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How To Treat Erectile Dysfunction? Complications and Diagnosis

With inputs from Dr. Natesh Prabhu

Updated on: December 2023

With inputs from Dr. Natesh Prabhu

Updated on: December 2023

Reviewed by Dr Raja Indana

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Table of contents

Erectile dysfunction

Is there a shame in getting treatment for a problem?

Addressing intimate health issues can be an uphill battle in a society where certain topics remain shrouded in secrecy and embarrassment. However, the 2017 Bollywood comedy-drama film “Shubh Mangal Saavdhan” took on this formidable challenge with wit, charm, and a dash of humor.

The movie fearlessly explores the sensitive topic of erectile dysfunction, shedding light on its impact on individuals and relationships. Through the lens of Mudit, portrayed by Ayushmann Khurrana, and his fiancée Sugandha, played by Bhumi Pednekar, this cinematic gem unraveled the layers of shame and social stigma surrounding this condition in Indian society. In doing so, it not only provided entertainment but also ignited a vital conversation about a topic that had long been relegated to the shadows — Erectile dysfunction. Is there a cure for it?

Unveiling the Stats: A Closer Look at the Prevalence of Erectile Dysfunction in India

Imagine a silent epidemic that affects millions of men across India. It’s a topic often whispered about but rarely openly addressed.

But here’s why it is so important to talk about this problem.

India is called the Impotence Capital of the World (Dr. Sudhakar Krishnamurti, 2022)*:

Impotence affects over 50% of males above 40, and leading contributing factors are heart disease, hypertension, excessive smoking, and drinking.
Recently, India has also seen a significant increase in heart diseases, and this has been reflected in the rise of impotence levels as well.
1 in every 10 Indian men is impotent, and this number could be even higher in metropolitan areas.
Approximately 25 out of every 100 patients with Erectile Dysfunction (ED) are below 30 years old.
This is a significant increase from only 5 to 7 patients a decade ago.
An internal survey on the prevalence of ED in young men revealed that out of 400 men who reported either the inability to get or sustain an erection, 100 were in their 20s.

From the impact on relationships to the mental health implications, erectile dysfunction can have far-reaching consequences.

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Chapter 1: What is Erectile Dysfunction?

Erectile dysfunction (ED) is a medical condition characterized by a consistent inability to achieve or maintain an erection that is firm enough for sexual intercourse.

ED can occur at any age, but the likelihood of experiencing it increases with age. It is more commonly observed among men over the age of 40.

Read: Erectile dysfunction in younger men.

Chapter 2: Why does it occur?

In order to understand why it happens, we need to know how an erection occurs in the first place.

The shaft of your penis, in its corpus cavernosum, consists of numerous vascular channels in the form of sinusoids. These are lined by vascular smooth muscles on the outside and by endothelial cells on the inside. They both are extremely responsible to signals from brain, sex hormones and local factors including nitric oxide. During the phase of sexual arousal the symphony between neuro-hormonal-vascular interplay fills the corpora cavernosum with blood and prevents its outflow too, making your penis hard and giving you an erection.

But there are times when certain medical or psychological conditions can interfere with the way the blood flows or the nerves work in your penis. When this happens, it can cause ED.

Chapter 3: So, what are these conditions?

Conditions that affect the blood flow or interrupt the working of nerves in your penis include:

(1) Certain medical conditions or diseases:

(a) Diabetes and Diabetes-Related Neuropathy:

Diabetes can damage blood vessels and nerves that play a crucial role in achieving and maintaining an erection.
Neuropathy, a common complication of diabetes, can impair the transmission of signals between the brain and penis, hindering erectile function.

(b) High Blood Pressure (Hypertension):

High blood pressure can lead to reduced blood flow to the penile arteries, making it difficult to achieve and sustain an erection.
The increased strain on blood vessel walls can cause damage over time, affecting the ability to attain an erection.

(c) High Cholesterol (Hyperlipidemia):

Elevated cholesterol levels can lead to plaque buildup in blood vessels, narrowing the arteries responsible for penile blood flow.
Reduced blood flow due to atherosclerosis can interfere with the ability to achieve and maintain an erection.

(d) Vascular Disease:

Vascular diseases, such as peripheral artery disease, can impair blood circulation throughout the body, including the penis, making it challenging to achieve and maintain an erection.
Narrowed or blocked blood vessels reduce the amount of blood that reaches the penis during arousal.

(e) Chronic Kidney Disease:

Chronic kidney disease can disrupt hormonal balance and cause imbalances in minerals and electrolytes, contributing to erectile dysfunction.
Reduced kidney function can lead to systemic changes that affect sexual health and erectile function.

(f) Arterioscelrosis:

This is a condition where the arterial compliance gets lost and this further leads to failure to augment the blood flow to the penis during the sexual performance.
Narrowed arteries due to arterioscelrosis reduce the availability of oxygen and nutrients needed for healthy erectile function.

(g) Peyronie’s Disease:

Peyronie’s disease involves the development of scar tissue within the penis, causing curvature and pain during erections.
The presence of scar tissue can interfere with the ability to achieve a straight and rigid erection.

(h) Low Testosterone (Testosterone Deficiency):

Low testosterone levels can lead to a decreased sex drive and difficulty in achieving and maintaining an erection.
Testosterone plays a crucial role in regulating sexual function, and inadequate levels can affect erectile performance.

(i) Stroke:

Strokes can damage the brain’s centers responsible for sexual arousal and the transmission of signals to the genitals.
Neurological impairment resulting from a stroke may disrupt the coordination necessary for achieving and sustaining an erection.

(j) Epilepsy:

Epilepsy itself is not a direct cause of erectile dysfunction, but some anti-epileptic medications may have side effects that affect sexual function.
Medications used to manage epilepsy can lead to sexual side effects, potentially impacting a person’s ability to achieve or maintain an erection.

(2) Psychological causes

(a) Stress and Anxiety:

Excessive stress and anxiety can lead to the release of stress hormones like cortisol, which constrict blood vessels and reduce blood flow to the penis, impairing the ability to achieve and maintain an erection.
Mental tension can also create performance anxiety, further hindering sexual function by causing worry and negative self-perception.

(b) Depression:

Depression can affect the brain’s neurotransmitters, leading to reduced libido and difficulty in experiencing sexual desire or arousal.
Feelings of hopelessness and low energy associated with depression can diminish motivation for sexual activity and lead to erectile problems.

(c) Relationship Problems:

Relationship conflicts and unresolved issues can lead to emotional distress and reduce intimacy and trust between partners.
This emotional strain can manifest as decreased sexual interest and difficulties in achieving or maintaining an erection, as emotional connection is often integral to healthy sexual function.

(d) Psychological Trauma:

Past psychological trauma, such as sexual abuse or traumatic experiences, can create emotional and mental barriers that interfere with sexual desire and functioning.
Trauma-related conditions like post-traumatic stress disorder (PTSD) may cause intrusive thoughts or flashbacks during sexual activity, impacting one’s ability to engage in a satisfying sexual experience.

(3) Injuries (trauma) to your penis and surrounding areas can also cause ED. They include:

(a) Penile Fracture:

A penile fracture occurs when the fibrous covering of the penis, called the tunica albuginea, tears due to trauma or an accident.
This tear can lead to immediate loss of erection, pain, and potential scarring, making it difficult to achieve or maintain erections in the future.

(b) Injuries to Pelvis Bones, Bladder, Prostate, and Spinal Cord:

Injuries to the pelvic bones, bladder, prostate, or spinal cord can disrupt the complex network of nerves and blood vessels that control and support erections.
Damage to these structures can interfere with the neurological and vascular processes required for a normal erectile response.

(c) Pelvic Surgery (Prostate, Colon, or Bladder Cancer Surgery):

Surgical procedures involving the prostate, colon, or bladder can inadvertently damage nerves and blood vessels responsible for erectile function.
Surgeons may take precautions to spare these structures, but there’s still a risk of impaired blood flow or nerve damage, leading to erectile dysfunction.

(d) Radiation Therapy:

Radiation therapy, often used to treat prostate or bladder cancer, can cause collateral damage to nearby blood vessels and nerves essential for erectile function.
Over time, radiation-induced fibrosis and scarring can hinder blood flow and nerve signaling, making it challenging to achieve or maintain an erection.

(4) Certain medications:

Erectile dysfunction is a common side effect of many prescription drugs. Common medications that list ED as a potential side effect include:

(a) Antidepressants:

Some antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), can lead to erectile dysfunction by affecting the balance of neurotransmitters in the brain, reducing sexual desire and impairing the ability to achieve or sustain an erection.
These medications may disrupt the normal sexual response by delaying ejaculation and interfering with the process of sexual arousal.

(b) Anti-anxiety Medications (Anxiolytics):

Anti-anxiety medications, such as benzodiazepines, can potentially contribute to erectile dysfunction by depressing the central nervous system, which may lead to decreased sexual arousal and difficulty in achieving and maintaining an erection.
These drugs may also cause drowsiness and sedation, affecting overall sexual performance.

(c) Blood Pressure Medications:

Certain blood pressure medications, such as beta-blockers and alpha blockers, can interfere with the relaxation of blood vessels, reducing blood flow to the penis and making it challenging to achieve and sustain an erection.
These drugs may also lower heart rate, potentially affecting sexual stamina and performance.

(d) Diuretics:

Diuretics, commonly known as water pills, can lead to erectile dysfunction by causing dehydration and electrolyte imbalances, which may disrupt overall physiological function.
Dehydration can reduce blood volume and affect blood pressure, potentially impacting the ability to achieve and maintain an erection.

(e) Antihistamines:

Antihistamines, often used to treat allergies, can cause erectile dysfunction as a side effect by interfering with nerve signaling and reducing sexual desire.
These medications may lead to drowsiness and reduced mental alertness, impacting sexual performance.

(f) Chemotherapy Drugs:

Chemotherapy drugs can have numerous side effects, including fatigue, nausea, and hormonal imbalances, which can contribute to erectile dysfunction.
These medications may disrupt the normal production of hormones and affect sexual desire and performance.

(g) Parkinson’s Disease Drugs:

Medications used to manage Parkinson’s disease can impact dopamine levels in the brain, potentially leading to sexual dysfunction.
Dopamine is a key neurotransmitter involved in sexual arousal, and alterations in its levels can affect erectile function.

(h) Prostate Cancer Drugs:

Drugs used in the treatment of prostate cancer, such as androgen deprivation therapy (ADT), can drastically reduce testosterone levels, leading to erectile dysfunction and decreased sexual desire.
Low testosterone is a common side effect of these medications and can have a profound impact on sexual function.

(i) Antiarrhythmics:

Antiarrhythmic medications may affect the electrical signaling in the heart, potentially leading to decreased blood flow to the penis and difficulty achieving or maintaining an erection.
These drugs can also cause fatigue and reduced physical stamina, impacting sexual performance.

(j) Sedatives:

Sedative medications, like benzodiazepines and barbiturates, can cause erectile dysfunction by depressing the central nervous system and reducing overall sexual desire and arousal.
These drugs can induce drowsiness and impair sexual performance and stamina.

(k) Muscle Relaxers:

Muscle relaxers can lead to erectile dysfunction due to their sedative effects on the central nervous system, which may reduce sexual arousal and interfere with the ability to achieve and maintain an erection.
These medications can cause drowsiness and impaired coordination, impacting sexual performance.

(l) Antiseizure Medications:

Some antiseizure medications can affect sexual function by altering neurotransmitter levels in the brain, potentially reducing sexual desire and impairing the ability to achieve or sustain an erection.
These drugs may also cause drowsiness and fatigue, affecting overall sexual performance.

(5) Other substances

Substances that have addiction potential may cause ED, including:

(a) Alcohol:

Excessive alcohol consumption can lead to nerve damage and hormone imbalances, affecting the ability to achieve and maintain an erection.
Alcohol is a depressant that can reduce sexual desire and impair the central nervous system, leading to temporary or chronic erectile dysfunction.

(b) Amphetamines:

Amphetamines can constrict blood vessels and increase blood pressure, potentially reducing blood flow to the penis, making it difficult to achieve an erection.
Prolonged amphetamine use may disrupt the body’s natural arousal response, contributing to erectile problems.

(c) Barbiturates:

Barbiturates, as central nervous system depressants, can slow down neurological processes involved in sexual arousal and response.
Chronic use of barbiturates may lead to reduced libido and difficulties in achieving and maintaining erections.

(d) Cocaine:

Cocaine is a powerful vasoconstrictor, narrowing blood vessels and reducing blood flow to the penis, often resulting in erectile difficulties.
Cocaine abuse can also lead to psychological factors like anxiety and performance-related stress, further exacerbating erectile dysfunction.

(e) Marijuana:

Marijuana can affect both physical and psychological aspects of sexual function, potentially causing temporary erectile issues.
While some individuals may experience increased sexual desire with marijuana use, others may encounter difficulties in achieving or sustaining an erection.

(f) Methadone:

Methadone, an opioid used for opioid addiction treatment, can disrupt hormonal balance and reduce testosterone levels, leading to erectile problems.
Opioid medications, including methadone, may also cause side effects such as reduced libido and delayed orgasm.

(g) Nicotine:

Nicotine, found in tobacco products, can constrict blood vessels, reduce blood flow, and impair the responsiveness of erectile tissues.
Smoking is associated with an increased risk of long-term erectile dysfunction due to the cumulative effects of vascular damage.

(h) Opioids:

Opioids can reduce sexual desire, interfere with hormone production, and affect the body’s natural pain response system, all of which can contribute to erectile dysfunction.
Opioid misuse or dependence can lead to chronic sexual issues, making it challenging to achieve or maintain an erection.

Chapter 4: Symptoms of Erectile Dysfunction

The primary symptom of ED is the consistent inability to achieve or maintain an erection sufficient for sexual activity. Other related symptoms may include:

Reduced sexual desire (low libido).
Difficulty getting an erection even with sexual stimulation.
Difficulty maintaining an erection during sexual intercourse.
Premature ejaculation or delayed ejaculation.

It is important to note that occasional difficulty in achieving or maintaining an erection may not necessarily indicate ED.

However, if this problem persists, it might be a sign of ED. If you experience any of these symptoms, it is important to speak with a healthcare professional. There are many effective treatments available to manage ED, and your healthcare provider can help you determine the best course of action.

Chapter 5: Diagnosis and Tests

Diagnosing ED involves a thorough assessment of your medical history, a physical examination, and sometimes specialized tests.

Physical Exams:

During a physical examination, a healthcare provider may check for physical abnormalities, such as:
- Abnormalities in the penis curvature, phimosis, and hypospadiasis.
- Nerve problems in the genital area by performing sensory tests to ensure that there are no nerve problems present.
- Signs of Androgenization: Assessing the development of secondary Sexual Characters

Lab Tests

To assess your overall health and identify underlying conditions, your doctor may recommend the following lab blood tests:
- Lipid panel.
- Kidney function tests.
- Thyroid tests.
- Complete blood count (CBC)
- Liver function tests.
- Testosterone test
- Vit D, Vit B12, Homocysteine
- Fasting Insulin levels
- FBS, HbA1c

Chapter 6: Risk Factors

Several factors can increase the risk of developing erectile dysfunction. These include:

Age: The likelihood of ED increases with age, but it can affect men of all ages.
Chronic Health Conditions: Conditions like diabetes, heart disease, and obesity raise the risk of ED.
Medications: Certain medications have ED as a side effect.
Smoking and Alcohol: These can contribute to vascular problems and increase the risk of ED.
Psychological Factors: Stress, anxiety, and depression can lead to ED.

Lifestyle Factors: Lack of exercise and an unhealthy diet can contribute to obesity and related ED risk.

Chapter 7: Complications

Erectile dysfunction can have a significant impact on a man’s life. It can lead to several complications, including:

Relationship Strain: ED can strain relationships and lead to emotional distress for both partners.
Low Self-esteem: Men with ED may experience decreased self-confidence and self-worth.
Depression and Anxiety: The psychological impact of ED can lead to or exacerbate mood disorders.
Reduced Quality of Life: ED can affect overall well-being, making it essential to seek treatment.

Chapter 8: Treatment: How Do You Fix Erectile Dysfunction?

There is good news for those who suffer from ED – it’s a treatable condition. In most cases, ED is caused by an underlying medical issue such as diabetes, hypertension, or even psychological factors. By addressing and treating these underlying conditions, it’s possible to cure ED.

Having said that, here are some of the most common treatment options:

Oral Drugs (PDE5 Inhibitors)

Sildenafil: A well-known medication that increases blood flow to the penis.
Tadalafil: Known for its longer-lasting effects, it allows for spontaneity in sexual activity.
Vardenafil and Avanafil: Similar to sildenafil and tadalafil, they also improve blood flow.

Testosterone Therapy

For men with low testosterone levels contributing to ED, hormone replacement therapy may be recommended.

Vacuum Erection Device

A vacuum erection device (VED) is a non-invasive device that creates a vacuum around the penis to draw blood into the area and facilitate an erection.

Intracavernosal (ICI) and Urethral (IU) Therapies

These therapies involve the injection or insertion of medications into the penis to promote an erection.

Self-Injection Therapy: Patients self-administer medication into the penis with a small needle.
Intraurethral (IU) Therapy: Medication is inserted into the urethra using a special applicator.
Regenerative or Restorative Therapies
PRP Injection
Penile ShockWave Therapy

Surgical Treatment

In cases where other treatments are ineffective, surgical options may be considered:

Semi-Rigid Implant (Bendable): A permanent but semi-rigid implant is placed in the penis, allowing for manual positioning.
Inflatable Implant: A more advanced option, it involves a fluid-filled implant that can be inflated for an erection.

Penile Implant: A fully implanted device that provides on-demand erections.

Chapter 9: What is Surgery Like?

Surgical procedures are typically performed under anesthesia and involve the placement of the chosen implant. Recovery times vary, but most men can resume sexual activity after a few weeks.

Chapter 10: Can ED Go Away Naturally?

In some cases, ED may resolve naturally, especially if the underlying cause is temporary. Lifestyle changes, such as improving diet, exercise, and managing stress, can also help improve erectile function.

Chapter 11: After Treatment

After undergoing treatment for ED, it’s important to be aware of a few key points:

Expectations: Treatment outcomes can vary, and it may take time to find the most effective approach for you.
Regular Follow-ups: Stay in touch with your healthcare provider to monitor progress and make any necessary adjustments to your treatment plan.
Healthy Lifestyle: Continue to prioritize a healthy lifestyle, as this can have a significant impact on long-term sexual function.

Chapter 12: What to Expect if I Have Erectile Dysfunction?

Dealing with ED can be challenging, but with the right approach, it is manageable. Here’s what you can expect:

Positive Outcomes: Many men respond well to treatment and experience improved sexual function.
Open Communication: It’s crucial to discuss your concerns with your partner and healthcare provider for better support and tailored treatment.

Patience: Finding the right treatment may take time, but don’t lose hope. Keep working with your healthcare team to address the issue.

Chapter 13: When to See a Doctor?

If you suspect you have ED or are experiencing symptoms, it’s advisable to see a doctor promptly. Early diagnosis and intervention can lead to more effective treatment outcomes.

Chapter 14: What Questions to Ask a Doctor?

Preparing questions for your doctor can help ensure you get the information you need. Here are some essential questions to consider:

What is the likely cause of my ED, and do I need any additional tests?
What treatment options are available, and which one would you recommend for me?
Are there any lifestyle changes I should make to improve my condition?
What are the potential side effects of the recommended treatment?
How long will it take to see results from treatment?
Should I involve my partner in the treatment process?
What is the long-term outlook for my sexual health?

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References

Is it normal for a 20-year-old to have erectile dysfunction?

It is relatively uncommon for a healthy 20-year-old to experience erectile dysfunction (ED). In India, as in many other countries, the prevalence of ED increases with age. However, ED can occur at any age due to various factors, such as underlying medical conditions, psychological stress, or lifestyle choices. If a 20-year-old is experiencing persistent ED, it’s essential to consult a healthcare professional to identify the underlying cause and explore appropriate treatments.

Can erectile dysfunction recover itself?

In some cases, especially if the cause of ED is temporary, it may resolve on its own without treatment. For example, if ED is due to stress or anxiety, it might improve once the underlying psychological factors are addressed. However, chronic or recurring ED is less likely to recover spontaneously and often requires intervention.

Is it safe to take Viagra in India?

Viagra (sildenafil) is a medication commonly used to treat ED. When taken as prescribed by a healthcare professional, it is generally safe for most men, including those in India. However, it is essential to consult a doctor before using Viagra, as it may not be suitable for individuals with specific medical conditions or those taking certain medications. Always follow your doctor’s recommendations regarding dosage and usage.

How long does Viagra last?

The duration of Viagra’s effects can vary from person to person, but it typically lasts for about 4 to 6 hours. It’s important to note that the medication does not induce an erection on its own; sexual stimulation is necessary for it to work.

Does smoking cause erectile dysfunction?

Yes, smoking is a well-established risk factor for erectile dysfunction. Smoking damages blood vessels and reduces blood flow, which can impair the ability to achieve and maintain an erection. Quitting smoking can improve vascular health and, in turn, may help alleviate ED.

Can porn induce erectile dysfunction?

Excessive or compulsive consumption of pornography may contribute to sexual difficulties, including ED, in some individuals. This phenomenon is sometimes referred to as “porn-induced erectile dysfunction.” It is thought to result from desensitization to sexual stimuli, leading to difficulties in real-life sexual encounters. Reducing or eliminating pornography consumption may help improve sexual function for some individuals. Read more here.

Can belly fat cause erectile dysfunction?

Yes, excess belly fat, often associated with obesity, can increase the risk of erectile dysfunction. Belly fat is linked to various health conditions, including cardiovascular disease and diabetes, which can impair blood flow and nerve function, both of which are crucial for achieving and maintaining an erection. Maintaining a healthy weight through diet and exercise can help reduce this risk.

Can erectile dysfunction be cured?

Erectile dysfunction can often be effectively treated and managed, depending on the underlying cause. Treatments can include lifestyle changes, medications like Sildenafil , hormone therapy, psychological counseling, regenerative therapies or even surgical options. Many men experience significant improvement or resolution of their ED with the right approach and guidance from healthcare professionals.

How many erections do men experience per day?

On average, men experience multiple erections during the day and night. These are often related to different stages of sleep and occur involuntarily. However, the number of erections can vary widely between individuals, and the frequency may decrease with age.

Can a man take Viagra every day?

Viagra should be taken as prescribed by a healthcare provider. It is typically not recommended for daily use unless specifically advised by a doctor. In cases where daily use is appropriate, a lower dosage may be prescribed to minimize the risk of side effects.

Can Viagra permanently fix ED?

Viagra and similar medications provide temporary relief from ED symptoms by enhancing blood flow to the penis. They do not permanently cure ED. To address the underlying causes of ED and potentially achieve long-term improvement, it’s essential to consider lifestyle changes, address any medical conditions, and consult with healthcare professionals.

Is ED permanent or temporary?

ED can be either permanent or temporary, depending on the underlying causes. Some cases of ED may be temporary and resolve with appropriate treatment or lifestyle changes. Others may be chronic, requiring ongoing management.

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Can erectile function return?

Yes, erectile function can often return or improve with the right treatment and lifestyle modifications. Many men experience significant improvement in their ability to achieve and maintain an erection after addressing the underlying causes of ED.

What is the fastest way to cure erectile dysfunction?

There is no single “fast” cure for ED, as treatment effectiveness varies from person to person. The fastest way to address ED is to consult a healthcare provider, receive a proper diagnosis, and follow their recommended treatment plan, which may include medications, lifestyle changes, or other interventions.

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How to cure ED in 7 days?

While it’s not realistic to expect a complete cure for ED within a specific timeframe like 7 days, it is possible to start addressing the issue promptly. Consult a healthcare provider for a comprehensive evaluation and personalized treatment plan. Treatment duration and effectiveness will depend on the underlying causes and individual response to therapy.

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