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august 2012

Managing Erectile Dysfunction

Dr K Subrahmanyam
Erectile dysfunction is a commonly presenting case in today’s practice and these days more and more men shed their inhibitions to seek medical help. However, despite it and the availability of safe and effective therapeutic options, ED remains largely under reported, under diagnosed and under treated. Treatment, wherever it is available, is mostly in the hands of unqualified practitioners. Approximately 70 per cent of ED goes undiagnosed.

What Is ED?
In general terms, Erectile Dysfunction may be explained as the inadequate and insufficient erection of penis for satisfactory sexual intercourse. The prevalence of ED increases with advancing age. The estimate of prevalence is approximately 40 per cent in men aged 40 years and 67 per cent in those aged 70 years. According to one study, about one in seven men aged 70 years has severe ED or suffers from a total inability to attain and/ or maintain an erection.

Causes Of ED

  • Psychogenic: Performance anxiety, depression, relationship conflict, misinformation, religious scruples and psychological disorders.
  • Organic: Vascular, arterial, venous, cavernosal and mixed.
  • Neurogenic: Central nervous system, peripheral neuropathy, post surgical and traumatic injury.
  • Hormonal: Hypogonadism: hypogonadotropic, hypergonadotropic.
  • Drug-induced: Diuretics and antihypertensives, anti-depressants, anti-anxiety and anti-epileptic drugs, antihistamines, non steroidal anti-inflammatory drugs, Parkinson’s Disease medications, antiarrhythmics, histamine H2- receptor antagonists, muscle relaxants, prostate cancer medications, and chemotherapy medications.

Treatment Options
Erectile dysfunction is a medical condition and it needs to be approached like any other disease. The assessment of detailed history and physical examination are vital to confirm the cause. This is followed by a detailed investigation, including a hormone profile (if appropriate) and blood sugar estimation (diabetes mellitus is a very common cause) as well as a penile doppler scan to rule out problems in the blood supply of the penis.

The introduction of oral medications has revolutionised the management of ED. The drugs currently used fall in the category of PDE-5 inhibitors and include Sildenafi (Viagra), Tadalafil, Vardenafil, and Avanafil. These drugs differ in time of onset as well as the duration of action.

An urologist may put you through some alternative treatments. Some of them are as follows:

  • Alprostadil intraurethral suppositories: A non-injectable prostaglandin pellet, which improves vascular flow by causing vasodilatation.
  • Intercavernosal injections: Local injections of one or a combination of alprostadil, papaverine, and phentolamine.
  • Vacuum constriction devices: Effective in most patients and can be purchased with or without a prescription.
  • Penile prostheses: Surgically placed non-inflatable (semi rigid) or inflatable devices.
  • Penile vascular reconstruction: Reserved for specific young patients having suffered from pelvic trauma involving penile vasculature.
ED And Heart Disease
Researchers note that erectile dysfunction is an early marker of coronary artery disease, with an average lead time between the manifestation of ED and presentation of CAD being two to five years. ED can serve as the proverbial “canary in the goldmine” for CAD – impaired flow becomes clinically apparent in the minute vessels of the penis before it begins to affect coronary perfusion.
Dr K Subrahmanyam is Senior Consultant Urologist and Transplant Surgeon, Apollo Health City, Hyderabad.