Erectile dysfunction


What is defined as erectile dysfunction?

It is the inability to maintain erection of the penis good enough for sexual intercourse. According to the Massachusetts Male Aging Study on sexual dysfunction, the problem can first emerge in a man as early as 40. Based on the study, an estimated 18-30 million men are affected by ED.

SO you don’t have to worry as you share this problem with millions of people, there is always a way to solve it.

Well, as it is a subject hard to discuss with doctors you can start here as it will give you a guide on everything you need , nevertheless you should eventually talk to your doctor before taking any medication or using any of the devices described later on.

How do penis get erected ?

There should be a stimulus first either by visual means or physical stimulus which goes to brain and then sent to penis by nerves. Then by hydraulic effect of blood entering and being retained in sponge-like bodies (corpora cavernosa) within the penis erection is achieved by keeping blood in the penis and preventing it from going out. So any problem in the blood supply , brain or nerves can result in erectile dysfunction.


What is the difference between libido and erectile dysfunction ?

 There is a big difference between libido and erectile dysfunction, libido is the urge to have sex and wanting it, while erectile dysfunction is as described above inability to maintain erection .

What are the signs and symptoms ?

 Erections that are too soft for sexual intercourse.

Erections that last only briefly.

An inability to achieve erections.

Men who cannot get or maintain an erection (75% of the time that they attempt sex ) are considered to have erectile dysfunction.

When should I see a doctor ? 

Probably the best time to take appointment is when erectile dysfunction become an issue for you or your partner.

What are the two main types of erectile dysfunction?

 Psychological vs organic, we will come these later on.

What are the possible causes of erectile dysfunction?

 1- Psychological is one of the main reasons of erectile dysfunction especially in young people. As we said above the erection need a stimulus visually or physically to get interpreted by brain and then the brain to send order to penis to get erected. So if in emotional stress , depression, anxiety or other mental health conditions it can affect erection.

2-Age, Sexual dysfunction and ED become more common as men age. According to the Massachusetts Male Aging Study, about 40% of men experience some degree of ED at age 40 compared with 70% of men at age 70. And the percentage of complete ED increases from 5% to 15% as age increases from 40 to 70 years. But this does not mean growing older is the end of your sex life. ED can be treated at any age.

 3- Diabetes mellitus.

4-cardiovascular diseases and atherosclerosis (blockage of arteries).

5-kidney disease.

6-multiple sclerosis.

7-Drugs anti-depressants and nicotine are most common.

8-pelvic surgeries and radiotherapy.

9-Lifestyle: smoking is a key cause of erectile dysfunction, prolonged bicycling increase erectile dysfunction by almost 2 folds. Being Overweight and less exercise. Drugs and alcohol use as well.

 Tests and diagnosis ?

 As a start your physician will take a full history and do physical exam, the most important part is examining the testes and penis.

Penile nerves function is a physical test might be done, also called bulbocavernosus reflex where the physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal.

It is important to note that not everyone need to do all the following tests, usually the physician will choose the appropriate tests for each patient.

Measuring testosterone levels can determine whether there is a hormonal imbalance, which is often linked to decreased desire. Blood cell counts, cholesterol levels, and liver function tests can reveal medical conditions that may account for ED.

Cardiovascular assessment is usually vital to assess for vascular disease.

 Other specific tests would include:

Duplex ultrasound, it is a device that will let your doctor see the blood flow to your penis and make sure it is fine.

Nocturnal penile tumescence (NPT) usually men have 4-8 erections during sleep, and a device is used to measure the rigidity and circumference during sleep erection.consistent of two rings connected to a device. If absent it usually indicate a physical problem and rule out psychological cause. see photo below.


Corpus cavernosometry (cavernosography) Saline is infused under pressure into the penis with a needle. If there is a leak there will be a need for continuous injection of saline .The leaking veins responsible may be visualised by infusing a mixture of saline and x ray contrast medium and performing a cavernosogram.


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