Globally, more than 150 million men are affected by ED, and this figure is expected to reach 322 million by 2025.According to some estimates, ED affects 8% of males aged 20–29 years and 11% of those aged 30–39 years. Males have a 40% chance of having some form of ED by their 40s. The risk then increases by about 10% per decade. Research on India's sexual health issues shows that a significant portion of Indian men experience impotence, making India the world's epicenter of impotence.
In India, impotence affects one in ten males; the number may be greater in larger cities. Approximately 25%of patients with erectile dysfunction (ED) are younger than 30 years old. Decreased penile erectile function is considered an early manifestation of systemic atherosclerosis and an early sign of Cardio-vascular diseases (CVD). Erectile dysfunction (ED) is defined as a recurrent or consistent inability to obtain and/or maintain a penile erection sufficient for satisfactory sexual performance.
Causes of ED:
Main causes of ED are: -
●Vascular: Vasculogenic ED occurs when the arteries and/or veins that bring blood to and from the penis, respectively, are not functioning correctly due to blockages, narrowing or other physiological causes.
● Neurological: Neurogenic ED consists of a large cohort of ED, accounting for about 10% to 19% of all cases. Can be central, peripheral, or both: -
Central Causes:
- Degenerative disorders (e.g., multiple sclerosis, Parkinson’s disease, multiple atrophy, etc.)·
- Spinal cord trauma or diseases
- Central nervous system tumors
Peripheral Causes:
1- Type 1 and 2 diabetes mellitus
2- Chronic renal failure; chronic liver failure
3- Polyneuropathy
4- Surgery (major surgery of pelvis/retroperitoneum) or radiotherapy (pelvis or retroperitoneum)·
5- Surgery of the urethra (urethral stricture, urethroplasty etc.)
● Hormonal: Diabetes mellitus is the endocrine disease most frequently causing erectile dysfunction due to the frequent vascular and neurological complications associated. Diabetic male erectile dysfunction is multifactorial, more severe and has worse response to oral treatment.
Hyperprolactinemia causes disorders of the sexual sphere because it produces a descent of testosterone. Thyroid hormone disorders (both hyper and hypothyroidism) are associated with erectile dysfunction, which will subside in half the patients with thyroid hormone normalization. The role of estradiol in the regulation of the erection mechanism is not well known either, although it is known that high levels may cause erectile dysfunction.
● Psychological: Common causes of psychogenic erectile dysfunction include:
1-performance anxiety
2- conflicts in relationships
3-sexual inhibition
4- childhood sexual abuse
5- fear of sexually transmitted diseases
Other causes include:
A) Side effect of certain medicines: blood pressure medicines, antiandrogens—medicines used for prostate cancer therapy, antidepressants, tranquilizers, or prescription sedatives—medicines that make you calmer or sleepy, appetite suppressants, or medicines that make you less hungry, Ulcer medicines
B) Certain health-related factors and behaviors: -Smoking, drinking too much alcohol, being overweight, not being physically active
Risk Factors for erectile dysfunction:
- Hypertension
- Diabetes
- Obesity
- Smoking
- Aging
- Heavy alcohol users
- Depression
- Hyperlipidemia
- Hypogonadism
Treatment of erectile dysfunction
1) Medications:
Oral: four main FDA-approved drugs for ED are:
- Sildenafil (Viagra)
- Avanafil (Stendra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
These drugs, known as PDE5 inhibitors, relax the muscles in the penis to enhance blood flow. All of these medicines work by relaxing smooth muscles and increasing blood flow in the penis during sexual stimulation. 2) Injectable: Many men get stronger erections by injecting a medicine called alprostadil into the penis, causing it to become filled with blood.
3) Vacuum Devices: Vacuum devices are mechanical pumps that create an erection by drawing blood into the penis
4) ED Rings: ED rings are bands that a personplaces around the base of their penis to maintain an erection. 5) Shock wave therapy: Acoustic waves running around the penile areas improve penile blood flow and improves erectile dysfunction.
5) Lifestyle Changes: limit or stop drinking alcohol, increase physical activity and maintain a healthy body weight, Regular exercise
6) Counseling: Speaking with a mental health professional, such as a counselor or psychologist, can often help people overcome stresses and anxieties linked with sex, relationships, and other areas of life.
7) Surgery: Implant a device to make the penis erect AND rebuild arteries to increase blood flow to the penis