As it was mentioned in the previous episode, the causes of impotency are due to some diseases and use of some medicines and many other socio psychological factors, the management of impotency will be discussed in this issue. Erectile dysfunction is a common disease of the male reproductive system, which seriously affects the life quality of patients and their partners. At present, erectile dysfunction is considered as a social-psychological-physiological disease with complex etiology. Of late major research is going on in this field and various treatment methods. Use of oral PDE5I (stands for Phosphodiesterase type 5 inhibitor), etc., are emerging.
Causes for impotency
There are many different causes, which may include conditions that affect blood vessels, neurological conditions, mental health conditions, and injuries. A sexual health specialist can diagnose and treat erectile dysfunction. The types of erectile dysfunction are vascular erectile dysfunction, neurogenic erectile dysfunction Hormonal erectile dysfunction and psychogenic erectile dysfunction etc., Vascular ED includes causes that affect the blood vessels that send blood to the tissues in the penis that allow to get and maintain an erection, or the valves in the penis that normally hold blood inside. Vascular ED is the most common type of ED.
Neurogenic erectile dysfunction, occurs as a result of nerve problems, which prevent signals gesture of touch by the opposite partner traveling from the brain to penis to create an erection. This can happen because of trauma, pelvic surgery, radiation therapy or neurologic conditions like stroke, spinal stenosis, and multiple sclerosis.
Hormonal ED refers to ED that happens as a result of testosterone deficiency or in some cases as a result of thyroid issues. Psychogenic erectile dysfunction involves psychological conditions that affect thoughts, feelings or behaviour that can cause ED.
Certain conditions or diseases
Diabetes and diabetes-related neuropathy have been identified as one of the leading causes of impotency in modern times. High blood pressure, high cholestero hyperlipidemia, vascular disease, chronic kidney disease, atherosclerosis, pevronie’s disease is a condition characterized by the build-up of scar tissue fibrosis in the sheath of tissue surrounding the penis’s erectile chambers, leading to penile curvature, pain, and potentially erectile dysfunction. Testosterone deficiency, stroke, epilepsy, injuries trauma to penis and surrounding areas can also cause ED. They include penile fracture, injuries to the pelvis bones, hip bones, sacrum and tailbone, bladder, prostate, and spinal cord. Pelvic surgery, including prostate, colon or bladder cancer surgery and radiation therapy also contribute to a greater extent for erectile dysfunction.
Certain medications
ED is a common side effect of many prescription drugs. Common medications that list ED as a potential side effect include antidepressants, anti-anxiety medications, anxiolytics, blood pressure medication, diuretics, antihistamines, chemotherapy drugs, medicines used for Parkinson’s diseases, prostate cancer drugs, antiarrhythmic, sedatives, muscle relaxers, ant seizure (fits).
Other substances
Substances that have addiction potential may cause ED, including alcohol, amphetamines, barbiturates, cocaine, marijuana, methadone, nicotine, and opioids. These substances can affect and suppress the central nervous system and damage the complexity of the nerves. They can also cause severe damage to blood vessels, which may lead to permanent erectile dysfunction.
Psychological and emotional conditions, depression, anxiety, stress, fear of sexual intercourse or intimacy, and genophobia, which is also known as coitophobia, is the intense and irrational fear of sexual intercourse or sexual intimacy, which can lead to significant anxiety and avoidance behaviours, low self-esteem.
Management
The first step in treating erectile dysfunction is identifying the underlying cause. A sexual health expert will help determine the best treatment. Unfortunately, post-graduation in sexual health medicine is rarely available in the medical colleges. Therefore, several self-styled sex specialists are mounting like mushrooms in every corner of the country, advertising by themselves over television, social media, and even big screen boards in Railway Stations, RTC complexes, etc., and cheating the pathetic public by charging thousands of rupees. Sadly, the Ministry of Health and Family Welfare is not bothered about this daylight fraud.
Treatment options may include exercise for at least 45 minutes three times per week or daily exercise may help reverse some cases of mild ED. Cardiovascular exercises may include brisk walking, jogging, swimming, bicycling, and jumping rope, which are suitable for the age of the individual. Advice can be obtained from a qualified sports medicine specialist or cardiologist.
For men with mild ED, quitting smoking can lead to improvement after several months. Discussing with a sex therapist, Oral medications that help increase blood flow to penis, including sildenafil (Viagra), vardenafil, (levira), tadalafil, (Cialis) or avanafil stendra etc., which should be used after consulting a qualified physician or urologist and excluding the impending side effects and complications of this oral medications which start to work within an hour after administration. People using nitrates and having a serious heart or liver problem, recent stroke, heart attack or a heart problem, or a rare inherited eye disease, such as retinitis pigmentosa, have to strictly follow the guidelines and advice of the specialists. Testosterone replacement therapy, which is available as a gel, injection, and patches, starts to work within four weeks.
Intracavernosal injection, hormonal replacement therapy, vacuum erection device, and penile prosthesis implantation can also be alternative treatments for patients who have organic erectile dysfunction. It is a surgical procedure where a device, or prosthesis, is implanted to restore erectile function in men who have erectile dysfunction (ED) and are unresponsive to other treatments, such as medication or vacuum devices. Otherwise, a penile implant is a procedure in which a surgeon places a device into penis to make it hard. The device doesn’t affect sensation, peeing or orgasm.
With the rapid development of technologies, some new methods, such as low-intensity extracorporeal shock wave and stem cell injection therapy, can even repair the organic damage of the corpora cavernosa. These are important directions for the treatment of male erectile dysfunction in the future. This non-invasive, penile low-intensity, focused shockwave therapy treatment improves blood flow by using sound waves. It can take two months to see improvement. Multiple medications that are injected directly into the penis to create an erection, including alprostadil, papaverin, phentolamine or a combination of Injectable medications start to work within 10 minutes. Vacuum constriction device so called penis pumps start to work almost immediately.
