Among the medical fraternity, the urologist diagnoses erectile dysfunction (ED) and treats it if the cause lies in his field of specialty.

The criteria to diagnose erectile dysfunction consists of a few steps that allow the urologist to come to a diagnosis and its possible cause thereby facilitating the right treatment option.

Diagnosis

  1. Physical exam
  2. Medical history
  3. Blood tests
  4. Urine tests
  5. Ultrasound
  6. Psychological evaluation

Physical exam

This will include a physical examination of your penis and testicles for any physical abnormality, STD lesions and to gauge sensitivity to touch.

The doctor will also examine your body for any hormonal problem. For example, enlargement of breasts will indicate a hormonal problem.

He or she will examine the pulse at all pulse points such as the wrists, ankles, groin, elbow, and temples to see if there is a circulation problem.

He will check your blood pressure to rule out hypertension.

The physical exam will also include the testing of your nerves for signs of any conduction failure.

History taking

Taking the history of the patient is about asking you questions to see and identify a reason for your ED. These will focus on the following:

Medical history

A medical history will help:

  • to understand whether you suffer from diabetes, hypertension, or any other disease and condition that could be causing you sexual dysfunction
  • Whether you have undergone any surgery on your pelvic area
  • Whether you are taking any medication that causes erectile problems

Stress history

The doctor will ask you leading questions regarding your mental setup. He will want to rule out mental stress, anxiety, and depression, which are common causes of ED.

Lifestyle history

The doctor will want to know the type of lifestyle you have.

  • Do you smoke?
  • Do you drink alcohol and if so how much?
  • Do you exercise or live a sedentary life,
  • What type of diet do you eat?
  • Do you indulge in recreational drugs?
  • He will want to calculate your BMI to know whether you are obese

All the above are potential risk factors of ED and will have to be dealt with.

Sexual history

The sexual history is all about knowing

  • What arouses you sexually and how often do you get aroused?
  • Do you get an erection in the morning?
  • Is the erection hard enough or do you find it difficult to penetrate?
  • When erect is your penis straight or curved?

 Blood tests

Blood tests in the lab are done more to identify a cause for your ED than to diagnose it. Blood tests are done to identify whether you harbor any causative comorbidities. The following tests are performed to rule out certain conditions

  • Complete blood count to look for anemia
  • Blood sugar for diabetes
  • Lipid profile for high cholesterol
  • Kidney and liver function tests to look for kidney or liver disease
  • Testosterone and/or prolactin blood levels are checked to look for any deficiency of these hormones.
  • Blood tests to look for heart problems

Ultrasound

Ultrasound of the penis will check the blood flow to the penis. Restricted blood flow can be due to arteriosclerosis (clogged arteries) caused by high cholesterol, high blood pressure, or pelvic trauma.

Effective treatments of erectile dysfunction

The treatment of erectile dysfunction lies in treating the cause. Treating any underlying organic or physical and psychological cause will solve the problem to a great extent.

If that does not help, treatment may require specific medication and/or devices such as a pump, besides treating the underlying causes.

Besides that, exercise regularly, lose your extra pounds, stop smoking, limit your alcohol, and do not abuse drugs. Then there are certain medicines that increase blood flow to the penis and boost your erection if taken an hour before sexual activity.

Treatment of ED due to nerve and muscle weakness

If you develop neuritis and myositis due to extra intake of alcohol, fortified vitamin supplements taken via the parenteral route produces wonderful results.

Lifestyle habits that cause erectile dysfunction, such as smoking and alcoholism should be curtailed. A smoker is highly associated with ED and smoking cessation significantly improves erectile function.

Obesity and a sedentary lifestyle have to be corrected by eating the right diet and exercising daily. Aerobics will be ideal for such persons.

Treating ED due to diabetes, hypertension, and atherosclerosis

Underlying diseases that may be the cause of male sexual dysfunction such as diabetes, hypertension, and atherosclerosis have to be controlled and treated with the right drugs and dosage to maintain blood sugar, blood pressure, and cholesterol levels within normal limits.

Treating sexual dysfunction caused by medicines

If on medicines that cause erectile dysfunction, you should consult your physician. For example, such medicines may include those taken to treat high blood pressure, depression, anxiety, heartburn, allergies, pain, seizures, and cancer. Your health provider may then switch you to other medicines.

Illicit drugs that contribute or can cause ED include amphetamines, barbiturates, cocaine, and opiates.

Managing ED due to stress

Erectile dysfunction due to stress is treated with the help of a psychiatrist. Just a bit of psychoanalyst talk and mild antidepressants in the right dosage will give immense relief.

People have completely recovered with psychological counseling, where stress, anxiety, and depression have been the cause of erectile dysfunction.

Treatment of ED due to testosterone deficiency

Testosterone hormone replacement therapy may improve ED in cases where it is deficient. Studies show that it does help men with low testosterone levels if ED is their only symptom.

Therapy consists of testosterone intramuscular injections, testosterone gel applied to the skin, and testosterone stick applied as an underarm deodorant.

However, testosterone is not administered to men with normal testosterone levels.

ED treatment in old age

Comorbidities and multiple drug treatments are a hard challenge in the management of health in elderly people.

Old habits die hard and old people (except for the disciplined few) continue to engage in the prevalent lifestyle.

The first step in the management of ED in elderly people, therefore, should be the modification of the prevalent incorrect lifestyle.

Correcting the wrong dietary habits, cessation of smoking, regular physical workouts, and reduction of extra body weight all account for the first step towards managing sexual dysfunction.

Phosphodiesterase-5 (PDE 5) inhibitors are a class of drugs, which are the most commonly used in treating ED in old people. They relax and dilate the blood vessels thereby improving blood flow to the penis.

According to the Turkish Journal of Urology , PDE 5 inhibitors are safe in old people even if they suffer from heart disease.

Another common cause of ED in old people is a fall in testosterone levels due to decreased testicular function. If this deficiency exists, it is corrected to improve penile erection.

ED treatment after radical prostatectomy

ED is common after surgery of the prostate and you may regain your sexual function after several months to two years. However, you will need the help of your doctor to find the right treatment.

The most common first line of treatment that works post radical prostatectomy is the use of drugs classified as Phosphodiesterase Type 5 inhibitors (PDE5i). They are easy to use, are safe, and effective in bringing back your sexual function.

Medicines to treat erectile  dysfunction

Four oral PDE-5 inhibitors that are effective and safe are currently approved by the U.S. Food and Drug Administration (FDA) for treating ED.

  • Avanafil (Stendra)
  • Sildenafil (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra)

All of them are effective within about one hour of ingestion and are typically used only when needed.

Once an erection is produced by sexual stimulation, the PDE-5 inhibitor helps to maintain the erection by increasing the vasodilatory effects of endogenous nitric oxide.

These drugs are Phosphodiesterase Type 5  inhibitors (PDE5i). By blocking the action of PDE5 enzymes, they enhance the vasodilator effect of cyclic guanosine monophosphate (cGMP).

This results in more blood flow to the corposa cavernosa in the penis giving you a proper erection. The difference in the action of these drugs is the duration of their action in the body. Viagra stays in the body for 4 hours, while Cialis acts for 36 hours.

Please note: These drugs are available through prescription only and should be not be taken without consulting your physician. They are known to produce side effects in people in whom they were contraindicated.

You should not take these drugs if you are taking nitrates for a heart condition. Both nitrates and these ED drugs dilate and relax the blood vessels. If taken together their synergistic effect can lead to a sudden drop in blood pressure, which may cause you to feel dizzy and faint.

These drugs are less effective in certain cases such as after prostatectomy surgery and in diabetes.

Devices to treat erectile dysfunction

A vacuum or Penis Pump is a vacuum creating pump that is used just before sexual intercourse. The penis is inserted into this pump, which creates a vacuum around the penis. This causes the blood to be sucked into the penis and cause an erection.

You then slip a tension ring around the base of your penis to hold the blood inside the penis so that it stays firm and erect. You then remove the vacuum device.

This way the penis stays firm enough to finish the intercourse. You then remove the ring after the intercourse. The ejaculation is restricted due to the tension ring.

Surgery for ED

Surgery for erectile dysfunction is indicated in hopeless cases and if the person wants it. It involves the surgical insertion of artificial inflatable or malleable rods in both sides of the penis to keep it erect. The inflatable rods allow you to control the time and the duration of the erection.

Surgical insertion of penile implants is recommended when all other lines of treatment have failed.

Alternative medicine and natural remedies have yet to prove their merits in treating erectile dysfunction.

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