that another could be put in. While the inflatable method gives a more natural feeling erection, there are the added potential problems of tubes blocking or pumps and valves malfunctioning.
It is essential that, if you are experiencing problems associated with erectile dysfunction, you discuss this with your doctor.
There are also a number of books and pamphlets regarding sexual issues and cancer available from your State Cancer Information Service, call 13 11 20 to find out more.