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Erectile Dysfunction Treatment

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in Fertility Care

Male infertility is the inability of a sexually mature male to cause a pregnancy in a fertile female after one year of regular, unprotected intercourse.

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Erectile Dysfunction Treatment

What is Erectile Dysfunction ?

Erectile dysfunction (ED), also known as impotence, is a sexual dysfunction in males characterized by a persistent or recurring inability to achieve or maintain a penile erection firm enough for satisfactory sexual activity.

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Symptoms and Psychological Impact

  • The primary symptom of ED is the inability to consistently obtain or keep an erection of sufficient rigidity and duration for sexual activity.
  • Psychologically, ED can cause significant emotional distress, affecting both self-image and relationships. A considerable share of affected individuals do not seek treatment due to embarrassment.

Causes & Risk Factors

ED arises from various overlapping factors—vascular, neurological, hormonal, psychological, or drug-induced.

Physical & Vascular Contributors

  • Common causes include cardiovascular disease, atherosclerosis, diabetes, hypertension, obesity, smoking, high cholesterol, and chronic kidney disease.
  • Injuries or surgery affecting nerves or blood supply—such as from pelvic trauma or prostate cancer treatment—can also induce ED.

Neurological, Hormonal & Drug-Related Causes

  • Neurogenic disorders (e.g., multiple sclerosis, Parkinson’s, epilepsy), endocrine issues like low testosterone or hyperprolactinemia, and certain medications (SSRIs, antihypertensives, antihistamines, antiandrogens, etc.) can contribute.

Psychological & Lifestyle Factors

  • Psychological contributors:stress, performance anxiety, depression, relationship issues.
  • Lifestyle behaviors smoking, alcohol, substance use, poor diet, inactivity also increase ED risk.

Psychological & Lifestyle Factors

  • Psychological contributors:stress, performance anxiety, depression, relationship issues.
  • Lifestyle behaviors smoking, alcohol, substance use, poor diet, inactivity also increase ED risk.
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Types of Erectile Dysfunction

Wikipedia doesn’t list formal clinical types, but clinical sources differentiate:

  • Organic ED: Physical causes like impaired blood flow, arterial disease, or nerve damage—most common, especially in older men.
  • Psychogenic ED: Rooted in psychological or interpersonal issues such as depression, anxiety, or stress.
  • Mixed ED: A combination of both organic and psychological factors is frequent in real-world cases.
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Diagnosis

While the Wikipedia article doesn’t detail diagnostic methods, common clinical steps include:

  • Thorough medical and sexual history and physical exam.
  • Evaluation for vascular, neurologic, hormonal, and psychological contributors.
  • Use of questionnaires (e.g., IIEF).
  • Imaging or further testing if needed (e.g., ultrasonography, hormone levels) .

Treatments and Procedures

First-Line Interventions

  • Lifestyle modifications: Regular aerobic exercise, healthy diet, weight loss, quitting smoking, and stress reduction.
  • Psychological counseling or sex therapy, especially when emotional or relational issues are involved.

Medications

  • PDE5 inhibitors (e.g., sildenafil, tadalafil, vardenafil): Increase penile blood flow and are the mainstay of pharmacological treatment.
  • Alprostadil options:
    Urethral suppository.
    Penile injections.
    Topical cream (e.g., alprostadil + DDAIP approved in Canada).

Devices & Surgical Options

  • Vacuum erection devices (penis pumps): Non-invasive mechanical option, often second-line.
  • Penile implants/prostheses:
    Malleable or inflatable devices surgically implanted; a definitive option when other treatments fail.
  • Vascular surgery: In selected cases, to correct blood flow issues.
  • Focused extracorporeal shockwave therapy: Emerging non-invasive treatment, currently under investigation.

Outcomes & Results

  • Most men respond well to PDE5 inhibitors, with improved function when appropriately used.
  • Lifestyle changes and psychological support can be highly effective, especially in mixed etiologies
  • Penile implants offer high satisfaction rates and are considered the standard for refractory ED.
  • ED can serve as an early warning sign for cardiovascular disease, making diagnosis itself clinically valuable.
  • Recent research emphasizes that metabolic health, more than testosterone levels, may better predict sexual function decline with age.
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