A New Treatment for Erectile Dysfunction: No Pills, Injections or Surgery!

In studies evaluating more than 6000 men, the risk of developing ED increased by a factor of 1.5. Sexual dysfunction is highly prevalent in men and women. In the MMAS, 52% of the respondents reported some degree of erectile difficulty. Complete ED, defined as (1) the total inability to obtain or maintain an erection during sexual stimulation and (2) the absence of nocturnal erections, occurred in 10% of the respondents.

Counseling for Erectile Dysfunction

Vascular diseases account for nearly 50% of all cases of ED in men older than 50 years. These diseases include atherosclerosis, peripheral vascular disease, myocardial infarction (MI), and arterial hypertension. Vascular damage may result from radiation therapy to the pelvis and prostate in the treatment of prostate cancer. [39] Both the blood vessels and the nerves to the penis may be affected. Radiation damage to the crura of the penis, which are highly susceptible to radiation damage, can induce ED.

Signs and symptoms

Data indicate that 50% of men undergoing radiation therapy lose erectile function within 5 years after completing therapy; fortunately, some respond to one of the PDE5 inhibitors. Trauma to the pelvic blood vessels or nerves can also lead result in ED. Bicycle riding for long periods has been implicated as an etiologic factor; direct compression of the perineum by the bicycle seat may cause vascular and nerve injury. [40] On the other hand, bicycling for less than 3 hours per week may be somewhat protective against ED. [40] Some of the newer bicycle seats have been designed to diminish pressure on the perineum.

Lifestyle modifications

Diabetes is a well-recognized risk factor for ED. A systematic review and meta-analysis found that the prevalence of ED was 37.5% in type 1 diabetes, 66.3% in type 2 diabetes, and 52.5% in diabetes overall—a rate approximately 3.5 times higher than that in controls. [42] The etiology of ED in diabetic men probably involves both vascular and neurogenic mechanisms. Evidence indicates that establishing good glycemic control can minimize this risk. The Massachusetts Male Aging Study (MMAS) documented an inverse correlation between ED risk and high-density lipoprotein (HDL) cholesterol levels but did not identify any effect from elevated total cholesterol levels. Mild and moderate ED occurred in 17% and 25% of responders, respectively. Although the rate of mild ED in the MMAS remained constant (17%) in men aged 40-70 years, the number of men reporting moderate ED doubled (17-34%) and the number of men reporting complete ED tripled (5-15%).

If the MMAS data are extrapolated to the US population, an estimated 18-30 million men are affected by ED. In the National Health and Social Life Survey (NHSLS), a nationally representative probability sample of men and women aged 18-59 years, 10.4% of men reported being unable to achieve or maintain an erection during the past year.

[54] There is a striking correlation with the proportion of men in the MMAS who reported complete ED. Studies conducted around the world report similar risk factors and similar prevalence rates for ED.

Erectile dysfunction may be caused by the following conditions:

Exercise and lifestyle modifications may improve erectile function. Weight loss may help by decreasing inflammation, increasing testosterone, and improving self-esteem. Patients should be educated to increase activity, reduce weight, and stop smoking, as these efforts can improve or restore erectile function in men without comorbidities. Precise glycemic control in diabetic patients and pharmacologic treatment of hypertension may be important in preventing or reducing sexual dysfunction. Cigarette smoking has been shown to be an independent risk factor. All studies demonstrate a strong association with age, even when data are adjusted for the confounding effects of other risk factors.

Risk Factors for Erectile Dysfunction

Persistent posttreatment ED is a listed adverse effect of the 5-alpha reductase inhibitors finasteride and dutasteride and of alpha blockers. However, a review of a United Kingdom medical record database found no evidence that the use of 5-alpha reductase inhibitors independently increase the risk for ED. In 71,849 men with benign prostatic hyperplasia (BPH), the risk of ED was not increased with the use of finasteride or dutasteride only (odds ratio [OR] 0.94), or a 5-alpha reductase inhibitor plus an alpha blocker (OR 0.92) compared with an alpha blocker only. In addition, the risk of ED was not increase in 12 346 men prescribed finasteride 1 mg for alopecia, compared with unexposed women libido pills men with alopecia (OR 0.95). The risk of ED did increase with longer duration of BPH, regardless of drug exposure. The independent association with aging suggests that vascular changes in the arteries and sinusoids of the corpora cavernosa, similar to those found elsewhere in the body, are contributing factors. Other risk factors associated with aging include depression, sleep apnea, and low HDL levels.

Alternative medicine

[17] Another study involving male subjects aged 45-54 years found a correlation with abnormal HDL cholesterol levels but also found a correlation with elevated total cholesterol levels. The MMAS included a preponderance of older men. Men with sleep disorders commonly experience ED. [43] Heruti et al recommended that in adult male patients, ED should be considered when a sleep disorder—especially sleep apnea syndrome—is suspected, and vice versa. Hypogonadism that results in low testosterone levels adversely affects libido and erectile function.

3.1 Basic parameters of penile erection

Hypothyroidism is a very rare cause of ED. Peyronie disease may result in fibrosis and curvature of the penis. Men with severe Peyronie disease may have enough scar tissue in the corpora to impede blood flow. Mental health disorders, particularly depression, are likely to affect sexual performance. The MMAS data indicate an odds ratio of 1.82 for men with depression.

Figure 3.

Other associated factors, both cognitive and behavioral, may contribute. In addition, ED alone can induce depression. Cosgrove et al reported a higher rate of sexual tadalista 2 5 dysfunction in veterans with posttraumatic stress disorder (PTSD) than in veterans who did not develop this problem. [45] The domains on the International Index of Erectile Function (IIEF) questionnaire that demonstrated the most change included overall sexual satisfaction and erectile function. [46, 47] Men with PTSD should be evaluated and treated if they have sexual dysfunction. Long-term predictions based on an aging population and an increase in risk factors (eg, hypertension, diabetes, vascular disease, pelvic and prostate surgery, benign prostatic hyperplasia, and lower urinary tract symptoms) suggest a large increase in the number of men with ED. In addition, the prevalence of ED is underestimated because physicians frequently do not question their patients about this disorder. In a prospective population-based study of 1709 men aged 40-70 years, Araujo et al found that ED was significantly associated with increased all-cause mortality.

• Oral medications like sildenafil, tadalafil, and vardenafil are common treatments for erectile dysfunction.
• Lifestyle changes such as exercise, weight loss, and quitting smoking can improve erectile function.
• Psychotherapy may help address psychological causes like anxiety, depression, or relationship issues.
• Vacuum erection devices use suction to draw blood into the penis, helping achieve an erection.
• Penile injections involve injecting vasodilators directly into the penis for an immediate effect.
• Hormone therapy may be prescribed if low testosterone levels are contributing to ED.
• Surgical options include penile implants or vascular surgery to restore blood flow.

[57] The increase primarily resulted from cardiovascular mortality. In a prospective study from the Prostate Cancer Prevention Trial database, Thompson et al reported that men presenting with ED had a significantly higher chance of developing a cardiovascular event over a 7-year follow-up period. [58] The hazard ratio was 1.45, which is in the range of risk associated with current smoking or a family history of MI. An analysis of 14 studies involving more than 90,000 patients with ED confirmed the relation between ED and an increased risk of cardiovascular events and mortality. [59] Compared with patients without ED, those with ED had a 44% increased risk of cardiovascular events, a 25% increased risk of all-cause mortality, a 62% increased risk of MI, and a 39% increased risk of cerebrovascular events.

5. Injectable or intraurethral medications

Prostate surgery for benign prostatic hyperplasia has been documented to be associated with ED in 10-20% of men. This association is thought to be related to nerve damage from cauterization. Newer procedures (eg, microwave, laser, or radiofrequency ablation) have rarely been associated with ED. Radical prostatectomy for the treatment of prostate cancer poses a significant risk of ED. A number of factors are associated with the chance of preserving erectile function.

Does hair loss treatment cause erectile dysfunction?

If both nerves that course on the lateral edges of the prostate can be saved, the chance of maintaining erectile function is reasonable. The odds depend on the age of the patient. Men younger than 60 years have a 75-80% chance of preserving potency, but men older than 70 years have only a 10-15% chance. The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) study, designed to determine whether an individual man’s sexual outcomes after most common treatments for early-stage prostate cancer could be accurately predicted on the basis of baseline characteristics and treatment plans, found that 2 years after treatment, 177 (35%) of 511 men who underwent prostatectomy reported the ability to attain functional erections suitable for intercourse. In comparison, 37% of men who had received external radiotherapy as their primary therapy reported the ability to attain functional erections suitable for intercourse, along with 43% of men who had received brachytherapy as primary treatment.

3.8 Discussion

Pretreatment sexual health-related quality of life score, age, serum prostate-specific antigen (PSA) level, race or ethnicity, body mass index, and intended treatment details were associated with functional erections 2 years after treatment. After surgery, one of the oral PDE5 inhibitors (sildenafil, vardenafil, or tadalafil) is frequently used to assist in the recovery of erectile function. The benefit of penile rehabilitation therapy is under investigation, but results have been mixed. ED is an adverse effect of many commonly prescribed medications. For example, some psychotropic drugs and antihypertensive agents are associated with ED. Treatment of ED, either through lifestyle interventions or by pharmacologic means, may improve prognosis and reduce risk.

• PDE5 inhibitors are effective but may cause side effects like headaches and flushing.
• Smoking cessation improves blood vessel health, enhancing erectile function.
• Weight management helps reduce the risk factors associated with ED.
• Pelvic floor exercises can strengthen muscles involved in erection and urination.
• Counseling may help men with ED related to psychological or emotional issues.
• Hormonal treatments are suitable for those with hormonal imbalances.
• Surgical interventions are typically reserved for cases unresponsive to other treatments.

Associated morbidity may include various other male sexual dysfunctions, such as premature (early) ejaculation and male hypoactive sexual desire disorder.