Q: What is Erectile Dysfunction or ED?
A: Erectile dysfunction (ED) is defined as an inability to
achieve and / or maintain an erection adequate for satisfactory
sexual performance. It is also referred to as erectile
difficulties or impotence.
It is
important to differentiate ED from premature ejaculation or
decreased libido as the causes are different and hence treatment
would entail a different approach.
ED is
highly prevalent in men especially after the age of 40 years.
Not only does the prevalence increase with age but also the
degree of severity. ED is directly linked to age, high blood
pressure, diabetes, high cholesterol levels, heart diseases and
smoking. It could also be due to medications used to treat high
blood pressure and depression. |
Q: What are the most common causes of ED?
A: The most common cause of ED is vascular or a problem with blood
flow in the blood vessels. Many studies have shown that ED can be a
precursor of underlying heart problem. Damaged nerves could also
lead to ED especially after patients have undergone major pelvic
surgeries.
In aged patients and patients with hypertension, diabetes and hypercholesterolaemia or high cholesterol in the blood, the basic
problem is atherosclerosis. This means that cholesterol plaques have
formed within the blood vessels, causing reduced blood flow to the
penile tissue. The resulting low oxygen levels leads to atrophy of
the penile muscle.
Very rarely, a lack of male hormone may contribute to ED.
Psychogenic reasons such as a stressful job, previous bad sexual
experience and anxiety could be the sole cause to ED but it is
usually associated with other etiologies as well.
Q: Why is ED a problem in those suffering from
diabetes?
A: One way diabetes interferes with the ability to achieve an
erection is through neuropathy or damaged nerves. Damaged nerves are
not able to send messages properly, including the messages the brain
sends to the penis to get an erection.
Diabetes may also be associated with vascular disease meaning less
blood may flow into the penis. Furthermore, patients with diabetes
may have low testosterone levels as diabetes lowers testosterone
levels.
Q: What are the risk factors for ED,
especially in those with diabetes?
A: The key to prevention is the same as reducing any risk factors
for heart attack. That includes diet control, regular exercise, a
positive attitude and not getting diabetes mellitus hypertension,
high cholesterol levels in the first place.
Q: How is ED assessed? What would you
consider the most effective treatment of ED? Who can take the drugs
and how should they take them?
A: Assessment should comprise a thorough medical and sexual history,
a systemic and focused physical examination and selected blood
tests.
Treatment for ED is mainly oral medication which is called the PDE 5
inhibitors. Occasionally for the more severe ED which is not
responsive to oral medication, injection and surgery might be an
option. Oral ED drugs are usually safe even in patients with cardiac
disease. The main contraindication is someone on nitrates for angina
or chest pain. They are not allowed to take any of the oral
medications.
Penile implants could still be offered especially when patients are
not responsive to less invasive treatment.
The role of hormone replacement is not clear at the moment. Future
treatment options include targeting other receptor sites in the
metabolic pathway of erectile function and gene therapy.
Q: What are the possible side--effects of ED
drugs?
A: The most common side effects is headache and facial flushes which
are mild and self limiting. The more worrisome side effect would be
visual disturbances. Although, we have not established firmly the
link between NAION and the PDE 5 inhibitors, nevertheless because of
all the media hype, I usually tell my patients to stop taking them
if they have any visual disturbances.
Q: What is the efficacy of herbal treatments
such as Tongkat Ali?
A: Herbal medication for ED is a multi million dollar business. Its
also easy for patients to get them over the counter. The main
problem is some of the preparation had traces of PDE 5 inhibitors
and its difficult to differentiate whether the efficacy is due to
the herbs or the PDE 5 inhibitors.
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