Neurologic illnesses leading to ED have been recently reviewed (64). The most common of them (i.e., consequences of prostatic surgery, stroke and Parkinson’s disease) are not typical of younger age and, similarly to conditions less common but more typical of younger men, such as spinal cord injury, multiple sclerosis and spina bifida, the clinical features of the underlying disease are clearly apparent, being ED one of the multiple manifestations, rather than a harbinger of a subtle condition. Diagnosis of neurologic origin of ED is often quite simple, based on medical history and physical exam. The clinical management is a multidimensional and coordinated work of rehabilitation and medical therapy, which includes ICI injection of vaso-relaxant drugs, vacuum device and surgery (64).
Association between metabolic syndrome (MetS) at baseline and incidence of major adverse cardiovascular events (MACE) during a mean follow-up of 4.3 years. Panel A represents the Kaplan Meier curves for incidence of MACE in a population of 211 men aged 18–52 years having or not MetS at baseline. This group represents the first tertile of age of a sample of patients (n=619) consulting the Sexual Medicine and Andrology Unit of the University of Florence for erectile dysfunction and followed-up for a mean of 4.3 years for the occurrence of MACE. Panel B represents the Cox analyses for the age- and smoking habit-adjusted incidence of MACE associated with the number of MetS components at baseline (glycaemia ≥100 mg/dL, triglycerides ≥150 mg/dL, HDL <40 mg/dL; blood pressure ≥135/80 mmHg, waist circumference >102 cm), according to the tertile of age, in the same population, during the same follow-up. The first, second and third tertile include 211, 199 and 209 patients aged 18–52, 53–60 and 61–88 years, respectively.
Your doctor will ask you questions about your symptoms and health history. They may do tests to determine if your symptoms are caused by an underlying condition. You should expect a physical exam where your doctor will listen to your heart and lungs, check your blood pressure, and examine your testicles and penis. They may also recommend a rectal exam to check your prostate. Additionally, you may need blood or urine tests to rule out other conditions.
Capogrosso, P., Colicchia, M., Ventimiglia, E., Castagna, G., Clementi, M. C., Suardi, N., … Salonia, A. (2013, May 7). One patient out four with newly diagnosed erectile dysfunction is a young man - worrisome picture from the everyday clinical practice [Abstract]. Journal of Sexual Medicine, 10(7),1833-41. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23651423
Physicians make a diagnosis of erectile dysfunction in men who complain of troubles having a hard enough erection or a hard erection that does not last long enough. It is important as you talk with your doctor that you be candid in terms of when your troubles started, how bothersome your erectile dysfunction is, how severe it is, and discuss all your medical conditions along with all prescribed and nonprescribed medications that you are taking. Your doctor will ask several questions to determine if your symptoms are suggestive of erectile dysfunction and to assess its severity and possible causes. Your doctor will try to get information to answer the following questions:
While self-esteem can be affected by the perceptions of others, it is largely how you feel about yourself. If you have a negative view of yourself and your abilities, it is going to color your experience and actions on a daily basis. Many people with low self-esteem get so caught up in their own perception of themselves, that they begin to project it onto others. For example, a man with low self-esteem might believe that he is not capable of satisfying a woman and, as a result, he becomes unable to perform in the bedroom. Low self-esteem can also be a sign of other psychological issues such as depression.
Schiavi et al. failed to find any difference in sexual dysfunction in alcoholics abstinent for 2-3 months in comparison with a nonalcoholic control group, speculating that alcohol-induced sexual dysfunction was reversible with abstinence. The aim of the present study was to estimate the prevalence of sexual dysfunction in males with alcohol dependence. We specifically assessed male subjects admitted to a treatment center with a diagnosis of alcohol dependence syndrome, without obvious hepatic cirrhosis or other co-morbidity. Female patients were excluded from the study as the number of women who use alcohol in India are few and the number of female alcoholics who avail of treatment centers are too few to contribute to significant statistical power. Also, the spectrum of sexual dysfunction is different in the female from the male.
After a full history and physical examination, the urologist likely has a perception of the etiology of the problem. Additional laboratory evaluations may be necessary to evaluate for specific types of organic disease. These tests might include serum chemistry, complete blood count, lipid profile, thyroid stimulation hormone/free thyroxine, and early morning serum testosterone to assess for metabolic abnormalities, such as diabetes mellitus, hyperlipidemia, renal dysfunction, thyroid disease, and hypogonadism (16). These are not mandatory components of the assessment in a patient with hypertonic cavernous smooth muscle as the source of ED.
For best results, men with ED take these pills about an hour or two before having sex. The drugs require normal nerve function to the penis. PDE5 inhibitors improve on normal erectile responses helping blood flow into the penis. Use these drugs as directed. About 7 out of 10 men do well and have better erections. Response rates are lower for Diabetics and cancer patients.
There is no evidence that mild or even moderate alcohol consumption is bad for erectile function, says Ira Sharlip, MD, a urology professor at the University of California San Francisco School of Medicine. But chronic heavy drinking can cause liver damage, nerve damage, and other conditions -- such as interfering with the normal balance of male sex hormone levels -- that can lead to ED.
The urologist must discuss the topic of ED delicately and caringly in order to earn the patient’s trust and be permitted to address his problem (15). It is important early during the visit to engage the patient and provide him reassurance that you will work as a team to evaluate and treat his disorder. A detailed history is the most important component of the evaluation. A thorough sexual history has many components. It should begin with information regarding onset, duration, severity, patient-suspected etiology of the ED. Ask the patient to define his specific concerns. The term “erectile dysfunction” is very broad, and the patient may actually have arousal issues or ejaculatory concerns or a combination of concerns. Ask specific questions regarding erectile hardness and sustainability during self-stimulation versus with a partner (global versus situational ED). Determine if the patient has ED in certain positions (lying down versus upright or seated). Inquire about libido and nocturnal erections. It is also important to ask the patient about past treatments and response. Inquire about any concomitant pain issues, irritative or obstructive voiding symptoms, or pelvic floor complaints.
Stress is your body responding to your environment. And it’s a good thing—in limited doses. When you get stressed out your body makes chemicals like adrenaline that make you stronger, faster, fitter, and even able to think more clearly. Most people call this reaction the “fight-or-flight” response, and it’s a life-saver in dangerous situations. In a very real sense, adrenaline makes you a part-time superhero. The problems happen when your body deals with constant stress.
Yet another common erectile dysfunction treatment that can be used in combination with oral drugs is a vacuum pump. This device consists of a plastic cylinder, a pump, a set of constriction bands, and a water-soluble lubricant. The lubricant is applied to the base of the penis to help form an airtight seal. The cylinder is placed over the flaccid penis and held tight against the pelvis. The pump is used to create a vacuum within the cylinder, drawing blood into the penis. Once the penis is engorged with blood, a constriction band is rolled off the cylinder to near the base of the penis. The constriction band is helpful for men with venous leakage, in which blood flows out of the penis as fast as it flows in. However, it should be left on for no more than 30 minutes at a time.
When blood sugar levels are out of control, nerve and blood vessel damage occurs throughout your body. Nerve damage breaks down the ability to turn sexual stimulation into an erection.6 Poor blood circulation reduces blood flow to the penis. Together they impact your ability to get an erection that is rigid and lasts long enough for sexual satisfaction.
Sildenafil (Viagra) was the first oral phosphodiesterase type 5 (PDE5) inhibitor approved by the FDA in the United States for the treatment of erectile dysfunction (it is not approved for women). Sildenafil inhibits PDE5, which is an enzyme that destroys cGMP. By inhibiting the destruction of cGMP by PDE5, sildenafil allows cGMP to accumulate. The cGMP in turn prolongs relaxation of the smooth muscle of the corpora cavernosa. Relaxation of the corpora cavernosa smooth muscle allows blood to flow into the penis resulting in increased engorgement of the penis. In short, sildenafil increases blood flow into the penis and decreases blood flow out of the penis.
Ultrasound with Doppler imaging (ultrasound plus evaluation of blood flow in the arteries and veins) can provide additional information about blood flow of the penis and may help in the evaluation of patients prior to surgical intervention. This study is typically performed after the injection of a chemical that causes the arteries to open up, a vasodilator (prostaglandin E1), into the corpora cavernosa in order to cause dilation of blood vessels and promote blood flow into the penis. The rate of blood flow into the penis can be measured along with an evaluation of problems with compression of the veins.
The bad news: Men with diabetes are three times more likely to report having problems with sex than non-diabetic men. The most common sexual problem is Erectile Dysfunction, or ED, sometimes called impotence. Even worse, because ED is such a private issue, many men feel embarrassed to discuss the problem with their doctor, or even their partner, so the problem is never addressed.