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Erectile Dysfunction

Dr. Rao has been in General Medical practice for the past 36 years treating patients with a variety of problems. One of them is Impotence...

No erection

A person indicating that he failed to get an erection

A person indicating that he failed to get an erection

Live a Better life By Overcoming Erectile Dysfunction a.k.a Impotence

What is Erectile Dysfunction?

Of late, in my day-to-day clinical practice, I am confronted by patients who are disillusioned by not being able to enjoy normal sexual pleasures.

In men, this is due to a partial or total lack of erection of the male genital organ-the penis. This is called Impotence or Erectile Dysfunction.

While most of them are men, some are women too. Women are also affected due to this lack of erection in their partners.

I'll illustrate this with 2 examples-

Case No.1- A Senior Citizen

An elderly male, aged 66 years, visited my clinic recently with the complaint of not being able to sustain an erection while having sex. He wanted a solution for this badly. I casually asked him-" Is your wife complaining?"

He said-"Yes". His next question was-" Why this is happening to me?"

"Well," I said, "it must be your age catching up with you." "Can you help me, Doctor?" he asked again.

Any co-morbid conditions for this patient?

This patient is undergoing treatment for-

  • Diabetes
  • Hypertension
  • History of head injury due to a fall.

Anyway, I decided to give it a try i.e. help him out of this situation. We'll come to this later.

Case No.2- A young lady

A young lady and mother of one child visited my clinic with a complaint of not getting satisfaction from having sex with her hubby as he seems to drift off and lose interest. The young husband does not seem to get a proper erection and feels as if he cannot carry on the act of coitus. "What can be the cause?" she asked me in a worried tone.

I decided to dig further into this query. I asked her hubby-" Yes young man, what's happening? Why can't you satisfy her?"

Upon which he replied-" Doctor, the Corona has wiped me out financially as well as emotionally. I have no work because I do event management and as of today, there are no events to manage. I get frustrated by the end of the day and I am not in a mood to talk also, leave aside having sex."

So, here we have 2 cases with varied histories but the same problem- failure to get an Erection.

What are the symptoms of Erectile dysfunction?

The first and foremost symptom is failure to have an erection of the penis. Now, this symptom can be co-related to symptoms of the following conditions-

  1. Aging- almost all processes related to other body parts like wrinkling of the skin, cataract of eyes, etc.
  2. Diabetes- the most common cause of erectile dysfunction. This involves nerve and blood vessel involvement of those that are being supplied to the penis.
  3. Hypertension- especially that which is caused due to atherosclerosis of arteries, can slow down the blood supply to the penis.
  4. Depression-this automatically reduces libido and ultimately, arousal.
  5. Dementia- forgetfulness, and tremors like in Parkinson's disease.
  6. Imbalance of hormones like thyroid hormone, testosterone, follicle-stimulating hormone[ FSH], etc.

What has age got to do with the erection of the penis?

As you can see from the above two cases, one is an elderly person and the other one is in his 30s. But both have similar problems- difficulty in arousal or erection of penis while trying to have intercourse.

Why is this happening? To know this, let us first learn about the anatomy and a little bit about the physiology of these organs.

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The Anatomy of the Male Genitals

The male genitalalia consist of, as you may be all aware of, the following organs-

  1. The testicles, lodged in a special pouch called the scrotum, outside the abdomen
  2. The Penis
  3. The Prostate gland
  4. And the seminal glands.

The picture below shows a 3D image of the organs and their placements-

As you can see in the picture above, the male penis is composed of spongy tissues- the corpus cavernosum and corpus spongiosum. These two spongy tissues have the ability to expand. To know how this happens, we will have to know a bit of its physiology.

The Physiology of having an Erection of the Penis

Sexual arousal occurs in a male person happens when he feels that he should have intercourse with his female partner[the female partner can be his spouse or some other female person responsive to his approach].

Just thinking about having sex with someone he may admire can also have similar effects. Now, what causes this erection or arousal? To know this, we will first have a look at the cross-section of the penis.

In the image shown below, you can visualize that the shaft of the penis is composed of many tissues, nerves, and blood vessels. All of these tissues contribute to having an erection, apart from the hormone, testosterone, which comes from the testicles.

Cross-section of the penile shaft

Cross-section of the penile shaft

What happens in the Erection of Penis?

Desire to have sex starts with physical attraction towards a person you admire or love. Even thinking about that person incites arousal.

Thoughts of physical intimacy can stimulate your brain to re-direct your sexual organs, specifically the male organ, the penis.

The Hormone Connection

The hormone, testosterone, present in large quantities in the testicles, also helps in having an erection of the penis. In the case of diabetes and/ or old age, the level of testosterone* in the blood is reduced or decreased, thereby reducing the stimulation of the penis. Sometimes, males having high prolactin levels[ it has inhibitory effects on the action of testosterone], hypothyroidism, etc., can cause sexual dysfunction. Correcting these hormonal imbalances can reverse this sexual dysfunction.

*The normal level of testosterone in an adult male is 270 to 1070 nanogram/decilitre[ng/dl]. I have provided a link below about testosterone levels and their effects.

The Autonomic Nerves

Have a look at the cross-section of the penile shaft. There is a nerve called the Dorsal Nerve. This is a parasympathetic nerve autonomic nerve.

In the penal shaft, there are 2 types of autonomic nerves. One is called Sympathetic-it is anti-erection, meaning it does not help an erection.

The second one is the parasympathetic autonomous nerve. This is pro-erection. Meaning, it helps in having an erection by causing dilation of the arteries in the corpus cavernosum [see the cross-section of the penal shaft].

This causes a rush of blood to the shaft of the penis, particularly the spongy tissue-the cavernosum. At the same time, there is constriction of the veins at their outlets causing a turgidity thereby leading to an erection.

Autonomic nerves are affected in conditions like multiple sclerosis, dementia, Parkinson's disease, nerve damage as in case of spinal injury, and in a stroke.

Testosterone Levels

  • High & Low Testosterone Levels: Symptoms, Signs & Side Effects
    High or low testosterone levels in men can cause symptoms and signs of weight gain, osteoporosis, decline in sexual desire, and a decline in physical energy and stamina. Higher than normal levels may normalize blood pressure and reduce the risk of ob

What are the causes of impotence?

What are the causes of impotence or erectile failure?

There are basically 2 causes:-

  1. Psychological
  2. Organic

As discussed in the above 2 cases, the first one comes under psychological causes. The patient concerned was depressed due to -

  • The Covid-19 lockdown and consequent loss of work
  • Worries about self-survival and that of his family members, again due to the pandemic.

When a person overthinks about his bad situation, this causes loss of libido and tiredness, and that happens mostly while going to bed.

Co-morbid conditions-Organic causes

In the second case, age along with co-morbid conditions like diabetes, hypertension, hypothyroidism, chronic pains, etc., lead to a lax penis even if the person wants to have sex. These are termed Organic causes.

Among the organic causes of erectile failure, diabetes is the most important. The impact of diabetes and associated factors on sexual function is multi-dimensional. Again, diabetic sexual dysfunction can be differentiated into two distinct clinical entities, namely-

  1. Transient or temporary dysfunction
  2. Progressive Dysfunction

Transient or temporary dysfunction

In the transient type of dysfunction, there is a reduction in libido and a mild degree of erectile failure. This is due to lethargy, tiredness, and probably, the impending malaise. There can be a recovery in these cases with proper medications and lifestyle changes like regular exercise, eating a balanced diet consisting of lots of fiber and antioxidants, and proper sleeping habits.

Progressive dysfunction

The second type of sexual dysfunction, which is organically determined by vascular[atherosclerosis or plaque build-up in the arteries of the penis] and neurogenic [ autonomic neuropathy] causes, due to hormonal derangement, is characteristically progressive, irreversible, and is aptly termed diabetic erectile failure or impotence.

Some of the chronic diseases like hypertension, heart disease, rise in cholesterol levels, chronic renal failure, liver disease like cirrhosis, besides diabetes, also cause and precipitate erectile failure. Chronic smoking[heart disease] and alcohol[cirrhosis] along with the above conditions, act like adding fuel to the fire.

Erectile Dysfunction

How can we treat Erectile Dysfunction?

Treatment of ED depends upon the age of the person and his co-morbid ailments[diabetes, hypertension, depression].

There are mostly 2 methods to do this-

  1. Drugs to stimulate the penis
  2. Mechanical stimulation.

Which are the most common drugs or the best drugs to treat Erectile Dysfunction?

Before starting any medications, the patient's co-morbid conditions have to be taken into consideration. Any co-morbid condition like diabetes or hypertension should be well controlled. Moreover, the drugs used to overcome ED can have interaction with these medicines. So, proper consultation with a physician is a must.

I use drugs like sildenafil[Viagra] and tadalafil[Tadafil] to help my patients in India who have erectile dysfunction. Dosage is- once a day 2-3 hours prior to sexual intercourse.

However, these drugs are to be consumed with precaution and should be had after proper consultation with your physician. They have side effects like nausea, flushing, hypotension, dizziness, etc.

Mechanical Constrictor Device

There is a mechanical device that when used can help maintain an erection for a longer period of time in a patient having erectile dysfunction. I have provided a link below that explains how the device works.

Just before I close this article, I would like to mention that there are herbal medicines for helping an erection. Ashwagandha-Withania Somnifera- is one of them. Taking ashwagandha tablets at a dose of 500mg/day improves libido in most cases, especially those having erection problems due to stress and depression.

More about Erectile Dysfunction

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.


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