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Urology Resources

Erectile Dysfunction

Erectile dysfunction (ED) is the constant inability to attain or maintain erection that is sufficient for satisfactory sexual intercourse. The basic process of erection requires blood to enter the penis as well as remain in the penis until the act of intercourse is completed.

Erection requires good blood supply, intact nerves, normal testosterone levels, and libido. Hence, any disease that affects the blood vessels, nerves (from diabetes, hypertension or drugs), Hormone levels (ageing) and mental health (stress, depression, alcohol or drugs) can cause ED.

Diagnosis

The diagnosis is mostly based on the history of the patient but a questionnaire has also been developed to help patients and doctors. The severity of ED is based on the score of this questionnaire. Other methods such as x-ray studies, ultrasound colour doppler and venous cavernosography, can also be done to verify ED but these are done if surgery is contemplated.

Premature ejaculation – a form of ED?

At present, although premature ejaculation is related to an anxiety state, many patients who suffer form ED also seem to have this problem. There are drugs available for this condition, from anaesthetic gel like lignocaine can be applied to the penis head 30 to 60 minutes before sexual intercourse, to anti-depressant medication like clomipramine, taken four hours before sexual intercourse.

Treatment

Treatment for ED falls into four groups:

Psychotherapy
Psychological therapy for those diagnosed with stress or depression related ED.
Surgery
If leaking veins is the cause, ligation surgery can be done. In severe ED, a penile implant can be inserted to artificially create an erection. Implants are expensive and carries risk of infection and implant failure.
Devices
A vacuum pump is used to suck out blood into the penis and thereafter, a ring is placed round the base of the penis to prevent blood from draining out. Many men find this cumbersome to use.
Drugs
Injection of prostaglandin (PGE1) or oral medications, namely PDE5 inhibitors (PDE5i) are still the most effective choice. PGE1 injections are painful and short-lived. Not surprisingly, PDE5i drugs are currently preferred. The first such drug was Viagra© which was launched in 1998. Subsequently, two other drugs, Cialis© and Levitra© became available. Viagra© and Levitra© last up to 4 hours. Cialis© has the advantage of a longer duration of action (up to 36 hours), while Levitra© has the fastest onset. Newer drugs are on the horizon and should be available in the coming years.

Natural Remedies

Every country has herbs and plants that are reported to be effective. From ginseng to Tongkat Ali, these plants have been processed into pills or are added to beverages. No medical study has conclusively shown them to be superior to PDE5i drugs, which are already effective in 90% of men who have ED.

ED medication is easily available from family doctors, who are adequately trained to treat and counsel couples. At the end of the day, ED affects the couple and sufferers need not suffer in silence.