Managements of Erectile Dysfunction

Male sexual dysfunction includes erectile dysfunction (ED), decreased libido, anatomical abnormalities (e.g., Peyronie disease), and ejaculatory dysfunction. ED, defined as the inability to achieve erections firm enough for vaginal penetration, affects millions of men in the United States. The Massachusetts Male Aging Study showed that the prevalence of ED increased by age: approximately 50% of men experienced ED at age 50, and nearly 70% at age 70.

Causes

The causes of ED may be results of disturbance in erectile physiology include hormonal, vascular, psychological, neurological, and cellular components. Testosterone is primarily responsible for maintaining sexual desire (libido) so hypogonadism is associated with ED.

Other hormonal causes of ED include hyperthyroidism and prolactinomas

Psychogenic erections, triggered by fantasy or visual stimulation, are mediated by sympathetic input from the thoracolumbar chain (T11-L2).

 Reflex erections are caused by tactile stimulation and are mediated by the parasympathetic nervous system (S2-S4).

 Overall, parasympathetic signals are responsible for erection, and sympathetic signals are responsible for ejaculation.

Risk factors

 Men with diabetes, hypertension, and coronary artery disease are at Increased risk of ED. Also improves in obese men who lose weight through diet and exercise

Medical Management

·         Phosphodiesterase Type 5 (PDE-5) Inhibitors:  The first lines of therapy for most men with ED are

o   Sildenafil (Viagra)

o   Vardenafil (Levitra)

o   Tadalafil (Cialis).

·         Intraurethral Alprostadil is effective in men of all ages who have various causes of ED and is inserted into the tip of the penis with an applicator

·         Intracavernosal Penile Injections a triple-therapy combination of alprostadil, papaverine, and phentolamine cause relaxation of cavernosal smooth muscle and penile blood vessels, and phentolamine antagonizes a adrenoreceptors

·         Hormonal therapy with   testosterone available for injection, skin patch, topical gel, or buccal oral tablets.

Nonmedical Treatments

Other treatments for ED include topical vacuum pump devices, surgically inserted inflatable penile implants and psychological counseling are used in ED treatments.