Overview of erectile dysfunction

I am going to write about an overview of erectile dysfunction.

Male erectile dysfunction

ED is described as the recurrent or consistent inability to obtain or sustain an erection of sufficient stiffness and duration for sexual intercourse. The occurrence of sexual activity declines with age in both men and women. Sexual issues become more frequent with aging. In men, the most frequent sexual difficulty is ED.

Research suggests a high prevalence of ED in the general population. The overall prevalence of ED was 16% in men with ages ranging from 20 to 75 years. It was 8% in men 20 to 30 years of age and 37% in men 70 to 75 years of age.

An exercise was associated with lower risk of ED, while smoking, obesity, watching TV and alcohol consumption were associated with a higher risk. The main causes of ED, such as diabetes mellitus and hypertension, a number of common lifestyle factors that include obesity, lack of physical exercise and lower urinary tract symptoms have been associated with the development of ED.

ED is a strong predictor of coronary atherosclerosis, and cardiovascular evaluation of a non-cardiac individual presenting with ED is now recommended. The lowest prevalence was observed in men without chronic medical conditions and those who engaged in healthy behaviors. Obese men with ED who engaged in an increased physical activity and weight loss experienced an improvement in ED in about 33% of patients.

The frequency of sexual activity appears to have a direct relation with the occurrence of ED. Men who disclosed sexual intercourse less than once per week developed ED at twice as much as men who disclosed sexual intercourse once per week after adjusting for comorbid conditions and other key risk factors.

Male erectile dysfunction and diabetes

The occurrence of ED in men with diabetes mellitus augments with age. In one study the prevalence augmented from 6% in men 20 to 24 years of age to 52% in those 55 to 59 years of age. Furthermore, the key factors associated with ED, in addition to increasing age, were poor sugar control, long period of diabetes, retinopathy (disease of the retina) and peripheral or autonomic neuropathy.

In an identical study, the severity of male impotence severity was directly correlated with the duration of diabetes, poor sugar control, treatment with diuretics, and presence of small vessel disease or heart disease.

Observational studies advocate that the presence of ED is a predictor of cardiovascular incidents in men with diabetes mellitus, as it is in men without diabetes.

Men with diabetes mellitus who acquire ED experience a notable decrease in quality of life assessments as well as an increment in depressive symptoms. Depression is a well-known contributor to male impotence. A large epidemiological survey disclosed that most men with diabetes mellitus and ED had never been questioned by their doctors about their sexual activity and, therefore, did not receive any treatment.

Male erectile dysfunction and heart disease

Many of the same risk factors are shared between ED and cardiovascular disease. Their pathophysiology is brought about by endothelial dysfunction. Atherosclerosis of the coronary arteries is more significant in individuals with vascular ED. ED predicts the existence and degree of subclinical atherosclerosis not influenced by conventional risk factors for cardiovascular disease and, therefore, ED may be regarded as an extra forewarning sign of coronary atherosclerosis.

Chest pain

Men with ED without an apparent cause, such as injury to the pelvis, and who have no symptoms of coronary artery disease or other microvascular disease should be examined for cardiovascular disease and associated risk factors prior to commencement of therapy for their sexual impotence, since there are possible cardiac risks linked with sexual intercourse in individuals with heart disease.

Other causes of male erectile dysfunction

  • Antidepressant drugs such as SSRIs (selective serotonin reuptake inhibitors)
  • Thiazide diuretics
  • Spironolactone
  • Clonidine, methyldopa or guanethidine
  • Ketoconazole
  • Cimetidine
  • Psychosocial factors such as stress and depression
  • Bicycling (diminution in oxygen pressure in the pudendal arteries)
  • Testosterone deficiency, hyperprolactinemia, hyperthyroidism, hypothyroidism
  • Stroke, multiple sclerosis, pelvic injury, prostate surgery

Male erectile dysfunction and treatment

Oral phosphodiesterase type 5 inhibitors such as Sildenafil, Tadalafil, Vardenafil, and Avanafil are the preferred drugs of use because of their efficacy and tolerable side effects. The reasoning for the use of these drugs is associated with vasodilation, induced by nitrous oxide, which is brought about by GMP (cyclic guanosine monophosphate) in commencing and sustaining an erection. Detumescence is linked with the breakdown of cyclic GMP by the phosphodiesterase type 5 enzyme (PDE5).

Oral phosphodiesterase type 5 inhibitors (PDE5) exert their function by augmenting intracavernosal cyclic GMP by competitively suppressing the PDE5 enzyme and, as a consequence, augment the number and duration of erections in men with ED. PDE5 inhibitors will not work without adequate ambiance and psychological signs that result in satisfactory sexual arousal and excitement to start the physiological changes in the penis.

Erectile function can be calculated objectively by using the International Index of Erectile Function (IIEF), the frequently used authenticated instrument to measure male sexual performance in clinical ED studies. A short form of the IIEF (IIEF -5) is a quick and effortlessly administered effective diagnostic tool in a clinical office setting. In the clinical testing environment, an increase of greater than or equal to 4 on the erectile function area of the IIEF is assessed as a minimally clinically important difference (MCID).

A salient characteristic in the success of PDE5 inhibitor treatment is instruction and guidance on appropriate use, including the duration of time it takes for the drug to take effect from the time of administration and taking the medication in a fasting state.

Sildenafil possesses the most lengthy safety record of the four PDE5 inhibitors. Use of nitrates is contraindicated with any of the available PDE-5 inhibitors. The duration of action of sildenafil, vardenafil, and avanafil is approximately 4 to 5 hours, whereas tadalafil is efficacious for about 36 hours after oral ingestion. Daily administration of low dose tadalafil eradicates the anxiety about onset and duration of action.


Sildenafil and vardenafil must be administered on an empty stomach (meals high in fat and alcohol delay absorption). Tadalafil, avanafil or vardenafil can be taken with food.

In one study of sildenafil and tadalafil, 66.3% of men preferred tadalafil and 33.7% for sildenafil as a treatment for their ED.


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