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Erectile Dysfunction

Some Facts About Erectile Dysfunction

  • Studies suggest 8-10% of men aged 20-30 suffer from ED.
  • Studies have shown roughly one half of American men over the age of 40 have some degree of ED.
  • About 30 million men in the U.S. are affected by ED.
  • More than 150 million men worldwide experience some form of Erectile Dysfunction.
  • 52% of men in the United States are affected by ED.
  • 40% of men in their 40s have ED, while 70% of men in their 70s suffer from the condition.
  • Studies have shown that erection problems affect 25% of men under 40.
  • While it is often thought of as a condition affecting older men, Erectile Dysfunction can actually affect men as young as their 20s.
  • About 7 in 10 men respond well to oral medications for ED.
  • 1 in 10 men is estimated to have ED at some point in his lifetime.
  • The worldwide prevalence of Erectile Dysfunction is expected to increase to 322 million men by 2025. (International Journal of Impotence Research, 2000).
  • Recent study showed that ED was prevalent in 26% of men younger than 40. (Boston University School of Medicine, 2002) (The Journal of Sexual Medicine, 2013).
  • 35% to 75% of men who have diabetes will also experience ED. (Boston University School of Medicine, 2002).
  • 30% of men with COPD have impotence. (Boston University School of Medicine, 2002).
  • Obesity and Diabetes are responsible for 8 million cases of ED. (Polski Merkuriusz Lekarski, 2014).
  • The majority (79%) of men with ED are overweight (BMI of 25kg/m2 or higher). (Polski Merkuriusz Lekarski, 2014).
  • People with depression have a 39% higher chance of developing ED than those without depression.
  • Sexual dysfunction is present for 20% to 25% of infertile couples. (Reproductive Partners Medical Group, 2020).
  • 1 in 4 men who seek ED treatment is younger than 40. (The Journal of Sexual Medicine, 2013).

What is Erectile Dysfunction

Erectile Dysfunction is the inability of a male to achieve or to maintain the erection of penis sufficient enough to penetrate during intercourse or during sexual activities. It is also called Impotence. ED is very common and one of the many sexual problems. It is the major cause of broken marriages. It is also a major cause of couple’s fight. Male partner feels very embarrassing due to this condition.

Myths about Erectile Dysfunction

Myth: Erectile Dysfunction only affects men over age 70.
Fact: Erectile dysfunction is more common in older men, but it can occur at any age. It affects about half of men ages 40–70.

Myth: Erectile Dysfunction is embarrassing but not dangerous.
Fact: Erectile Dysfunction can be a alarming that you are at greater risk for some life-threatening conditions such as heart disease, Type 2 diabetes and stroke.

Myth: Erectile Dysfunction is psychological only.
Fact: In the past, psychological factors alone were thought to cause Erectile Dysfunction.But now medical specialists know that physical conditions can cause or contribute to erection problems.

Myth: Erectile Dysfunction means there is something wrong with the penis.
Fact: To achieve an erection, a man needs a healthy brain and penis, healthy blood vessels and nerves, and adequate amounts of the male hormone testosterone. If any aspect of this system is affected, erectile dysfunction can result.

Myth: Taking testosterone supplements will cure Erectile Dysfunction.
Fact: Hormonal changes, like low levels of testosterone, can cause Erectile Dysfunction, but this is not the only cause. Talk with your Sexologist before beginning testosterone supplements.

Myth: Medications are the only way to treat Erectile Dysfunction.
Fact: Many treatments are available to treat Erectile Dysfunction. Medications work for some men, but others benefit from simple mechanical devices, surgery or counseling.

Myth: I am too young to have ED.
Fact: You might think that you won’t have to worry about ED until you are in your 60s or 70s. But the most common age group for taking treatment for ED is in the late 40s and early 50s. And one 2013 study published in the Journal of Sexual Medicine found that about 25% of men who sought care for ED for the first time were under age 40.

Myth: Erectile Dysfunction leads to infertility.
Fact: Erectile dysfunction does not directly lead to infertility. But, it causes difficulties in conceiving and can delay pregnancy. Any underlying fertility conditions and not being able to maintain an erection may cause a man to refrain from sexual activity. There are good chances of restoring their fertility after recovering from ED.

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When to approach a Sexologist

Your family physician is the first place to start if you are experiencing problems related to erectile dysfunction.

Reasons for a visit may include (but are not limited to):

Problems getting and/or maintaining an erection.
You have other medical issues, such as heart disease, diabetes, or obesity etc.
Problems with premature or delayed ejaculation.
Problems in sexual desire.

Sign and Symptom of Erectile Dysfunction

  • Unable to attain erection:- Patient is not able to erect penis at the time of sexual activities.
  • Unable to maintain erection:- Sometimes patient may erect penis but unable to sustain that erection. He may loose erection at the time of penetration for example.
  • Decreased Libido:- Sex drive of patient is also low due to ED.He may excuse of being fatigue.
  • Low Self Esteem:- There is a decrease in the self confidence of the patient not only for sexual activities but in all other aspects of the life also.
  • Performance Anxiety:- Patient has fear of failure in mind,so he try to escape from sexual act.
  • Cardiovascular Diseases:- He may be suffering from other cardiac or systemic disease such as CAD, HTN, DM etc.
  • Drug Abused:- Patient could be consuming some substances to combat ED.
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Physiology of Erection of Penis

Erection of penis is a complex process. It involve the combine impact of vascular system, nervous system, Hormonal and muscular and psychological factor after a sexual stimulation. After stimulation nerve endings in penis releases NO i.e.Nitric oxide. Which causes muscular relaxation in penis. Penile muscles expands. Expansion leads to veno-occlusion, which is the process of reducing the rate of blood flow out of the corpora cavernosa, resulting in blood accumulation and rigidity. It should be clear that veno-occlusion is necessary for erectile function.

1.Stimulation of Nerves

We feel aroused on getting visual, auditory, touch or psychological sexual stimuli. These stimuli reaches to the brain. The sexual center of brain gets activated and sends sexual signal to penis via spinal cord.

2.Release of Neurotransmitters

Sexual signal sent by brain are travels downward to the nerve endings of penis. Nerve endings of penis in cavernosal tissues releases a neurotransmitter Nitric Acid i.e.NO This nitric acid plays an important role in penile erection.

3.Formation of cGMP

Neurotransmitter Nitric Acid i.e.NO activates an enzyme GC i.e.Guanylate Cyclase,which in turn converts GTP i.e. Guanosine Triphosphate into cyclic Guanosine MonoPhosphate i.e. cGMP. In addition to cGMP, cAMP is also formed from ATP i.e. Adenosine TriPhosphate with the help of enzyme Adenylate Cyclase i.e. AC.

4.Smooth Muscle Relaxation and Vasodilation

On accumulation of cGMP, the relaxation of smooth muscles of penis take place and blood vessels of cavernosal tissues dilates. The blood fills in the arteries and arterioles of penis and penis erects.

5.Tumescence

With the expansion of penile muscles blood fills into the arterioles of penis and this initiates a process called Veno-occlusion. Due to this process rate of blood flow out of corpora cavernosa reduces,resulting in blood accumulation and rigidity.

6.Detumescence

After getting orgasm, semen is ejaculated out and an enzyme PDE5 i.e. Phosphodiesterase type 5, converts cGMP into GTP. As concentration of cGMP reduces smooth muscles of penis contracts and vasoconstriction take place. and penis slowly comes into flaccid condition.

Causes of Erectile Dysfunction

Many factors are responsible for erectile dysfunction. With advancing age male sex hormone testosterone decreases,it can cause ED. Apart from this many medical condition such as coronary artery disease, hypertension, diabetes mellitus, injury to penis, hormonal imbalance can cause ED. Broadly Erectile dysfunction can be divided into two categories, Physiological and Psychological. Let’s know in details the cause of ED.

Physiological Causes

  • Cardiovascular:- Patient suffering from chronic heart disease, coronary artery disease, hypertension or atherosclerosis.
  • Neurological:- Parkinson’s disease, congenital neurological defects, nervous system weekness, multiple sclerosis.
  • Endocrinological:- Diabetes mellitus, hyperthyroidism.
  • Hormonal:- Reduced testosterone, Raised prolactin, Raised estrogen.
  • Renal:- Chronic kidney disease.
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Medical Conditions Causing ED

  • Hypertension:- Interference in blood flow due to HTN.
  • Hyperlipidemia:- Raised cholesterol causes blockage in blood vessels reducing blood flow.
  • DM-type2:- Diabetes damages the blood vessels and reduce the blood flow.
  • Surgery:- Surgery of pelvis region can damage the blood flow of that region, surgery for bladder cancer, surgery for prostate cancer.
  • Peyronie disease:- Penis bend due to scaring in penile tissues. Causes pain during sexual act. It can be treated only by surgery.

Medication Causing ED

  • Antihypertensive:- Certain B-blocker such as metoprolol etc.
  • Antidiabetic:- Metformin etc.
  • Antidepressants:- Such as Escitalopram,cyclic antidepressant etc.
  • Antipsychotic:- Such as Risperidone, Olanzapine.
  • SSRIs:- Selective serotonin reuptake inhibitor such as Paroxetine etc.
  • Antiallergic:- Excess use of cetirizine, Levocetirizine etc.
  • Radiations:- For the treatment of cancer.

Psychological Causes

  • Depression, Anxiety.
  • Stress
  • Fear of sexual failure.
  • Guilt about sexual performance.
  • Relationship Conflicts.
  • Poor body image.
  • Financial stress.
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Life Style Related Cause

  • Smoking:- Smoking causes narrowing of arteries and reduces blood flow.
  • Drinking:- Excessive use of Alcohol is one of the cause of ED.
  • Drug Addiction:- Use of drugs such as opium products, marijuana etc causes ED.
  • Physical inactivity:- No workout,no exercise causes reduced blood flow.
  • Obesity:- If BMI is more than 25 they are prone to have ED.

Who Are At Great Risk of ED

Erectile Dysfunction can affects any male, in any region or at any age after puberty. But mention below are at higher risk of having ED.

  • If you are at the age of 40.
  • If you are diabetic.
  • If you are hypertensive.
  • If you are in depression.
  • If you are taking antidepressants,SSRIs,antihypertensive medicines.
  • If your libido is reduced.
  • If your BMI is 25 or more.
  • If you are physically inactive.
  • If you are taking medicine of hair loss i.e. finasteride.
  • If you are using gym supplements.
  • If you are consuming excessive alcohol.
  • If you are chain smoker.
  • If you are drug addict.
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Diagnosis of Erectile Dysfunction

The most important part in the treatment of ED is diagnosis. Proper diagnosis can cure the problem permanently. So Sexperts in our clinic Dr.SPSingh Clinic Pvt.Ltd. do their best in diagnosis of ED. They treat the root cause of the problem,so that patients get well permanently.

Patient’s Medical History

Patient’s medical history is taken in detail. He is asked for his age, blood group, marital status, job profile, any physical activity recently and in past, have consumed gym supplements or not, any history of smoking, drinking or drug addiction. Any health condition such as hypertension, heart disease, diabetes, thyroid ailments, epilepsy, tuberculosis, any neurological condition, any treatment for long term, medication for their ailments, have undergone any surgery recently or in past, living in which geographical area, any psychological problem such as OCD, Multiple personality disorder, depression, anxiety or stress, any financial stress etc.

Patient’s Sexual History

In addition to medical history sexual history is also taken in details. Patient is asked for any sexual experience, if married, any premarital sexual history, about extramarital affairs, any history of STDs i.e. sexual transmitted disease. About ongoing sexual problems, when he came to know about the condition first, had he taken any treatment about the problem, which medicines he had taken till now to overcome the problems, about relationship with partner. About morning erection, nocturnal erection, masturbation, nightfall, about body images in mind etc.

Physical Examination

Sexologist carefully examine the body of patient to see the sign of ED or other disease responsible for ED. Inspection of body, testicles and penis is done. Lower eyelid inspected for pallor-sign of anemia, upper eyelid for ictrus-sign of jaundice, nails and tongue for cyanosis-sign of hypoxemia, neck for thyroid disorder, testicles for sign of hypogonadism, penis size and shape, for any sign of deformity or Peyronie disease. Testicles are palpated for any sign of testicular torsion or any epididymal cyst, penis for phimosis. Auscultation for any sign of heart abnormality. Proper examination helps in diagnosis of ED and root cause of ED.

Laboratory Tests

For the proper diagnosis of ED, certain tests are required to rule out heart problems, vascular,hormonal,or neural cause:-

  • Complete Blood Count (CBC)
  • Lipid Profile
  • Liver Function Tests(LFT)
  • Renal Function Tests(RFT)
  • T3,T4,TSH
  • Testosterone Level
  • Prolactin
  • LH, FSH
  • Vit B12,
  • Vit D3
  • Urine R/E
  • Semen Analysis

Psychological Assessment(IIEF)

International Index of Erectile Function is done for assessment of psychological factors. It is in the form of a questionnaire. It contains 15 questions having question from 5 categories. Each question have six (6) option varying from extreme low to extreme high and carry five (5) marks. Five categories are (i) Erectile Functions-6 question, (ii) Orgasmic Function-2 questions, (iii) Sexual Desire-2 questions (iv) Intercourse Satisfaction-3 question, (v) Overall Satisfaction-2 question. Depending upon the score obtained in each domain the cause of ED is determined.

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Penile Doppler

For the assessment of arterial insufficiency, and venous leak penile ultrasonography is performed. To perform penile doppler intracavernosal injections are given to erect the penis. Penile doppler gives clear picture about:

  • Echogenicity of corporal tissue.
  • Peak flow velocity of cavernosal arteries.
  • Thickness of tunica albuginea and cavernosal arteries.
  • Diameter and wave form of arteries.

Presence of persistent end-diastolic flow of greater than 5 cm/sec in penile doppler suggest Venous Leak ED.

Nocturnal Penile Tumescence And Rigidity(NPT)

Nocturnal Penile Tumescence and Rigidity test is also known as Rigiscan. It is performed to establish the diagnosis of ED.  Patient wear a plastic, ring-like device around penis to test whether he have erections during the night while he sleep. Test uses an electronic monitoring device that will record how firm the erections are, the number of erections, and how long they last. Each night during deep sleep, a man normally has three to five erections.  If patient have erections during test, it shows that he is physically able to have an erection and cause of ED is psychological. If patient do not have an erection during test, his ED is due to a physiological reason.

DICC

For the diagnosis of Venous Leak ED, a confirmatory test is done known as Dynamic Infusion Cavernosometry and Cavernosography i.e. DICC. The procedure require administration of an erectogenic medicine.This test documents

  • Severity of venous leak
  • Sites of leakage

Venous Leak is confirmed if cavernosometry results are (i) an intracavernosal infusion rate of greater than 10 cc/minute of saline to maintain the erection. (ii) drop of intracavernosal pressure of greater than 50 mmHg within 30 seconds of terminating the saline infusion. And cavernosogram shows visualization of penile veins or venous leakage from the crura.

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Treatment of Erectile Dysfunction

Treatment of ED requires a proper diagnosis and to know the root cause of the ED. Our Sexpert at Dr.SPSingh Clinics Pvt.Ltd, after careful examination of the patient, by knowing medical and sexual history of the patient, after evaluation of tests and some specialised test for ED, knowing the root cause of the ED, defines a proper line of treatment for that patient, in which minimal done with the patient and maximum for the patient. Management of ED have many options available. These are Listed below. All the medicines available online and offline for ED increases blood flow at the time of sexual activities and inhibits an enzyme phosphodiesterase type 2,3,4,5. Different therapies are proposed for the treatment of ED.

Psychological Therapy

Our first approach to treat ED is psychological. If the cause of Erectile Dysfunction is psychogenic, the psychological therapy is of most importance in the treatment of ED. Psychological treatment helps to integrate the treatment into the sexual relationship and resolve psychological issues such as performance anxiety, porn induced ED, negative thoughts, low self-confidence, guilt, intimacy issues and communication problems between partners. Psychological Therapy can prevent the recurrence of the sexual problem after treatment because men learn to manage their dysfunctional response patterns associated with ED.

  • Couple Counseling:- If ED results from problem in relationship it is unlikely to resolve until these problems are addressed. For this Relationship counseling is necessary. It can be difficult to talk to your partner about ED, but it often helps you to get rid of ED.Speaking to your partner about ED and involving them in the process to overcome it is an important part of the therapy to a more satisfying sexual relationship.
  • CBT:- Cognitive Behavioural Therapy is a talking therapy that can help you manage problems by changing how you think about things and your behaviour. CBT is an effective approach in managing ED. By learning to understand yourself, your thought patterns, and your responses, you can effectively change them to help resolve your problems.
  • Meditation:- Meditation is the best way to boost your mental abilities. It brings peace of mind. Meditation is very helpful in the management of psychogenic ED.

Sex Therapy

Sex therapy can be regarded as a specific type of psychotherapy, focusing specifically on sexual experiences.Sex therapy for ED may or may not include:

  • Investigating body-mind connectedness and interoceptive awareness.
  • Developing mind/body skills to manage anxiety and source inside of oneself for arousal.
  • Evaluating if any of the partner is depending on being a viewer of erotic sources for sexual arousal, such as pornography.
  • Understanding if masturbation habits that shape sexual arousal may not be conducive to arousal or functioning with a partner.
  • Assessing whether one is considering sexuality as a “performance” and is very orgasm-focused, rather than enjoyment.
  • Identifying relational communication problems.
  • Sensate focussing, slowly increasing senses of arousal, focussing on sexual stimulation and magnifying it.

Medicines

A. Allopathic Medicines:- Some medicines are used to gain erection during sexual activities, these medicines are called PDE5 Inhibitors i.e. Phosphodiesterase type 5 Inhibitors. These medicines prevent degradation of cGMP into GTP,by deactivating PDE5 enzyme. Hence concentration of cGMP remains high and penile muscles relaxation continues. Some of them are listed below, we should not take these medicines without the advice of a Sexologist. PDE5 Inhibitors are strictly contraindicated in the patient taking Nitrates.

  • Sildenafil:- Viagra 50 or 100mg.
  • Tadalafil:- Cialis 5,10 or 20mg.
  • Vardenafil:- Levitra 10 or 20mg.
  • Avanafil:- Stendra 100 or 200mg.

B. Herbal Medicines:- Herbal medicines are safest from all other medicines, having no side effects and ability gained last longer for many years.These medicines also work in a similar way by inhibiting pde5 enzyme,but because herbal medicines are used as a whole part,its active gradient increases rigidity of penis and other part counteracts the side effect. So,there is no side effect of a herbal medicine. Many Herbs are used to treat ED.Some of them are given below. These are mostly used as a different-different combination of many herbs, depending upon the root cause of the ED and inner nature of patient. That’s why these medicine are customised and every patient gets distinct medicine.No two patients have similar medicines,even having same kind of ED.

  • Ashwagandha
  • Shatavari
  • Konch Bees
  • Swet Musli
  • Kaali Musli
  • Akarkara
  • Salam Mishri
  • Ginseng
  • Yohimbine
  • And Many More

Intracavernosal Injections(ICI)

These are some prostaglandins given as an Injection in the cavernosal chamber of penis. Injection is given on lateral base of penis to prevent neuro-vascular system dorsally,and urethra ventrally. Medicines used in ICIs are Alprostadil, Papaverine, Phentolamine and Atropine. Caverject is the famous brand uses medicines as Bimix which contains Papaverine and Phentolamine, Trimix which contains Alprostadil,Papaverine and Phentolamine, Qudmix which contains Alprostadil,Papaverine,Phentolamine and Atropine. These medicines activates enzyme AC i.e. Adenylyl Cyclase and Inhibits enzyme PDE2,3,4. And increases relaxation of smooth muscles of penis and acts as vasodilators. Some side effects are also seen with these injections, such as Priapism- Sustained prolonged erection, Bruising, Fibrosis, Pain, Peyronie Disease.

Intraurethral Suppository

There are some prostaglandins used as a suppository to treat the Erectile Dysfunction. These suppository or pellet are placed in the urethra through a system called MUSE i.e. medicated transurethral system for erection. Prostaglandin used is Alprostadil. It is available in strength of 125 mcg,250 mcg, 500 mcg or 1000 mcg. Initial dose is 125mcg. Regular use have side effects. Alprostadil increases blood flow by relaxation of smooth muscles of cavernosum.

Platelets Rich Plasma Therapy(PRP)

This is very useful therapy to treat Erectile Dysfunction. It regenerate the vascular tissues of penis, thereby increases the blood flow. Patient’s own blood is withdrawn and centrifuged and blood contents are seperated. From platelets rich plasma injection is prepared and this injection is known as PRP Injection. This PRP Injection is injected into the corpora cavernosum of lateral base of penis. P-Shot i.e. Priapus Shot is a type of PRP Injection. This therapy also have some side effects like, fibrosis, bruising,and pain.

Androgen Replacement Therapy

Where the causing factor of Erectile Dysfunction is deficiency of testosterone, Androgen Replacement Therapy(ART) is considered. This is also known as Hormone Replacement Therapy i.e.HRT. If testosterone levels falls below 300 ng/dL than ART is considered. Testosterone and its derivatives are given to the patient in the form of injections, tablets, capsules or patches. These androgens increases overall blood flow of body and temporary increase in libido. Although this therapy have some side effects such as Decreased Libido in long run, weight gain, deep vein thrombosis, heart diseases, and cancerous in nature. ART is given in many form:-

  • Transdermal Patches:- Androderm and Testoderm.
  • Topical Gels:- Androgel,Testim, applied topically.
  • Nasal Gels:- Natesto, pumped into each nostrils.
  • Injections:- Testosterone Enanthate, Testosterone cypionate, Testosterone Propionate.
  • Oral Pills:- Testosterone Undecanoate, Methyltestosterone.
  • Implants:- Testopel (Long acting implant lasts 3-6 months), an pellet implanted in soft tissue which slowly release testosterone.

Stem Cells Therapy

Stem cell therapy is the newest approach in the management of Erectile Dysfunction. Stem cells are the primitive cells from which all other tissues develops. The source of stem cells used is stored umbilical cord or bone marrow. Stem cells therapy can improve erectile function through neovascularization and nerve regeneration. Different types of stem cells are Totipotent stem cells, Pluripotent stem cells, Multipotent stem cells, Oligopotent stem cells, and Unipotent stem cells. Treatment of ED is carried out by using mesenchymal stem cells, derived from bone marrow or foetal stem cells, given in the form of intravenous injection in the penis.

Penile Vacuum Pump

Vacuum Erection Devices (VED) are the devices used to achieve the erection by creating vacuum in the cylinder. This device contains a cylinder which has gradation on it, a pump to create vacuum, and some rubber rings. Cylinder is placed over the penis and vacuum is created. As vacuum increases penis erects. Rubber ring is placed at the base of penis to prevent the backflow of the blood,and penis remains erect. We should use quality VED, as local vacuum pump may not create enough vacuum to erect the penis. Patient must use VED in the direction of a Sexologist. The device may be difficult to use in some patients with buried penis and having fatty lower abdomen. VED may cause little pain and penile sensation problem due to continuous use of constricting rings. The device can be manual or electronic.

Shockwave Therapy

Shockwave Therapy is the new approach in the management of erectile dysfunction. Li-ESWT i.e. Low Intensity Extracorporeal Shock Wave Therapy is used to treat ED. Shockwaves are acoustic waves that carry energy and can be targeted and focused noninvasively to affect penile tissues. When Li-ESWs, which are relatively weak but focused, targeted to deep tissues of penis, causes mechanical stress and microtrauma. This promotes a process called angiogenesis. It results in increased vascularization of penile tissue. LI-ESWT stimulates the production of angiogenesis-related growth factors, such as 1.Endothelial nitric oxide synthase (eNOS) and 2.Vascular endothelial growth factor (VEGF), and endothelial cell proliferation factors, such as 3.Proliferating cell nuclear antigen (PCNA).
LI-ESWT induces neovascularization, which improves blood supply and treat ED. According to Treatment Protocol we gives total of 1500 SWs. In first three weeks, two treatment session per week, then three weeks of no treatment, then again three weeks of two treatment session per week. SWs are given at the Five points, three along the penile shaft and two at the crural levels. The Energy Flux Density (EFD) of SWs would be 0.09 mJ/mm square. There are 12 treatment session in 9 weeks. In every session 125 SWs are given and every focused point receives 25 SWs in each session.

Exercise

We have to maintain the blood flow at the time of sexual activity to treat the ED. Regular exercise, yoga, physical workout helps to maintain the blood flow. We can choose any kind of regular physical activity such as running, jogging, Brisk Walk, simple walking etc. In my opinion Brisk Walk is the best option, as running and jogging causes jerking movements on the knee, which may cause pain later in the age of 60.

Kegel Exercises are also good option to maintain the blood flow in pelvic floor muscles. Rich blood flow in coccygeus muscles helps to treat erectile dysfunction. Kegel exercise must be done in perfect way to gain results from kegel. Patients do kegel after watching some clips on u-tube may not getting results they expect, because they are not doing it in the way it should be. Movements in the abdominal muscles,legs muscles and buttock muscles while doing kegel lowers the results of kegel. So before doing kegel we must consult a sexologist.

Modifying Lifestyle

In the management of erectile dysfunction modified lifestyle has a major role. Some habits causes hindrance to get rid of ED. We should evaluate our lifestyle and should avoid those habits causing reduction in blood flow.

  • Stop smoking:- Smoking causes constriction in blood vessels and reduces blood flow in the body. To treat ED we must stop smoking.
  • Excessive Drinking:- Excess alcohol depresses our nervous system and reduces body blood flow. Drinkers are advised to avoid alcohol in order to have better sex life.
  • Drug addiction:- Any kind of addiction whether of opium or medical drugs damages the nervous system. Avoid any kind of addiction to cure erectile dysfunction.
  • Junk Food:- To eat junk food at the time of conventional food time can lowers our energy level. Junk foods are of no nutritional value. Fatty and spicy food should be avoided.
  • Awaking overnight:- Night is for rest. Patient should have sleep of 8 hours in night. Awaking overnight is never good for our blood flow.
  • Drink Plenty of Fluids:- To wash out toxins of our body we should drink 3-4 L of water daily. We should add freshly prepared juices and soaps to our diet. Canned and packaged juice should be avoided, they contains preservative added in it.

Penile Implants

When treatment with medicines is not possible then Penile Prosthesis are considered for the management of Erectile Dysfunction. These prosthesis are surgically implanted into the penis to obtain erection. This surgery is irreversible, as the penile tissues altered permanently and normal physiological erections does not occurs after surgery. Two types of Implants are used, Malleable Penile Implants and Inflatable Penile Implants.

  • Malleable Penile Implants:- These implants are made of silicone rubber with a central metallic core. The advantages of malleable devices are that they are easy to implant, easy to operate, and have minimal risk of failure. Disadvantage of these semi-rigid devices is that the penis is never fully rigid nor fully flaccid,interfere with urination, and difficult to conceal. Genesis and Spectra are branded malleable penile implants.
  • Two Piece Inflatable Penile Implants:- This prosthesis consists of two cylinders and a scrotal pump. Reservoir is included in the proximal part of cylinders. Detumescence can be done by bending the penis at midpoint. Ambicor is the branded two piece implant.
  • Three Piece Inflatable Penile Implants:- It consists of two cylinders, a scrotal pump and a reservoir of saline. Cylinders are implanted in the penile shaft, pump in the scrotum and reservoir is placed in suprapubic space. Three-piece prostheses provide excellent rigidity when erect and natural appearance when flaccid. AMS 700 and Titan are the branded three piece inflatable penile implants. Infection is the most common complication of penile implant surgery.

Surgery

When the cause of Erectile Dysfunction is Arterial insufficiency or Venous Leak, Penile Surgery is recommended. After diagnosis and confirmation of arterial insufficiency in the findings of penile doppler and pudendal arteriogram, Penile Arterial Bypass Surgery is suggested. Revascularization and Arterialization are the procedures performed in the surgery to obtain normal function.

  • Arterial Revascularization:- When epigastric artery is anastomosed with dorsal penile artery.
  • Arterialization:- When epigastric artery is anastomosed with deep dorsal vein.
  • Venous Surgery:- Venus surgery is not recommended.

Specialised Food for ED

To increase the blood flow of body there are some food, which will help to treat ED.

  • Grams:- In addition to proteins grams increases testosterone.
  • Fenugreek:- Increases testosterone.
  • Cinnamon:- Increases testosterone.
  • Walnuts:- Increases testosterone.
  • Dates:- Khajoor also increases testosterone.
  • Dark Chocolates:- Sex mood elevators.
  • Yohimbine
  • L-arginine
  • Ginseng
  • Ginkgo biloba
  • Horny goat weed
  • DHEA
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Prevention of Erectile Dysfunction

Prevention is better than cure. Peoples must be careful about their lifestyles, Eating habits,and Environment in order to prevent from diseases. We advises here these habits so that we keep Erectile Dysfunction away.

  • Morning Brisk Walk:- We should keep ourself active by doing some workout, physical activities,and morning walk at least for 30 minutes daily.
  • Kegel Exercise:- Blood flow should not reduced in penile tissues. In order to maintain it we must do Pelvic Floor Muscles Exercises regularly. First of all we have to learn to locate these muscles. We must focus on these muscles. While doing kegel, muscles of legs,abdomen and buttocks should not move, only practise for coccygeus i.e. pelvic floor muscles. Doing Kegel regularly will help to maintain the proper blood flow during sexual activities and increases our ability to hold the ejaculation.
  • Stop Smoking and Drinking:- Smoking and excess drinking reduces blood flow in the body, thereby causing ED.
  • Stay away from drug addiction:- Addiction of opium substances, and other drugs increases toxins in the body and these toxins reduces blood flow.
  • Avoid Oily and Spicy Food:- Fatty food increases cholesterol in blood, narrowing the blood vessels and reduces blood flow.
  • Drink Plenty of Water:- We must drink daily 10-15 glasses of water. Water releases harmful toxins out of the body through urination. Water detoxify the body and keep us away from ED.
  • Specialised Food for Sex:- Certain foods increases male sex hormone the Testosterone. More is the testosterone in body, more we remain active in sexual activity.Some of them are, 1. Fenugreek, 2. Cinnamon, 3. Grams, 4. Dates(Palm), 5. Walnuts, 6. Dark Chocolates, 7. Coffee.

Frequently Asked Questions To Sexologist

What is Erectile Dysfunction?

Erectile Dysfunction is the inability of a person to achieve or maintain erection at the time of sexual activity.

What are the reasons of Erectile Dysfunction?

Psychological reasons like stress,anxiety,depression,relationship problems and Physiological reasons like coronary artery disease, hyperlipidemia, diabetes etc.

What are causes of ED?

Psychogenic:- Stress,anxiety,depression,performance anxiety,guilt,relationships conflict, Vasculogenic:- Atherosclerosis,HTN, High cholesterol, Hormonal:- Deficiency of testosterone, hyperprolactinemia, neurogenic:- Multiple sclerosis, Parkinson’s disease.

How ED is diagnosed?

Diagnosis is made by personal history, medial history, laboratory tests, IIEF, penile doppler, rigiscan,and DICC.

What are symptoms of ED?

Symptoms of ED may include difficulty in achieving an erection, maintaining an erection, or/and a reduced sexual desire.

How common is erectile dysfunction in your 20s?

Erectile dysfunction is not as common for younger men to experience; it affects about a quarter (26%) of men under the age of 40. Some studies have shown the prevalence of ED to be only 8% for men aged 20 to 29.

What is the main cause of erectile dysfunction?

The main cause of ED is primarily due to lack of blood flow to the penis.

Does erectile dysfunction last forever?

No, ED is treatable and even reversible.

What helps ED immediately?

A fast way to treat erectile dysfunction is by using a vacuum device or erectile dysfunction ring, or taking medications that increase blood flow to the penis.

What is the precaution for ED?

Follow a healthy diet plan. Controlling your blood pressure and diabetes may help prevent ED. Avoid drinking too much alcohol. See a counselor who has expert knowledge in treating people who drink too much alcohol. Do regularly exercise.

Can ED be cured permanently?

Yes, with the right diagnosis, support, and treatment, it’s often possible for erectile dysfunction to go away permanently.

Can a man with erectile dysfunction satisfy a woman?

The most important tool for a satisfying sex life is communication with your partners, especially when you’re coping with an ED. It doesn’t have to signal the end of your sex life. You and your partners can still enjoy physical intimacy and a satisfying sexual life.

How effective Are the medication used for ED?

Medications that are used to treat erectile dysfunction can be very effective for certain patients. Men who have mild or moderate erectile dysfunction often experience great results after using these medication.

Is erectile dysfunction caused by low testosterone?

It could be — but not necessarily.

Does caffeine affect erectile dysfunction?

Consuming too much caffeine can have all kinds of effects on your body — but it’s probably not related to ED one way or the other.

Can tight underwear cause erectile dysfunction?

No, this one is a total myth.

Can riding a bicycle cause erectile dysfunction?

Some studies suggest that frequent riding compresses the pudendal nerve and could lead to erection issues. Bike seats are also related to testicular pain and pelvic floor dysfunction, which could contribute to ED.

Can erectile dysfunction cause infertility?

Having erectile dysfunction doesn’t necessarily mean having low sperm count. But if you struggle to get or keep an erection during sex, you and your partner could have trouble conceiving.

Should I see a Sexologist about erectile dysfunction?

Definitely. Consult Sexologist if ED occurs.

Can ED cause other sexual problem?

Often, it may occur or coexist as premature ejaculation or as a decreased sexual desire.