Erectile Dysfunction

Erectile Dysfunction refers to a condition in which the penis is unable to maintain an erection sufficiently for sexual intercourse. Some people may not have an erection. Some people may have premature ejaculation. Some people may experience pain when ejaculating.

The most common cause is due to insufficient blood supply to the genitals. It can be found 5% in people under 40 years old, 37.5% people over 40-70 years old. This disease can be treated. If a problem is found and promptly treated, People with this problem do not worry. Because most of them are temporary. If it is permanent, there may be a psychological or physical problem. As you get older, your sex drive may change. is that erection may take longer and not as strong as when young in addition, it may require more stimuli than usual. At the climax, it’s not the same as before. Semen is less than before. This condition does not mean a condition that decreases sexual desire or a problem with ejaculation.

Genital Structure

The male genitals consist of three inflatable tubes called corpuscarvernosum Two tubes running parallel to the urethra are on top and one is the corpus spongiosum on bottom. When flaccid, the length is about 8.8 cm. When stimulated, the blood enters the sponge tube, allowing it to expand up to 7 times, making the penis larger and harder, and has a length of 12.9 cm as long as it is excited. In sexual relations, the penis is still erect, but when the blood is ejected from the penis, it becomes weak.

Penis Erection Process

Initially, there must be sexual desire that arises from the brain being stimulated, which may be caused by sight, smell, sound, touch, and from the thought that passes that sexual desire to the spinal cord and stimulates the genitals and the blood flowing into the genitals

The blood vessels in the genitals must be dilated in order for blood to enter the penis fully. Therefore, if there are factors affecting all three mechanisms, it will cause erectile dysfunction.

Erection Mechanism

In order for the penis to become erect, it must have the following important components:

The arteries that supply the genitals must not be constricted because the erection must contain blood. If there are atherosclerosis, blood cannot fully supply the genitals. Conditions that cause atherosclerosis include: People who smoke, diabetes, high blood fat, high blood pressure, etc.

The peripheral nervous system, which is the system that receives the sensations produced by physical contact.

The spinal cord, which is the system that connects sensation from the peripheral nerves to the central nervous system and relays commands to the penis.

The central nervous system, which consists of various stimuli such as sight, hearing, smell, including imagination and past experiences Mental is important.

Symptoms of erectile dysfunction

Causes of erectile dysfunction often have multiple causes. If there are multiple causes, it will increase the chances of occurring. The causative factors are:

• Age: it was found that if older people could find this disease increased, it was found that people aged 40-49,50-59,60-70 years old could find ED at 20.4,46.3,73.4% respectively.
• Society and economy found that people with high incomes, knowledge and good occupations have less ED problems than people with low incomes.
• Congenital disease or chronic congenital disease must be a chronic disease that has been long enough, should be a disease that affects the arteries and veins. Genital muscles can cause erectile dysfunction such as diabetes, kidney disease, alcoholism, arterial disease, atherosclerosis erectile dysfunction in this group found 70 percent of the important diseases are:
• Cardiovascular disease because it decreases blood flow to the genitals.
• Hypertension
• Diabetes usually occurs after about 10 years of diabetes, with the main cause being hardened arteries.

Erectile dysfunction from prostatic hyperplasia

• Surgery and accidents affecting the nerves that control the erection, such as pelvic surgery, prostate surgery. Having an accident on the genitals, spinal cord bladder, the pelvic bones may damage the nerves, causing sexual impotence, urethral surgery
• Taking many drugs may cause a decrease in sexual desire. Some species may cause sexual impotence.
• lifestyle behaviors, including
• Smoking: 45% higher incidence of ED among smokers than non-smokers, 35% among normal people.
• Alcohol use: 54% of people who drink alcohol have ED, 28% of normal people.
• Exercising People who exercise are found to be less than those who do not exercise.
• Emotional ED is found in about 10-20 percent of patients with erectile dysfunction. The condition may be caused by stress. job-related anxiety Families, fear of sexual failure, or being blamed by a partner can sap confidence.

Causes of Erectile Dysfunction Divided by erection mechanism can be divided into 3 steps:

• Failure to induce an erection is often caused by mental, brain, nervous system and testosterone deficiency.
• Failure for the red blood to flow into the genital organ but the penis does not grow long and hard enough is often caused by insufficient blood circulation to the penis.
• Failure to contain the arterial blood flow in the penis and linger long enough and long enough for the penis to become fully erect and long enough for intercourse to be successful. Usually caused by the elderly with fibrosis instead of arteries.

The causes of erectile dysfunction are classified according to different systems.

• Arterial dysfunction is the most common cause.
• Diabetes
• Hypertension
• Hyperlipidemia
• Smoking
• Irradiation
• People who ride bicycles or motorbikes for long distances.
• Disorders of the nervous system. Divided by different levels as follows:
• Brain level such as brain tumors, epilepsy, paralysis, Parkinson’s, Alzheimer’s disease.
• spinal cord level The most common cause is getting into an accident.
• Nerve level and nerve endings The most common cause is diabetes. It can also be seen in people who undergo abdominal surgery. prostate surgery
• Disorders of the veins It is often found in elderly people with diabetes due to hardening of the veins.
• Abnormalities in hormonal levels People with less testosterone are more prone to ED problems with decreased sex drive but it is not related to erectile dysfunction.
• Psychological disorders, which can be divided into two categories, those with pre-existing mental illnesses. Such as depression, those who are stressed, and the second type is those who have sexual problems, which may be caused by premature ejaculation or incomplete erection, causing chronic anxiety.

the severity of erectile dysfunction

• Mild symptoms, being able to have sexual intercourse almost every time.
• Moderate symptoms, about half of them had sexual intercourse.
• Severe symptoms are unsuccessful sexual intercourse.

Diagnosis

• History of illness. existing disease Medication used regularly, frequency of sexual desire erection frequency The frequency of these secretions, you must be prepared to answer the doctor’s questions.
• Examine the penis to see if it has an erection or not. If there is no erection, it may mean that there is a problem with the nerves. Is there a loss of hair on the genitals? If there is a cause, it may be caused by the endocrine glands.
• Laboratory diagnosis, the doctor will take a blood test to check liver function, sugar, kidney, fat, general blood result. For those with low sex drive, testosterone levels may be tested. In addition, one must also observe erections during sleep. If they can erect at night or in the early morning, the cause is likely to be from the mind.

Treatment

• Initial treatment to eliminate or reduce risk factors to a minimum is to change lifestyle behaviors such as eat foods that are high in fiber, foods that are low in fat, reduce salt, no alcohol, no smoking.
• Psychotherapy Psychological treatment if the problem of sexual impotence is caused by the psyche, the doctor will help reduce anxiety.
• Drug Therapy includes oral drugs, injections or intravenous drugs.
• Use of drugs used to treat first erectile dysfunction. Which must be taken 30 minutes – 1 hour before sex should be taken on an empty stomach. The pill lasts 4-5 hours to the point that some people are able to have sex in the morning when taking the pill at bedtime. This drug will be effective only when the user must have sexual desire. This drug will increase the blood supply to the genitals. The size used is 50 mg per day should not be used more than 1 time per day for those who have liver disease Kidney failure or age over 65 may start at 25 mg per day if the results are not good and there are no complications, then gradually increase the dose. This drug is contraindicated in people with heart disease taking nitrate drugs. This drug should not be used because it can cause dangerously low blood pressure, fainting. As for taking this drug in combination with other antihypertensive drugs is not harmful. Drugs in this group that are available in Thailand include Levistra.
• Alpha blocker drugs include yohimbine [Procomil] originally used as an aphrodisiac but at present, it is known that this drug acts on the brain and dilates blood vessels at the extremities, including the penis, causing erection. The dose of the drug used is 18-30 milligrams to be taken consecutively for 1-3 months, but must be careful of complications such as high blood pressure. heart palpitations frequent urination
• Take the drug under the tongue, it works in 10-25 minutes, when used under the tongue, the side effects of the drug are low, only nausea and vomiting.
• Testosterone hormone drugs are suitable for those who have low testosterone levels in the blood.
• injection into the genitals These drugs cause the blood vessels to dilate. This drug begins to act 5-20 minutes after injection and lasts for 1 hour. The side effects of the medication may cause a condition known as doping, which can cause pain at the injection site and bleeding.
• insertion of drugs into the urethra, It starts to work in 8-10 minutes and lasts for 30-60 minutes and must use a rubber band to keep the penis erect for a long time. Side effects are irritation to the urethra. The testicles may bleed from the urethra.
• Use of Vacuum Devices By using a vacuum to cover the genitals, then pump the air out of the pipe, causing the blood into the genitals until the genitals harden well, then use rubber bands.

Surgery

There are 3 methods of surgery.

• Surgery to insert prostheses into the penis. This tube is connected to a pump then pump water into the tube to cause an erection.
• Surgery for clogged arteries due to an accident is suitable for young people.
• Vein correction surgery is not popular.

In choosing a treatment, the doctor will consider the age and the pre-existing disease. If you have any disease, you must tell the doctor before every treatment because there are some conditions that may be dangerous if having sex, such as

• recently had a heart attack or stroke in the past 2-3 months
• Some types of irregular heartbeats.
• Chest pain due to uncontrolled ischemic heart disease.
• Uncontrolled blood pressure.
• Uncontrolled heart failure.
• Severe valvular heart disease

Protection

Although erectile dysfunction may occur from time to time in men, we can reduce erectile dysfunction by the following methods.

• Management of sexual organs to be strong.
• Avoid drinking alcohol and drugs.
• Stop smoking.
• Exercise regularly.
• Reduce stress and anxiety.
• Relax to the fullest.
• Annual physical examination

Q&A : Erectile Dysfunction

MD. Suebphong Angchoun

See Full Bio