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Erectile dysfunction

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Erectile dysfunction refers to a problem wherein the male is unable to start or sustain an erection for sexual intercourse. It is the most common sexual problem in the males.

The male finds it difficult to get an erection despite adequate sexual stimulation and also there is difficulty in sustaining or maintaining an erection.This makes it difficult to penetrate the vagina during intercourse.

The causes of erectile dysfunction are many. In the young age, most of them are due to psychological causes. They are work or finance related stresses, lack of privacy,  relationship problems with the partner  etc. These problems lead to erection problems and one the man fails to penetrate, he loses confidence. This leads to a vicious cycle of poor erection and loss of confidence which worsens the already poor erections. He starts avoiding sexual intercourse and this worsens the relationship between the partners. Unless this cycle is broken, the treatment is ineffective.

The basic problem in erectile dysfunction:

Erection needs adequate blood supply to the penis. When a man is excited, the blood supply to the penis increases . However the blood supply may not be adequate in many situations. These are, diabetes, atherosclerosis, psychological problems and other abnormalities of the artery and vein of the penis.

Erectile dysfunction Treatment
Erectile dysfunction

Apart from inadequacy of blood supply, nervous disorders like sensory neuropathy as happens in diabetes can result in erection problems. There could be decreased male hormone levels (testosterone) which can cause this problem.

Evaluation and tests:

 These include history, physical examination, and some basic and also specialized tests. The tests include tests for diabetes, thyroid disorder, hormone assays like serum testosterone , Doppler scan  of the penis to assess the blood flow adequacy .


 Drugs which increase the blood flow to the penis are the mainstay of the treatment. Examples of these drugs are sildenafil, tadalafil, vardenafil etc. These drugs are available widely and are used commonly. However as they sometimes have cardiovascular side effects, they are available only on the prescription of specialists. These drugs should be taken as,’on-demand drugs’ which means that they should be taken about one hour before intercourse. There is no need to take them if not needed. There are two strategies in taking them. One way is taking them for a short period of time till the time the person gains confidence and is able to get erections without the help of these drugs.After that , these drugs can be stopped. The second strategy is to take them as and when needed but on a permanent basis. This strategy is adopted when the person is old, has long standing diabetes, hormone disorders, neuropathy etc. which are not amenable to reversal.

In either case, the drugs work well because they are highly effective.

In case these tablets fail to give the desired result then the urologist/andrologist will advise the 2nd line treatment which is injection of the drug directly into the penis. This is not as scary as one would think. Upto 1 ml of the drug is injected into the penis by the patient himself or even his spouse can inject it. This is the same way a diabetic patients self injects insulin. In fact insulin syringe and the needle are used. So this causes very little pain and is more effective than oral tablets.

If all these fail in treating erectile problem, then the patient may be advised to undergo penile prosthesis implantation. These are silicon rods  which are  implanted into the penis under anesthesia. These keep the penis in an erect state and enable penetration without compromising on the pleasure and fertility function.The silicone prosthesis come in two types -inflatable  and semirigid.Inflatable implants are expensive but can be manipulated to flaccid and rigid states by pressing on a button. Semirigid ones give a permanent erection to the penis but are more popular in India as they are cheaper and easier to insert.

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