Erectile Dysfunction (ED)

Diagnosis

The healthcare provider might perform a number of tests to identify the disease and determine the cause because ED can have a wide range of causes. Effective treatment for ED is only possible once the cause has been identified.

Many times, a healthcare provider can diagnose erectile dysfunction and suggest a course of treatment based solely on a patient’s physical examination and responses to inquiries about their medical history.

Tests to look for underlying problems could consist of:

• Physical examination: This could involve closely inspecting the penis and testicles as well as testing the nerves for sensitivity.
• Psychological exam. To check for depression and other potential psychological factors that could be causing erectile dysfunction, a healthcare provider may ask several screening questions.
• Blood tests: Your blood sample could be sent to a laboratory for analysis, aiming to detect indications of heart disease, diabetes, low testosterone levels, and various other health conditions.
• Urine tests (urinalysis): Numerous details, such as information on protein, sugar, and testosterone levels, can be learned from urine analysis. A lack of testosterone, diabetes, kidney illness, or any condition that might cause ED can all be indicated by abnormal measures of these substances.
• Ultrasound: It entails utilizing a transducer, which is held over the blood vessels supplying the penis. It produces a video image that enables the healthcare provider to determine whether the patient has issues with blood flow.

An ultrasound may be used on persons with ED to assess blood flow and look for any venous leaks, atherosclerosis, or tissue scarring. This test is carried out both with the penis erect (often brought about by an injection of an erection-inducing medications) and when it is soft.

• Bulbocavernous reflex: This examination measures penis nerve feeling. The healthcare provider will squeeze the penis head, which should immediately cause the anus to contract. A delay in response time indicates faulty nerve function.
• Nocturnal penile tumescence (NPT): This examination evaluates a man’s erection while he is asleep. A man often experiences five to six erections while sleeping. A issue with nerve function or blood flow to the penis may be the cause of the absence of these erections.

By encircling the penis with three plastic bands of differing strengths, the snap gauge technique is carried out. The subsequent evaluation of erectile function depends on which of the three bands breaks. The elastic bands around the tip and base of the penis are how the strain gauge method operates. The bands stretch and measure changes in penile circumference if the penis becomes erect during the night.

• Penile biothesiometry: This test uses electromagnetic vibration to assess nerve function and sensitivity. Reduced sensitivity to these vibrations could be a sign of damaged nerves.
• Vasoactive injection: By injecting specific solutions, an erection is induced during this test, causing the blood vessels to dilate (enlarge) and allow blood to enter the penis.
• Dynamic infusion cavernosometry: Men with ED who have venous leaks get this test. In this test, a specified amount of fluid is pushed into the penis. Healthcare providers can assess the degree of the venous leak by calculating the rate at which fluid must be pumped in order to achieve a hard erection.
• Cavernosography: This examination includes injecting a dye into the penis and is used in conjunction with dynamic infusion cavernosometry. The venous leak is then visible by using an X-ray of the penis.
• Arteriography: Candidates for vascular reconstruction surgery are subjected to this test. In order to take X-rays, a dye is injected into the artery that is thought to be damaged.

Treatment

The healthcare provider’s primary focus is to ensure that the patient receives appropriate care for any medical conditions that might contribute to or exacerbate their erectile dysfunction.

Depending on the underlying causes, severity, and presence of erectile dysfunction, the patient may have a range of therapy options available to them. The healthcare provider will consider the patient’s preferences and provide an explanation of the risks and benefits associated with each treatment. The treatment choices may also be influenced by the preferences of the patient’s partner.

• Oral medications: For many men, oral medicines are an effective erectile dysfunction treatment. Which consist of Sildenafil (Viagra), Tadalafil (Adcirca, Cialis), Vardenafil (Levitra, Staxyn), and Avanafil (Stendra)

Nitric oxide is a naturally occurring substance the body produces that relaxes the muscles in the penis. All four drugs work to boost its effects. As a result of the increased blood flow, the patient can respond to sexual stimulation by getting an erection.

Taking one of these pills does not guarantee the immediate occurrence of an erection. Sexual stimulation is required to trigger the release of nitric oxide from the penile nerves. These medications enhance that signal, enabling some individuals to achieve normal penile function. It is important to note that oral erectile dysfunction drugs are not aphrodisiacs and do not elicit a feeling of excitement. Furthermore, they are not necessary for men who already experience regular erections.

Based on your unique circumstances, your doctor will assess and determine the most suitable medication that may be effective for you. It is important to recognize that not all individuals will respond to erectile dysfunction medications, and certain conditions like diabetes or prostate surgery can reduce their effectiveness.

Additionally, certain medications, such as nitrates like nitroglycerin (Nitro-Dur, Nitrostat, etc.), isosorbide mononitrate (Monoket), and isosorbide dinitrate (Isordil, Bidil), commonly prescribed for angina, can potentially be harmful when used in combination with erectile dysfunction medications. If you have heart disease or heart failure, or if you have very low blood pressure (hypotension), certain medications can pose potential risks and may be considered dangerous in such cases.

• Additional medication may include:
  • Alprostadil urethral suppository: During alprostadil (Muse) intraurethral treatment, a small alprostadil suppository is inserted into the penis and into the penile urethra. The patient inserts the suppository into their penile urethra using a specific applicator.

The erection often begins within 10 minutes and lasts between 30 and 60 minutes when it’s effective.

• • Alprostadil self-injection: Alprostadil is injected into the base or side of the penis using a tiny needle in this procedure. Sometimes, medicines that are typically prescribed for different illnesses are combined or used alone for penile injections. Examples include phentolamine and alprostadil. When two or three medications are added, these combination drugs are frequently referred to as bimix or trimix.

The dosage of each injection is designed to produce an erection that lasts no more than an hour. Because of the very thin needle used, little to no discomfort is often felt at the injection site.

• • Testosterone replacement: Low levels of the hormone testosterone can further complicate erectile dysfunction in some individuals. In this situation, testosterone replacement therapy may be prescribed as a first step or in conjunction with additional treatments.

A healthcare provider may suggest an alternate course of treatment if medication are ineffective or inappropriate in certain situation. Other therapies include:

• Penis pumps: A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The pump is used to remove the air from the tube after it has been positioned over the penis. As a result, a vacuum is created, drawing blood into the penis.

To keep the blood in and maintain the erection, the patient will wrap a tension ring around the base of their penis. The vacuum device will then be removed away.

If a penile pump is an appropriate course of treatment for the patient, the healthcare provider may suggest or prescribe a particular model. They will be able to confirm that it meets their requirements and was produced by a respectable company in this way.

• Penile implants: During this procedure, devices are surgically inserted into each side of the penis. These implants are made using flexible (bendable) or inflated rods. The patient has control over when and how long they get an erection by using inflatable devices. Their penis remains firm but flexible by using the malleable rods.

In general, penile implants are not typically recommended as a first-line treatment option, and healthcare providers often explore alternative options before considering them. However, individuals who have exhausted conservative therapies and have not achieved satisfactory results often report high levels of satisfaction with penile implants. It is important to note that like any surgical procedure, there are risks of complications, such as infection. If a patient is currently experiencing a urinary tract infection, undergoing penile implant surgery is not advisable.

• Exercise: Recent research has demonstrated that exercise, especially aerobic activities ranging from moderate to strenuous, can have a positive impact on erectile dysfunction. Engaging in regular exercise, even if it is less demanding, has been associated with a reduced risk of experiencing erectile dysfunction. Moreover, the risk may be further lowered by increasing overall physical activity levels.
• Psychological counseling: The healthcare provider may advise the patient or their partner to see a psychologist or counselor if the erectile dysfunction is brought on by stress, anxiety, or depression, or if the condition is causing stress and marital conflict.