Author
Dr.Pramod
MBBS,MS(Gen-Surgery), DNB(Urology) ChM Urology(Edinburgh, UK)
Author
Dr.Pramod
MBBS,MS(Gen-Surgery), DNB(Urology) ChM Urology(Edinburgh, UK)
In a study from John Hopkins Institute in 2007, the overall prevalence of ED in men aged above 20 years was 18.4% suggesting that ED affects 18 million men in the USA. Among men with diabetes, the prevalence of ED was 51.3%, so it’s a fairly common problem.
What causes ED?
Treatment options?
Penile Doppler scan with an injection may be required occasionally
in special situations.
Whatever is causing ED, there is a treatment option that can provide
a satisfying solution.
If you try one of the treatment options listed and it doesn’t work
for you or you aren’t completely satisfied, don’t be discouraged and
give up hope.
These treatment options have varying degrees of success for each man
depending on the cause of the ED. Irreversible blood vessel or nerve
damage may impact the success of some of these treatments.
It is important to know all of your available options and discuss
them with your doctor to determine which will be appropriate for you
and your lifestyle.
Lifestyle modifications: Exercise regularly (5 times a week),
healthy weight, avoid smoking, restrict alcohol intake to 2 drinks
or less per day, adopt better sleep habits, take care of your other
health issues such as high blood sugar and heart, artery or kidney
disease.
Non-Surgical Options: Oral medications, penile injections, vacuum
erection device
Surgical option: Penile implants
Oral medications:
These drugs are known as phosphodiesterase type 5 (PDE-5)
inhibitors. They work to relax muscle cells in the penis for better
blood flow and to produce a rigid erection. These medicines work in
about 7 out of every 10 men with ED. They can be effective
regardless of age or race. However, they only work if a man is
sexually stimulated. Their effects last for only a set amount of
time. Men should take these medications 30-60 minutes before sexual
activity. These drugs do not treat a lack of sexual desire. As with
any drug, some men may experience side effects when taking PDE-5
inhibitors. The most common are headaches, flushing (redness) of the
face, runny or stuffy nose, upset stomach, dizziness and muscle
aches. Those side effects are usually mild-moderate, but taking
these drugs with alcohol may make them worse. Be sure you tell your
doctor about all drugs you are taking, including prescriptions,
over-the-counter medications or supplements or recreational drugs
before you take any PDE-5 inhibitors.
Penile self-injection:
Alprostadil (Prostaglandin)
Injection therapy uses a needle to inject medication directly into
the base or side of the penis. These medications improve blood flow
into the penis to cause an erection. The recommended frequency of
injection is no more than three times weekly and should produce an
erection in 5-20 minutes. Beyond a possible fear of needles, men may
experience pain, fibrosis and risk of a persistent erection with
these injections. 60-65% of men discontinue this mode of treatment
after 1 year.
Vacuum Erection Devices (VED):
A mechanical ED pump used to
pull blood into the penis can cause an erection. The system includes
a plastic cylinder, an external penile pump and a tension band to
place at the base of the penis. When the penis is erect, the ring is
placed at the base to maintain an erection long enough to have sex
(up to 30 minutes). This is a drug-free non-invasive method of
treatment, but the person will not be able to ejaculate soon after
the orgasm due to a constrictive ring at the penile base.
Penile Implants:
In use since 1971, penile implants have
helped many men return to active sex life. A penile implant is a
medical implant that is implanted into the penis in the operation
theatre. The implant is entirely concealed within the body. Two
basic types of implants are available. With malleable or bendable
implants, two silicon-type cylinders are inserted into the penis. To
have an erection, a man bends his penis upward into an erect
position. The second type, an inflatable implant has a pair of
inflatable cylinders which is attached to a fluid reservoir and a
pump hidden inside the body. To have an erection, a man presses on
the pump. This transfers fluid into the cylinders, making the penis
rigid. To return the penis to a natural flaccid state, the pump is
deflated.
Premature ejaculation is when semen is released sooner than a man or his partner would like. PE might not be a cause for worry. But, PE can be frustrating if it makes sex less enjoyable and impacts your relationship.
A study looking at 500 couples from five different countries found the average time taken to ejaculate during intercourse was around 5 minutes. However, it's up to each couple to decide if they’re happy with the time taken – there’s no definition of how long sex should last. Occasional episodes of premature ejaculation are common and aren't a cause for concern. However, if you're finding that around half of your attempts at sex result in premature ejaculation, it might help to get treatment.
There are many reasons why men have PE. There can be biological, chemical, and/or emotional reasons. There may be issues with the brain signals that rule sexual excitement.
Common treatments are behavioral therapy, tablets and creams. Many people try more than one option at the same time.
Medical Therapy: They lower serotonin levels. You’ll usually be advised to take it one hour before sex, but not more than once a day. Your response to the treatment will then be reviewed after four weeks (or after six doses), and again every six months.
Numbing Creams or Sprays: There are creams and sprays that you can put on the head and shaft of the penis before sex to lower sensation. They also cause vaginal numbness, so they should be washed off before sex.
It happens when semen travels backward into the bladder instead of through the urethra (the tube that urine passes through).
Men with retrograde ejaculation still experience the feeling of an orgasm and the condition doesn't pose a danger to health. However, it can affect the ability to father a child.
Prostate gland surgery or bladder surgery is the most common cause of retrograde ejaculation. Other causes are diabetes, multiple sclerosis, and a class of medicines known as alpha-blockers, which are often used to treat high blood pressure (hypertension).
Most men do not need treatment for retrograde ejaculation because they are still able to enjoy healthy sex life and the condition does not have adverse effects on their health.
Men who want to have children can have sperm taken from their urine for use in artificial intrauterine insemination (IUI) or in-vitro fertilization (IVF).
Anejaculation is the inability to ejaculate semen despite stimulation of the penis by intercourse or masturbation. If anejaculation is caused by medications, stopping the medicine will most likely restore normal function.
Vibrostimulation: The vibrator acts by providing a strong stimulus for a long duration (20-30min) to the penis. Vibrator stimulation results in ejaculation in about 60% of men suffering from a neurological (spinal cord) injury. This is a simple and quite effective way of retrieving semen in order to proceed with artificial insemination (inserting sperm directly into the uterus).
Primary hypogonadism is caused by a problem in the testes. This type is most frequent and usually affects development in childhood and adolescence.
Secondary hypogonadism is caused by a problem in glands (pituitary gland, hypothalamus) that tell the testes to make testosterone. This type is more common among older men.
One must give it time. On the other hand, there are chances of multiple births, i.e, if more than one embryo is transferred into your uterus. The use of multiple embryos is done to increase the chances of conception. Stress can also be brought on by the length of the process, hormonal changes, and medication.
The chances of a fetus born with malformation is similar to natural conception.
Hypogonadism can occur at any age. The symptoms will be different depending on your age when it develops. Common symptoms in adult men include:
Male hypogonadism is diagnosed based on:
Congenital penile curvature although present since birth will become obvious during erection when he reaches puberty or early adult life.
Peyronie’s Disease is caused by the way a person’s body heals wounds. Injury or damage to the outer tissues of the penis causes scar-like tissue (plaque) to form.
PEYRONIE’S DISEASE IS NOT A DISEASE YOU CAN CATCH FROM SOMEONE ELSE AND IT IS NOT CAUSED BY ANY KNOWN DISEASE THAT CAN BE PASSED TO OTHERS.
Peyronie’s disease usually occurs in two phases — the acute (or active) phase and the chronic (or stable) phase. The first painful phase can last up to about 18 months. For most men, the chronic, or stable, phase begins 12-18 months after symptoms first appear.
Fig: Peyronie’s disease with penile curvature and plaque
Andrologists may treat Peyronie’s using non-surgical or surgical treatments.
Non-surgical treatments may include tablets, penile traction devices and shots/injections directly into the plaque which brings higher doses of the drug directly to the problem.
Surgery is an option for men with severe penile curvature that find it difficult to have sex. There are three surgeries used to help men with Peyronie’s Disease:
Priapism got the name from Priapus. Roman statue showing Priapus – the god of fertility. The distinguishing feature of the deity is the great erect penis, which was to symbolize the economic well-being of the owners of the House of the Vettii in Pompeii.
Priapism can happen in young boys (age 5-10), young adults (around age 20) and mature men (over age 50).
Priapism happens when blood flow to the penis doesn’t work correctly. Some things that could cause this are:
When an erection lasts for too long, the blood becomes trapped in the penis. The blood trapped in the penis is unable to go to other parts of the body. The lack of oxygen can damage or destroy tissue in the penis. This can disfigure the penis. It may also cause problems like erectile dysfunction (when the penis cannot become erect) in the future.
Ischemic priapism (most common, 95%) calls for emergency care. Blood must be drained from the penis. There are several ways to do this:
Nonischemic priapism (less common, 5%) often goes away without treatment. Simple ice and pressure on the perineum may help end the erection. A watch and wait approach is used before surgery.