What you need to know about Erectile Dysfunction?

What is Erectile Dysfunction?

Erectile dysfunction is the medical term for difficulty getting an erection. It can also mean difficulty in keeping an erection long enough for fulfilling sexual activity. It is a common problem amongst men, affecting as many as one in every three men as they grow older.

ED is a common condition that can happen at any age. Currently more than 150 million men worldwide have ED and this number is expected to double by 2025. In Asia, the number of men with ED is projected to rise to almost 200 million by 2025.

How does an erection occur?

A man cannot have an erection simply because he wants one. Brain messages, nerve impulses, muscle reactions, hormone levels and blood flow all play a part. The penis becomes firm when messages from the brain cause blood to fill the two spongy-tissue chambers in the shaft of the penis. During an erection these chambers are filled with seven times the normal flow of blood.

What causes Erectile Dysfunction?

There are many reasons why you may have erection problems. They may be related to problems with your physical health. Common causes include:

  • Blockage in the arteries to the penis
  • Diabetes
  • Neurological disorders e.g. Spinal Cord Injury (SCI)
  • Side effects of medications
  • Chronic disease i.e. kidney/liver failure
  • Alcoholism and drug abuse
  • Smoking
  • Age. The incidence increases with age
  • High blood pressure, (hypertension)
  • Heart disease
  • Prostate problems, including an enlarged prostate or cancer
  • Hormone problems
  • Disease of the erectile tissue of the penis
  • Stress and anxiety from work/home
  • Depression
  • Worry about poor sexual performance

Emotional problems may affect your ability to get an erection. You may be going through a particularly stressful time in your life. For example: a divorce, operation, redundancy, retirement or death of a loved one. This can lead to erectile problems without any physical cause.

About 30 million men in the United States have ED repeatedly, as a chronic condition. For 66% of these men, ED is linked to other chronic conditions, including diabetes, high blood pressure, high cholesterol, or obesity. For the other 34%, ED results from chronic depression, worry and anxiety, or certain medicines.

Symptoms of Erectile Dysfunction

Symptoms of erectile dysfunction will vary from man to man, depending on its frequency and severity. Symptoms may include:

  • Difficulty getting and maintaining an erection, despite stimulation.
  • Erections may not remain hard enough for penetration for intercourse.
  • Once penetration has taken place, sometimes erections can not be maintained to continue or complete sexual intercourse.

Erectile dysfunction can cause anxiety about sexual performance and this can exacerbate the problem.

How is ED treated?

For patients with Spinal Cord Injury there are various methods that can be used to obtain or sustain an erection. These methods include:

  • Oral medication (PDE-5 inhibitor)
  • Injection into the penis
  • Vacuum pump
  • Constriction rings
  • Combination of these methods

The management of erectile dysfunction begins with identification and treatment of any treatable organic or psychogenic sources. In some cases, treating these conditions may be enough to correct the erectile function. If the patient is still experiencing impotence, therapeutic options include, oral medications, such as Viagra, Cialis, Levitra, Stendra, etc., intraurethral suppositories, injection therapy with medications used to dilate the blood vessels in the penis, vacuum erectile devices, and the most invasive option of penile prosthesis.

The main contraindication regarding these treatment options is nitrate use, such as nitroglycerine for chest pain, with any of the oral ED medications, as this combination of medications can cause severe drop in the blood pressure. Any of the pharmacological treatment options also carry the risk of priapism, which is an erection lasting longer than 3-4 hours. This condition requires urgent evaluation and treatment by the urologist or in the emergency department in order to prevent permanent damage to the blood flow in the tissue of the penis.

Diagnosis Erectile Dysfunction

The most important components of diagnosis of erectile dysfunction include detailed medical/surgical, psychological, and sexual history and a thorough physical examination. This should include defining the problem and clearly distinguishing ED from complaints regarding ejaculation and/or orgasm. The patient and partners expectations should be established during this phase of the evaluation process, as well. Also important in the evaluation process is checking basic labs, including serum testosterone, prostate specific antigen (PSA), and a complete blood count. These labs can contribute to identifying the source of erectile dysfunction, and can also act as a pre-treatment baseline in patients who are found to have low testosterone levels.

Summary of important points

  • Erectile dysfunction is a significant clinical problem largely undertreated in the community; the issue should be explored in any man who is over 40 years of age or has cardiovascular disease.
  • Erectile dysfunction may be an early marker of subclinical metabolic and vascular disease.
  • The physical symptoms of ED are often associated with depression, a loss of self confidence, loss of intimacy in a relationship, and a reduced quality of life.
  • The severity of ED should be evaluated with a self assessment questionnaire.
  • Partner inclusion will improve success of treatment and increase treatment compliance.
  • Treatment of ED should follow a stepwise approach, including ongoing education and support.
  • PDE-5s are first line treatment. They are contraindicated in the context of recent myocardial infarction, concurrent nitrate therapy, and high risk cardiovascular disease.
  • Second line treatments for ED can be offered in conjunction with PDE-5 inhibitors to increase success rates.
  • Penile implants are well tolerated and have high success rates in well selected patients.


There is an old adage that a ‘problem shared is a problem halved’ and this is true for many men suffering from erectile dysfunction. ED is a man’s condition but a couple’s concern. By discussing your problem with your partner, the pressure may be relieved and normal erectile function improved. Don’t let age be a barrier to seeking medical advice as it is considered normal for most men and women to enjoy sexual activity throughout all stages of their lives.