Erectile Dysfunction & Premature Ejaculation
Diagnosis and treatment

Erectile dysfunction

Definition of erectile dysfunction is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It comes with various names which include impotence, Brewers droop, limp dick, whiskey dick or mati pucuk in the local lingo.

Mechanism of erection

In simple terms, upon sexual stimulation, there is neural initiation which leads to release of neurotransmitters. This neurotransmitters causes relaxation of vascular and cavernous smooth muscle (these tissue is present in the penis). This in turn leads to increased blood flow in the penis and also increase in the intracavernous pressure. Due to increase in the pressure there is penile erection.

Cause of erectile dysfunction

Physiological and medical causes are responsible for majority of cases. At some point in life every men will experience impotence, this is usually secondary to stress and fatigue. Most often things come back to normal over time.

Atherosclerosis, has been blamed for being the most common cause of erectile dysfunction. This condition damages the small blood vessels supplying the penis which in turn reduces the blood supply to the penis.

Other causes include:

  • diabetes
  • high blood pressure
  • high cholesterol levels
  • heavy smoking
  • medication
  • spinal injury or nerve damage
  • low testosterone
  • chronic alcohol abuse
  • overweight etc

Challenges treating men with erectile dysfunction

85% of men with ED want help and only 10% will seek help. The majority of men with ED experience it for more than a year prior to seeking treatment.

Management of erectile dysfunction

Modification of the reversible courses which include lifestyle modification, change medication that induce reduction in blood flow to the penis and hormone replacement.

Oral erectogenic agents like Viagra, Cialis and Levitra (PDE 5 inhibitors) are the 1 st line of treatment. You should discuss with your doctor prior to starting this medication.

Other forms of treatment which are available include:

  • vacuum constriction device
  • intracavernous injection
  • intraurethral alprostadil
  • extracorporeal shock wave therapy

Your doctor will advice you on the starting dose and the possible side-effects. This should also minimise the unrealistic expectation seen in most patients. The cooperation of sexual partner in the diagnosis and treatment is also important.

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