Erectile dysfunction

Erectile Dysfunction refers to the inability of the penis to be erect sufficiently for sexual intercourse. Some people may not be erect, some may ejaculate prematurely, and some may experience pain during ejaculation. The main cause is insufficient blood flow to the penis. The incidence is higher with age, namely, it occurs in 5 percent of people under 40 years old and 37.5 percent of people aged 40-70 years old. This disease can be treated if the problem is found and treated promptly. People with this problem do not need to worry because it is mostly temporary. If it is permanent, it indicates a mental or physical problem. As we age, there may be changes in our sexual intercourse, namely, it may take longer to get an erection and it may not be as hard as when we were younger. In addition, we may need to use more stimuli than usual. When we reach our climax, it is not the same as before. There is less semen than before. This condition does not mean that sexual desire has decreased or that there is a problem with ejaculation.

Structure of the genitals

The male penis is made up of three spongy tubules called the corpus carvernosum, two of which run parallel to the urethra, on the top, and one on the bottom. When flaccid, it is about 8.8 cm long. When stimulated, blood enters the spongiosum, allowing it to expand up to 7 times, making the penis enlarged and erect, reaching a length of 12.9 cm. As long as there is sexual excitement, the penis remains erect, but when blood is released from the penis it becomes flaccid.

Stages of erection

• It starts with the feeling of sexual desire, which occurs in the brain, which may be stimulated by sight, smell, sound, touch, and thought.
• The feeling of sexual desire is transmitted to the spinal cord and stimulates the genitals, causing blood to flow into the genitals.
• The blood vessels in the genitals must expand in order for blood to fully enter the genitals.

Therefore, if there are factors that affect all three mechanisms, it will cause sexual dysfunction.

Mechanism of erection

For the penis to become erect, the following important elements are required:

• The arteries that supply the penis must not be narrowed because for the penis to become erect, blood must be stagnant. If the arteries are hard, blood cannot fully supply the penis. Conditions that cause hardening of the arteries include those who smoke, diabetes, high cholesterol, high blood pressure, etc.
• The peripheral nervous system, which is the system that receives sensations from physical touch.
• The spinal cord is the system that connects sensory inputs from the peripheral nerves to the central nerves and transmits commands to the penis.
• The central nervous system, which consists of all stimuli such as sight, hearing, smell, as well as imagination and past experiences, the mind is also important.

Symptoms of erectile dysfunction

• Unable to remain erect throughout intercourse
• Penis is not fully erect
• Unable to remain erect at all

If you have these symptoms for more than 2 months or if they recur, you should see a doctor.

Causes of erectile dysfunction

The causes of erectile dysfunction are often multiple. If there are multiple causes, the chances of it occurring are higher. The contributing factors include:

• Age: It was found that the older the age, the more common this disease was found. It was found that those aged 40-49, 50-59, 60-70 years old had ED at 20.4, 46.3, and 73.4 percent, respectively.
• Social and economic studies have found that people with high incomes, knowledge, and good occupations have fewer ED problems than people with low incomes.
• Underlying disease or chronic disease: Underlying disease must be a chronic disease that has been present for a long enough period of time. It should be a disease that affects the arteries, veins, and muscles in the genital area. It can cause erectile dysfunction, such as diabetes, kidney disease, chronic alcoholism, and atherosclerosis. Erectile dysfunction in this group is found in 70 percent. Important diseases include:
• Cardiovascular disease because it reduces blood flow to the genitals.
• High blood pressure
• Diabetes usually occurs about 10 years after having diabetes, which is mainly caused by hardening of the arteries, autonomic nervous system.

Erectile dysfunction due to enlarged prostate

• Surgery and trauma that affect the nerves that control erection, such as pelvic surgery, prostate surgery, trauma to the penis, spinal cord, bladder, or pelvis can damage the nerves, causing erectile dysfunction. Surgery that involves the urethra.
• Many types of medication can reduce sexual desire, and some can cause impotence.
• Lifestyle behaviors include:
• Smoking: Smokers are more likely to have ED than non-smokers, with an incidence of 45% and 35% of non-smokers.
• Alcohol consumption: 54% of people who drink alcohol have RD, while 28% of people in the normal group have it.
• Exercise is less common in those who exercise than in those who do not.
• Psychological ED occurs in about 10-20 percent of patients with erectile dysfunction. This condition may be caused by stress, anxiety about work, family, fear of sexual failure or being criticized by a partner, which causes a loss of confidence.

Causes of erectile dysfunction, classified by erection mechanism

The causes of ED can be divided into 3 stages according to the erection mechanism:

• Failure to induce an erection is often due to mental, brain, nervous system, and androgen deficiency.
• Failure of red blood to flow into the penis, such as the heart, but the penis does not expand, lengthen, and become hard enough, is usually caused by insufficient blood circulation to the penis.
• Failure to contain enough influx of arterial blood into the penis long enough to achieve a full erection long enough for successful intercourse is often due to the elderly having scar tissue replacing the arteries.

Causes of erectile dysfunction by system

• Arterial abnormalities are the most common causes. Major causes include:
• Diabetes
• Hypertension
• Hyperlipidemia
• Smoking
• Radiation therapy
• People who ride long distances, ride motorcycles
• Neurological disorders are divided into different levels as follows:
• Brain level, such as brain tumors, epilepsy, paralysis, Parkinson's disease, Alzheimer's disease
• Spinal cord level, the most common cause is an accident
• Nerve and nerve ending level. Common cause is diabetes. It is also found in those who have had abdominal surgery, prostate surgery.
• Venous abnormalities are common in older people with diabetes due to hardening of the veins.
• Hormonal imbalance: Men who have low levels of testosterone often have ED, which is a decreased sexual desire, but it is not related to erectile dysfunction.
• Mental disorders are divided into two types: those with pre-existing mental illnesses, such as depression, and those who are stressed. The second type is those with sexual problems, which may be caused by premature ejaculation or incomplete erection, and chronic anxiety.

Severity of erectile dysfunction

• Mild symptoms: Sex is almost always successful.
• Moderate symptoms: Sex is about half the time successful.
• Severe symptoms: Sex is not successful.

Diagnosis

• Medical history, existing diseases, regular medications, frequency of sexual desire, frequency of erection, frequency of ejaculation. You must have this information ready to answer your doctor's questions.
• Physical examination: Feel the penis to see if it is erect. If it is not erect, it may mean that there is a problem with the nerves. Is there any loss of pubic hair? If so, it may be due to the endocrine glands.
• Laboratory diagnosis: The doctor will take blood to test liver function, sugar, kidney, fat, and general blood test results. For those with low sexual desire, testosterone levels may need to be measured. In addition, the erection of the penis during sleep must be observed. If it can be erect at night or in the early morning, it indicates that the cause is likely mental.

Treatment

• Initial treatment must eliminate or reduce risk factors to the lowest possible level, which means changing lifestyle behaviors, such as eating foods high in fiber, low in fat, reducing salt, and abstaining from alcohol and smoking.
• Psychotherapy If sexual dysfunction is caused by a psychological issue, the doctor will help reduce anxiety.
• Drug therapy includes oral, injectable, or suppository medications.
• The first drug used to treat impotence must be taken 30 minutes to 1 hour before having sex. It should be taken on an empty stomach. The drug will be effective for 4-5 hours, so some people can have sex in the morning even though they took the drug before going to bed. This drug will be effective only if the person who uses it has a sexual desire. This drug will increase the blood flow to the genitals. The dosage is 50 milligrams per day. It should not be used more than once a day. For those with liver disease, kidney failure, or those over 65 years old, you may start with 25 milligrams per day. If the results are not good and there are no complications, the dosage can be increased. Contraindications to using this drug are those with heart disease and taking nitrate drugs. This drug should not be used because it may cause low blood pressure, fainting, and danger. Taking this drug with other blood pressure-lowering drugs does not have any adverse effects. Drugs in this group that are available in Thailand include Levistra.
• Drugs in the alpha blocker group include yohimbine [Procomil], which was originally a stimulant of sexual desire, but it is now known that this drug acts on the brain and dilates blood vessels in the extremities, including the penis, causing an erection. The dosage used is 18-30 milligrams and should be taken continuously for 1-3 months, but be careful of complications such as high blood pressure, palpitations, and frequent urination.
• Use sublingual medication, effective in 10-25 minutes, placed under the tongue, low side effects, only nausea and vomiting.
• Testosterone hormone pills are suitable for people who have low blood levels of testosterone.
• Injection into the penis, these drugs cause blood vessels to dilate. The drug begins to work 5-20 minutes after injection and lasts for 1 hour. Side effects of the drug may cause a condition called erectile dysfunction, which causes pain at the injection site and bleeding.
• The drug is inserted into the urethra and takes effect in 8-10 minutes and lasts for 30-60 minutes. A rubber band must be used to keep the penis erect. Side effects include irritation of the urethra and possible bleeding from the testicles.
• Using a Vacuum Devices by placing a vacuum device over the penis and then pumping air out of the tube, allowing blood to enter the penis until it becomes erect and then using a rubber band to tie it off.

Surgery

Surgery, which has 3 possible surgical methods

• A prosthetic tube is surgically inserted into the penis. This tube is connected to a pump that pumps fluid into the tube, causing an erection.
• Surgery to repair blocked arteries due to accidents is suitable for young people.
• Surgery to repair veins is not popular. In choosing a treatment method, the doctor will consider the age and the disease you have. If you have any disease, you must tell the doctor before receiving treatment every time because there are some conditions that may be dangerous if having sex, such as:
• Have had a heart attack or stroke in the past 2-3 months
• Have some type of abnormal heart rhythm
• Have uncontrolled chest pain due to uncontrolled ischemia
• Have uncontrolled blood pressure
• Have uncontrolled heart attack
• Have severe valvular stenosis

Protection

Although erectile dysfunction in men can occur from time to time, we can reduce it in the following ways.

• Exercise to strengthen the penis
• Avoid drinking alcohol and drugs
• Stop smoking
• Exercise regularly
• Reduce stress and anxiety
• Get plenty of rest
• Have an annual physical examination