Erectile Dysfunction: Management and Treatment

Erectile Dysfunction: Management and Treatment


Erectile dysfunction (impotence) is the inability to have and maintain an erection firm enough to have sex.

Occasionally, the problem of erections is not a concern. However, if erectile dysfunction is a persistent problem, it can cause stress, affect your self-esteem and contribute to relationship problems. Problems with getting or maintaining an erection can be a sign of a basic medical condition that requires treatment and a risk factor for heart disease.

If you are concerned about erectile dysfunction, talk to your doctor, even if you have dysfunction (ED).

Erectile dysfunction (ED) occurs when a man has persistent problems with getting and maintaining an erection. Without treatment, erectile dysfunction can make sex difficult. The problem is reported by 1 in 5 men, and this number increases with age. Sometimes treating the underlying condition is enough to restore erectile dysfunction. In other cases, medication or other direct treatment may be needed.

What is an erection?
Erectile dysfunction can be the result of a problem with one of them. Also, problems with stress and mental health can cause or worsen erectile dysfunction.

For example, a small physical condition that slows down your sexual response can cause anxiety about maintaining an erection. Anxiety can cause or worsen erectile dysfunction.

Physical reasons:
It is always worth consulting a doctor about persistent erection problems as it can be caused by a serious illness.

Whether the cause is simple or serious, a proper diagnosis can help resolve any underlying medical problem and resolve sexual difficulties.


heart disease and blood vessel narrowing

hormonal disorders that include thyroid disorders and testosterone deficiency

structural or anatomical disorder of the penis, such as Peyronie’s disease

smoking, alcoholism and drug addiction, including cocaine use

treatments for prostate disease

surgical complications

lesions in the pelvic region or spinal cord

radiotherapy in the pelvic region

Atherosclerosis is a common cause of problems with blood circulation. Atherosclerosis causes narrowing or blockage of the arteries in the penis, preventing the necessary blood flow to the penis to get an erection.

Many prescription medications can also cause erectile dysfunction, including the following. Anyone taking prescription drugs should consult their doctor before stopping or changing medications.

medications to control high blood pressure

heart drugs such as digoxin

some diuretics

drugs that affect the central nervous system, including certain sleeping pills and amphetamines

anxiety treatments

antidepressants, including monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants

opioid pain relievers

certain anticancer drugs, including chemotherapeutic agents

drugs for the treatment of prostate


hormonal drugs

peptic ulceremia with cimetidine

Physical causes make up 90% of ED cases, with much less psychological causes.

What are the symptoms of erectile dysfunction?

You may have erectile dysfunction if you regularly:

difficulty getting an erection

difficulty maintaining an erection during sexual activity

decreased interest in sex

Other sexual disorders associated with erectile dysfunction include:

premature ejaculation

delayed ejaculation

an orgasm, which is the inability to achieve orgasm after intense stimulation

You should talk to your doctor if you have any of these symptoms, especially if they lasted two months or more. Your doctor may determine if your sexual disorder is caused by a underlying condition that requires treatment.


Treatment of erectile dysfunction

How Can I Treat Erectile Dysfunction?
You can work with a healthcare professional to treat the underlying cause of your erectile dysfunction (ED). Choosing treatment for erectile dysfunction is a personal decision. However, you can also benefit from talking with your partner about which treatment is best for you as a couple.

Go to tip:

Talk to your doctor to see a counselor if there are psychological or emotional problems that affect your illness. The counselor can teach you how to reduce your anxiety or stress related to sex. Your counselor may suggest that you bring your counseling partner to learn how to support him or her. While working to relieve your anxiety or stress, your doctor may focus on treating the physical causes of erectile dysfunction.

Online pharmacies:
It is possible to buy online treatment for erectile dysfunction. However, caution is advised.

The US Food and Drug Administration (FDA) has a consumer safety directive on this, including a recommendation to confirm that an online pharmacy:

It’s in the US. UE. and allowed

You have a licensed pharmacist to answer your questions.

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It offers direct contact with a person who can discuss any problem.

You can confirm that the pharmacy is licensed using this list of Checked Pharmacy Practice Websites (VIPPS).

The FDA also offers tips for detecting the dangers of an unsafe website, including monitoring for the following clues:

There is no way to contact the website by phone.

The prices are significantly lower than those offered by legal online pharmacies.

Prescription drugs are available without a prescription, which is illegal.

Personal information is not protected.

The FDA adds that these illegal sites can dispense drugs of unknown quality and origin, even by sending the wrong drug or dangerous product.

Talk about alternative remedies:

Some men say that some alternative oral medications can help them get and maintain an erection. However, not all “natural” remedies or supplements are safe. The combination of certain prescriptions and alternative medicines can lead to significant health problems. To ensure coordinated and safe care, talk to a healthcare professional about alternative medicines, including the use of vitamin and mineral supplements. Also, never order medicines online without talking to your doctor.

Prescribe the medicines you take by mouth:

Your healthcare professional may prescribe an oral medicine or oral medicine, such as one of the following, to help you get and maintain an erection:

sildenafil (viagra)
Vardanafil (Levitra, Staxin)

Tadalafil (Cialis)

avanafil (Stendra)

All of these drugs work by relaxing the smooth muscles and increasing blood flow to the penis during sexual stimulation. You should not take any of these medicines to treat erectile dysfunction if you are taking nitrates to treat heart disease. Nitrates expand and relax blood vessels. The combination can cause a sudden drop in blood pressure, which can cause fainting, dizziness or falls, which can lead to possible injury.

Talk to your healthcare professional if you are taking alpha-blockers to treat enlarged prostate. The combination of alpha-blockers and drugs for erectile dysfunction can also cause a sudden drop in blood pressure.

A health care professional may prescribe testosterone if you have low levels of this hormone in your blood. While taking testosterone can help with your erectile dysfunction, it is often not helpful if your erectile dysfunction is caused by circulatory or nerve problems. Taking testosterone can also cause side effects, including a large number of red blood cells and difficulty urinating.

Testosterone treatment has also not been proven to help with age-related or late onset hypogonadism-related erectile dysfunction. Do not take testosterone therapy that is not prescribed by your doctor. Testosterone therapy can affect the way other medicines work and can cause serious side effects.

The role of endothelium in dysfunction


The role of the endothelium in erectile dysfunction has been observed for several years and the overlap of erectile dysfunction and other conditions, especially coronary heart disease, HVB, affecting endothelial function / dysfunction are clearly present. It is now known that the endothelial cell affects the vascular tone and affects the process of atherosclerosis and affects erectile dysfunction, QVB and peripheral vascular disease.

The role of endothelium in erectile function has become clearer with the suggestion that the phosphodiesterase type 5 (PDE5) inhibitor, sildenafil, improves erectile function. The erection occurs by the release of nitric oxide (NO) from vascular endothelial cells. The decrease in NO production of endothelial cells leads to a negative effect on the smooth muscle of the body and leads to less relaxation of the smooth muscle cells by decreasing blood supply and as a result of ED. It is well known that a similar phenomenon affects the coronary artery system and produces CVD.

It is important to understand that erectile dysfunction is often associated, if not directly, with endothelial dysfunction and that the release of NO from the vascular system of the penile arteries is directly related to the function of intact healthy endothelium. Faced with endothelial dysfunction, the erection process does not proceed normally.

Testosterone and Erectile Function:

Among the phenomena associated with human aging are decreased erectile function and testosterone levels. In addition, there is an increased risk of CVD, muscle loss, decreased bone density and libido, and all of these factors interact with testosterone metabolism. Androgens play a key role in maintaining erectile function through four major mechanisms. Androgen deprivation has been shown to exacerbate the release of NO synthase, impaired expression and activity of PDE5, impaired cavernous nerve function, and contributes to venous-occlusive disease. the penis. The role of testosterone replacement therapy (TRT) as a potential for improving erectile function in men with erectile dysfunction remains a problem for patients and physicians who are satisfied with androgen deficiency treatment, which includes physicians and medical professionals. primary care Androgens are known to have a significant impact on smooth muscle function in the cancerous body.

TRT has been reported to increase the efficacy of PDE5 inhibitors in hypogonadic men using these therapies with a suboptimal response to PDE5 inhibitors alone. In addition, researchers have shown that TRT in hypogonadic men can improve erectile function even without the benefit of PDE5 inhibitors. In addition, guidelines for the management of erectile dysfunction in hypogonadic men by the European Association of Urology recommend monitoring human eugonadal status before initiating treatment with PDE5 inhibitors. Testosterone measurement consists of a serum sample, which should ideally be obtained in the morning due to the normal variation of daily testosterone at its peak in the morning. Because TRT is relatively safe and men can potentially see improvement in erectile function, it seems prudent to consider this problem when presenting a patient with ED.

Vacuum devices
Vacuum erection devices are a mechanical erection tool for men who do not want or cannot use drugs or find that they do not work.
The penis becomes rigid with a vacuum pump sealed around it to draw blood. This prevents him from leaving the penis with the aid of an accompanying tape.
The lack of spontaneity with the use of vacuum devices means that many men consider other treatments for erectile dysfunction.

What non-surgical treatments are available for erectile dysfunction (ED)?

Education and Communication:

Education about sex, sexual behavior and sexual reactions can help a person overcome his fears of sexual dysfunction.

Talking honestly with your partner about your needs and concerns can also help overcome many barriers to a healthy sex life.


Medications such as sildenafil (viagra), vardenafil (levitra) or tadalafil (Gialis) can help improve sexual function in men by increasing blood flow to the penis. Men taking nitrate-containing drugs such as nitroglycerin should not take oral medications for erectile dysfunction. The combination of nitrates and these specific drugs can cause low blood pressure (hypotension). The most common side effects of these drugs are indigestion, nasal congestion, redness, headache and temporary vision disorders.

Diagnostic evaluation of erectile dysfunction


The penis consists of two parallel cylinders of erectile tissue, the corpora cavernosa and a smaller cylinder, placed ventricularly, the spongy body surrounding the urethra and forming distally.glands (Figure 1). The cavernous cavernosa consists of a network of interconnected cavernous spaces, bordered by the vascular endothelium. They share an incomplete partition that allows them to function as a single unit. 3 Blood circulation is mainly provided by the cavernous branches of the inner pudal artery. Each branch is divided into numerous terminal branches that open directly into cavernous spaces. The venous drainage of the erectile bodies occurs through post-cavernous venules that join to form large discharge veins that penetrate the tunica albugina before entering the deep dorsal vein.

The autonomic and somatic nerves innervate the penis. The parasympathetic nerve fibers originate from the sacral segments of the spinal cord, while the sympathetic nerves originate from the lower thoracic and upper lumbar segment.3 Somatic sensory and motor fibers enter and exit the sacral brain and innervate the penile nerve.