What is ED?

Erectile Dysfunction (ED) is a common condition in men, particularly those over the age of 40. ED means that you struggle to achieve or maintain an erection sufficient for sexual intercourse. Some men with ED can get an erection but are unable to maintain it, while others are unable to achieve an erection at all. This can significantly impact not only your sex life, but also relationships and your mental well-being.

ED is often a temporary issue. Stress, fatigue or alcohol can all cause issues with sexual performance. ED may also warn of a more serious underlying issue like hardened arteries or high blood sugar (diabetes).

Some medications and cancer treatments can also cause ED as a side effect. If you have long term erectile dysfunction, you should go to a sexual health clinic for a diagnosis and start treatment.

There are several types of underlying cause for ED:

  • Vascular causes are the most common, and occur due to the narrowing or blockage of blood vessels, such as in heart disease, high cholesterol, diabetes and obesity.
  • Neurological causes occur when your nerves are unable to relay the signals from your brain to your penis to cause an erection. This can be from damage to your nervous system, diabetic neuropathy (nerve damage caused by high blood sugar levels), or multiple sclerosis (MS).
  • Hormonal causes are due to imbalances of certain hormones, e.g. testosterone deficiency (reduces sex drive), prolactin excess, and any thyroid imbalance.

 

Check our blog post on The Physical Causes of ED for more information on the health conditions that can lead to ED.

A good first step to treat erectile dysfunction is often by increasing cardiovascular exercise to lose weight and improve circulation, or quitting smoking to improve vascular health.

If there are no underlying health issues that might be causing your ED, therapy may be an option. Erectile dysfunction is not a purely physiological issue; stress, depression, anxiety and relationship issues can all contribute to ED. Check our blog post on The Psychological Causes of ED for more information.

For more persistent cases of ED, there are a variety of treatment options available.

Current Treatments

The most common treatments for ED are oral medications. They function by increasing blood flow to the penis upon stimulation. They are known as PDE5 inhibitors, and include sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra).

All PDE5 inhibitors work in the same way. PDE5 is an enzyme which causes your blood vessels to tighten up. This allows your body to change your blood pressure as it needs to. However, it also reduces blood flow.

PDE-5 inhibitors prevent this enzyme from working. This means they allow more blood to flow into the penis, making it easier to achieve and maintain an erection.

The best known of these options is Viagra, which contains the active ingredient sildenafil citrate. Viagra is available over the counter as Viagra Connect, but Sildenafil tablets (the generic version) are also available. Both work faster when taken on an empty stomach (30 minutes to an hour), and only facilitate an erection when the user is sexually aroused. Cialis is another popular option which lasts much longer than Viagra (24-36 hours) but is more expensive.

If oral medications do not work, your doctor or pharmacist may recommend a higher dose, or another treatment:

  • Vacuum pumps are tubes which draw blood into your penis to allow an erection to take place, and are often recommended for those who have not seen results with oral medications, or have experienced side effects.
  • Penile implants are devices which are surgically inserted into your penis, and are often recommended for those who have not seen results with any other treatment.

 

What Does the Future Hold?

Although they are often effective treatments, ED medications are not suitable for everyone (including those taking alpha blockers and nitrates, or at risk of heart attacks), and can cause a range of side effects in some people. For these patients, new types of treatment are being developed.

Melanocortin activators are currently being investigated for their potential to treat ED. Melanocortin activators work on melanocortin receptors, which are found in the central nervous system and have been linked to erections.

The main benefit of melanocortin activators is that they work by a completely different mechanism to PDE5 inhibitors, and therefore may be beneficial for patients in whom e.g. Viagra has been unsuccessful.

Another potential treatment for erectile dysfunction is gene therapy. In principle, gene therapy involves the delivery of new genetic material via a vector (a small package) into a cell, where the new genetic material can tell the cell to produce more/less of a certain substance to correct a deficiency/excess which has caused disease.

In the case of ED, the production of certain molecules (e.g. nitric oxide) can be increased by gene therapy to increase erectile function. Although lab testing has given promising results, there is still much research to be done to evaluate its safety and efficacy.

Plasma-rich platelet treatments have also been discussed. Platelets are small fragments of blood cells, which normally help to stop bleeding and begin the process of cellular repair. By injecting these platelets into the penis, the hope is that they will begin the process of repairing damaged tissue and possibly start building new blood vessels around the penis. However, as this treatment is fairly new, the trials carried out are somewhat mixed with how they track, apply and measure their results. Once a method has been settled on, we may see more from PRP in the future.

Conclusion

  • Erectile dysfunction is a common condition among older men, with many causes.
  • A range of treatments are currently available, such as oral medications (PDE5 inhibitors), vacuum pumps and surgical implants.
  • New ED treatments are being developed. Melanocortin activators and gene therapy are promising, but more research must be carried out to determine how effective these can be.

 

References

Cleveland Clinic – Erectile Dysfunction

Medical News Today – Viagra

PubMed – Melanocortins in the treatment of male and female sexual dysfunction

NCIB – Gene therapy as future treatment of erectile dysfunction

 

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