Erectile Dysfunction: Causes and Treatment

Impotence and erectile dysfunction are common sexual health problems, especially between the ages of 40 and 70. Because the problem is often temporary, it is usually not a cause for alarm. However, if it happens repeatedly, you should see a specialist, because it can sometimes be a sign of a more serious underlying condition.

Erectile dysfunction

The main mechanism that creates an erection is a strong flow of blood into the penis and prevention of blood leaving it because the venous outflow pathways close. Erectile dysfunction occurs in 2 main situations:

• Failure of the venous outflow pathway to close; in this situation, blood that has entered the penis leaks back out.

• Reduced or interrupted arterial blood flow; in this situation, enough blood does not enter the penis.

Causes of erectile dysfunction in men

Many men temporarily lose the ability to get or maintain an erection from time to time. This problem can have several possible causes, including:

• Stress, fatigue, and anxiety

• Heavy alcohol use and drug use

• Diabetes

• Heart and vascular disease

• Use of some medications

• Hormonal problems and thyroid disorders

• Surgical procedures

• Accidents and physical injuries

• Obesity and lack of physical activity

• Mental health problems and depression: if this problem happens repeatedly, it may be related to underlying disease or psychological factors. If a person only occasionally has difficulty with erections, emotional and psychological causes are more likely. In these situations, psychologists and counselors can be helpful in reducing anxiety and supporting treatment.

• High blood pressure

• Parkinson's disease

The most common effects of erectile dysfunction

• Reduced self-confidence

• Effects on mood

• Conflict with a sexual partner, and even separation or weakening of family relationships

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How the examination and visit are done

The doctor will ask about your lifestyle, relationships, and any related problems you may have. A general checkup, such as measuring blood pressure and examining the genital area, is performed to look for visible signs. If symptoms such as frequent urination are present, a prostate examination may also be done to check for prostatitis.

Treatment of erectile dysfunction

Treatment for erectile dysfunction is usually effective and can resolve the problem, but it depends on the underlying cause. Giving the doctor a complete medical history is very helpful in finding the cause. For example, in people who have full morning erections but develop erection problems while awake, psychological factors, nervous tension, and stress are strongly considered. Therefore, specific treatments are used for some causes of erectile dysfunction:

• Medication treatment: In Iran, medicines such as sildenafil, tadalafil, or vardenafil are often prescribed by doctors for erectile dysfunction.

• When narrowing of penile blood vessels, high blood pressure, or high cholesterol is present.

Blood-pressure-lowering medicines and statin medications may be used to lower cholesterol.

• For hormonal problems, such as low male hormone levels, meaning testosterone deficiency, hormone replacement medicines such as oral, injectable, or topical forms of testosterone may be used.

• For erectile dysfunction caused by medication side effects, the person's medication regimen should be reviewed, and the medicine causing the problem should be stopped and replaced when appropriate.

Although these medicines may be available from pharmacies without a prescription, it is better for the patient to use them only after consulting the treating physician, so the cause can be identified, the expected benefit can be assessed, and any contraindication to the medicine can be ruled out.

• Vacuum devices: A vacuum pump is placed over the penis, draws more blood into the penile circulation, and produces an erection.

Because this device can be difficult to use, it is mostly suitable for men for whom oral treatments are not appropriate or have not been effective.

• Intraurethral suppositories

Things a person can do to help with erectile dysfunction:

• Lose weight if overweight.

• Stop or reduce smoking.

• Follow a healthy diet containing fresh vegetables and fruits.

• Do regular aerobic exercise.

• Reduce or avoid stress and anxiety.

• Stop drug use and reduce alcoholic drinks.

Things that should not be done:

• Avoid cycling, especially more than 3 hours per week.

• Heavy alcohol use above the recommended limit