Let’s revisit Erectile Dysfunction


Erectile dysfunction (ED) is an inability to maintain a penile erection firm enough to have satisfactory sex. Some men may completely fail to get an erection to have penetrative sex, and others may get an erection but struggle to maintain it for long enough. 

ED is a relatively common problem, and its prevalence increases with aging, as it commonly occurs secondary to chronic ailments. However, men, especially in Asian countries, are reluctant to seek treatment as they fear being called impotent.  

Studies show that ED is a relatively common problem. For example, population-based surveys in Malaysia show that about 16% of men above the age of 40 have moderate to severe ED. However, the prevalence of ED rises to 40% if doctors take mild ED into consideration. That is a significant number, and these numbers continually rise with aging. 

ED and male anatomy 

Some discussion of the male anatomy is essential when understanding ED. Penis mainly contains of corpora cavernous and corpus spongiosum. Both of these tissues are highly spongy and are highly porous. 

During sexual arousal, these spongy tissues get filled with blood, which results in a hard erection. It is almost like an inflated balloon. Thus, the male penis is well-supplied with blood vessels. This flow of blood to penile tissues starts with sexual arousal or excitement. 

It means that ED is mainly due to low sexual desire (psychogenic) or poor rush of blood into the spongy tissues (vascular).  

Low testosterone may indeed reduce libido. However, in most men, ED is mainly an indication of worsening vascular health. This is vital to understand, as it means that improving vascular health through physical and physiotherapy may help in ED. 

Symptoms of ED 

its more than just failing to have sex 

Everyone knows that if there is trouble getting an erection, or reduced sexual desire, it might be ED. There could be specific other issues like difficulty maintaining an erection, delayed ejaculation, etc.  

However, now new studies show that it is unwise to see ED as an isolated disease condition. Generally, a person living with ED would have other signs and symptoms. ED is mostly secondary. Moreover, it could be a first presenting sign of other grave illnesses in many cases. 

It is now clear that ED causes not only a decline in sexual life but also self-esteem. Therefore, it considerably increases the risk of mental health issues. However, the relationship of ED with mental health issues is dual-sided. ED may cause stress, anxiety, and depression, and anxiety or depression may make ED worse. 

Causes of ED 

Here are some of the common causes of ED: 

  • Psychological– It is pretty complicated; for some, it could be the stress of a job, anxiety, or depression, while others may be merely worried about sexual performance. In some cases, there could be more severe mental disorders, too. 
  • Chronic ailments are the leading cause of ED, as most middle-aged men live with one or another chronic ailment like heart disease, diabetes, obesity, neurological conditions, and much more. 
  • Hormonal decline– unlike common belief, it is among the less relevant causes. It is true that there is a constant decline in testosterone levels with aging. Nonetheless, most men have adequate testosterone levels to maintain sexual function. That is why ED is rarely treated with testosterone replacement therapy. 
  • Wrong lifestyle choices– it is also among the significant causes. A sedentary lifestyle, wrong dietary choices, lack of physical activity, and, more importantly, alcohol or other substance abuse are some of the significant causes of ED. 

To conclude, ED is a complex and multidimensional illness, and one should seek treatment for the condition. Although it is not life-threatening, it may indicate falling health. Popping up pills like Viagra is a temporary solution and not a treatment. Only a medical specialist can help gain better health and get rid of the condition. 

Along with medications, ED is better managed through lifestyle interventions, physical therapy, physiotherapy, etc. Physiotherapy, like the use of extracorporeal shock wave therapy (ESWT), is one of the emerging new treatments for the condition. 

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