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Friday, November 15, 2019

Erectile Dysfunction (ED): Not an Uncommon Problem in Men

By the year 2025, it is estimated that there will be over 320 million men worldwide who suffers from ED

What is Erectile Dysfunction (ED)?

Erectile Dysfunction is defined as the inability to obtain or maintain an erection sufficient for satisfactory sexual performance. This problem is mainly associated with aging and has a significant increase in men over age 50. In men between the ages of 60 to 69 years, the prevalence of ED can range from 20% to 40%, and by the age 70, the prevalence increases to 50% – 100%. It is predicted that by the year 2025, there will be over 320 million men worldwide who suffers from ED.

What causes ED?

The causes of ED are many; i.e. the inadequate blood flow to fill the corpora and/or the inability to prevent the venous flow from leaving the penis, termed veno-occlusive disease.  These blood flow issues are a direct result of a medical condition, a surgical complication, or a pharmacologic side effect.

Cardiovascular disease is also linked with ED. ED symptoms predict an increased risk for a future development of cardiovascular disease, coronary artery disease, peripheral artery disease, and stroke.

How is it diagnosed and treated?

The initial visit begins with a complete medical, surgical, social, and sexual history. The medical history should identify all medical conditions, their onset, severity, treatment options started and failed, and any current treatments. The focus is identification of any risk factors leading to ED.

The psychological history should include any psychological conditions and duration of the condition, such as depression and anxiety, and any medications taken for these conditions. A social history includes the patient’s living arrangements, relationship status, health status of his family members, and the use of tobacco, alcohol, and illicit drugs.

When collecting data on the sexual history, all domains of a man’s sexual health should be considered. Information gathered includes the presence/absence of erectile functioning, onset of the problem, severity of ED, previous treatments tried, the presence/absence of nocturnal erections, and frequency of intercourse. Identify any ejaculatory problems and any change in libido.

Specific data collected during the physical examination and suggested laboratory tests aid in the identification of comorbidities. Each assessment and treatment plan is individually based on the patient’s needs and symptoms.

Treatment of ED needs to place more importance on prevention, early intervention in treating comorbid conditions, and promoting behavioural changes prior to initiating these other options.

Dietary changes, development of an exercise programme, weight control, smoking cessation, and stabilisation of comorbid conditions, can lead to improvements in ED

What are the treatments available in the healthcare industry?

PDE5 Inhibitors

All PDE5 inhibitors have a similar site of action, efficacy, and safety profiles, but they vary in time to onset and the duration of action. Men with diabetes mellitus with ED may be less responsive to PDE5 inhibitors. Risk factors for poor response to the PDE5 inhibitors include patients with severe diabetic neuropathy, severe cavernosal injury, psychological stress, and anxiety.

These drugs must be used with sexual stimulation to be effective; however, up to 35% of patients with ED may fail to respond to this therapy. Despite high efficacy rates (between 45% and 78%), many patients will drop out of this therapy within 24 months due to factors such as cost, dissatisfaction with erection, or loss of interest in sexual activity.

Vacuum device or Injection Therapy

Vacuum device and injection therapy has high response rate but are not in favour due to cumbersome usage. Although highly effective, the dropout rate is high as well. Therefore, penile implant is the last option available.

Shockwave Therapy

Shockwave therapy however has been gaining in popularity due to the ease of use. Without using medicine or surgery, it aims to improve angiogenesis (new vessel formation) by introducing micro trauma and sheer stress to penile vasculature with improved blood flow and there will be longer lasting improved erectile function.

60-75% patients can expect improvement in sexual function although the response rate is less in diabetic patient (50%). So far, this is the only treatment looking at improving the underlying cause rather than symptomatic improvement alone.

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