By Dr Zubair Abdulahi, 26 January 2020.
Erectile dysfunction or impotence is described as the inability of a male to achieve or maintain an erection sufficient for satisfactory sexual performance.
Erectile dysfunction is the most common sexual problem in men, affecting around 30 to 50% of men throughout life but commoner as the age increases. Erectile dysfunction strains the intimate relationships of affected men, reduces their quality of life and causes self-esteem problems.
Typically, erectile dysfunction is a complex condition involving many paths. As such, management may be difficult sometimes. It may also be a symptom of a more serious underlying condition. Secondary impotence describes erectile dysfunction in someone who had achieved and sustain an erection for a long time before recent events. Having an inability to achieve an erection or sustain it once in a while is no great concern. However, persistent problems should warrant a visit to your doctor.
How Does An Erection Occur?
In normal circumstances, an erection of the penis is caused by joint actions of the brain and spinal cord, nerves, hormones (chemical messengers in the body), and blood vessels. A problem in any of these processes can cause an inability to develop or sustain an erection. An erection may occur in response to touch, smell and visual signals. It may also be evoked by thought or memories.
What Causes Erectile Dysfunction?
The main causes of erectile dysfunction are
Organic causes: Diseases of blood and blood vessels (e.g. Smoking, diabetes, coronary artery disease), hormonal disorders, drug usage and nerve problems are a common cause of erectile dysfunction.
Psychological causes: People with anxiety disorders (including performance anxiety) or depression may have low libido or find it difficult to have or maintain an erection.
The following are important considerations in erectile dysfunction are:
Partner factors: Their sexual interests and overall health status.
Relationship factors: Communication problems, differences in desire for sexual activity or partner violence.
Individual factors: Prior sexual or emotional abuse, existing psychiatric conditions (anxiety and depression), prior surgery or accidents, especially in the groin area.
Culture or religious factors: Inhibitions or conflicted attitudes to sex.
Medical factors: Existing medical illness such as diabetes, hypertension, epilepsy, sickle cell anaemia or drugs such as antihypertensive, antipsychotics, and anti-ulcer medications. Ageing may also reduce one’s ability to start or maintain an erection.
How Is A Diagnosis Of Erectile Dysfunction Made?
The first step is having a thorough consultation with a medical doctor who will enquire about the condition as well as prior sexual history. Questions will be asked about current medical illnesses (such as diabetes and hypertension), the use of medications (such as antihypertensive and antidepressants), and psychosocial issues. A physical examination will also be carried out to assess the blood pressure, heart rate, the genitals and surrounding structures as well as the body in general.
This clinical assessment is followed by blood tests, urine analysis, and hormonal tests. In some cases, ultrasound scans of the penis and tests to uncover the cause of the condition. Special tests may also be carried out to assess the functionality of the muscles of the penis.
How Is Secondary Impotence Managed?
If a cause of the condition is found, a management plan is started immediately. The following are ways by which treatment is proffered:
Treatment of the cause of the condition: This may be the cessation of a particular medication or the start of another medication.
Sex counselling and lifestyle changes: Usually, a referral to a sexual counsellor is made for assessment. Lifestyle changes are also suggested (cessation of smoking, weight loss, increased activity levels, and reduction of alcohol intake).
Oral and Injected Medications: Hormonal pills and special medications (e.g. Viagra, Cialis) for erectile dysfunction may be prescribed for use before the onset of sexual activity.
Surgery: Where indicated, surgery may be offered as a cure for erectile dysfunction or as a means to implant special devices within the penis that helps with the maintenance of erections during sexual activity, especially after the failure of medications and other therapies.
Special devices: These include vacuum pump devices and constrictors worn on the penis before sexual activity.