Male erectile dysfunction is defined as "the inability to achieve or maintain an erection sufficient for sexual intercourse" is one of the most common sexual dysfunctions in men. Although erectile dysfunction can be primarily psychogenic in origin, most patients have an organic disorder, commonly with some psychogenic overlay. Some men assume that erectile dysfunction is a natural part of the aging process and tolerate it; while others find it devastating. Withdrawal from sexual intimacy because of fear of failure can damage relationships and have a profound effect on the overall wellbeing of the couple. Since erectile dysfunction often accompanies chronic illnesses, such as diabetes mellitus, heart disease, hypertension, and a variety of neurological diseases, physicians from many medical disciplines will see patients with this disorder.
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Several neurotransmitters are involved in penile erection. Nitric Oxide is the principal neural mediator of penile smooth muscle relaxation and therefore of erection. Nitric oxide accounts for the relaxing factor. It is formed from its precursor, L-arginine, by nitric oxide synthase. Nitric oxide activates guanil cyclase to form intracellular guanosine monophosphate, a potent second messenger molecule for smooth muscle relaxation, thus facilitating erection.
Psychogenic influences are the most likely causes of intermittent erectile dysfunction in young men. "Performance" anxiety may result in inhibitory sympathetic nervous system activity, and anticipatory anxiety can make the condition self perpetuating. A psychogenic component is often present in older men, secondary to an organic cause. Underlying relationship problems are a common cause of erectile failure and this possibility should be explored in men of all age.
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Erectile dysfunction can be treated in many ways. They are:
Psychosexual Counselling: Patients who have a sizeable psychogenic component may be helped by psychosexual counselling. Since the recognition that an organic element is present in most patients, this approach is increasingly being used in conjunction with pharmacological treatment.
Hormonal Therapy: Testosterone may improve erectile dysfunction in some patients with diagnosed hypogonadism. New transdermal formulations of testosterone and dihydro-testosterone, as well as oral formulations without associated liver toxicity, have been developed for use. Less commonly, surgery is used to remove tumours secreting prolactin. |
Drug Treatment: New drugs, such as inhibitors of phosphodiesterase-5 that affect the breakdown of cGMP, look very promising. Trials of one such drug, Sildenafil, have shown a response rate of around 90% in men with erectile dysfunction of no known organic cause. In diabetic subjects with clear organic erectile dysfunction, Sildenafil showed a 50% response rate. This drug is generally well tolerated, and has no appreciable effect on pulse rate or blood pressure.
Mechanical Devices: The simplest and least expensive erectile dysfunction treatment is a vacuum constriction device. Air is pumped out of the cylinder with the hand held pump to create a vacuum and cause an erection. This treatment is reliable and has few adverse effects when used properly.
Vascular Surgery: Arterial reconstructive surgery is sometimes indicated in men with arterial occlusive disease. The best results are obtained in young patients with isolated arterial lesions following trauma. The results are generally poor as only 30% of patients report long term improvement.
However, drug treatment with Sildenafil (Viagra) has achieved prominence in comparison to other forms of treatment. A non-invasive, safe and effective treatment, Sildenafil has achieved blockbuster status and has received regulatory approval in over 110 countries.
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