Erectile dysfunction (ED) is one of the most common problems men bring to a urologist, and one of the least talked about. Many men wait years before seeking help, often because of embarrassment or the belief that it is simply part of getting older. ED is common, it is treatable in most men, and it can sometimes be an early sign of a health problem elsewhere in the body. Here is what it is, why it happens, and what a consultation involves.
What is erectile dysfunction?
ED means having trouble getting or keeping an erection firm enough for sex, most of the time, over a period of at least a few months. An occasional difficulty, after a stressful week, too much alcohol or poor sleep, is normal and is not ED. It becomes worth looking into when it keeps happening, when it is getting worse, or when it is affecting your confidence or your relationship.
Why it happens
An erection depends on healthy blood vessels, healthy nerves, the right hormone levels and a relaxed mind, all working together. A problem with any one of them can cause ED. The common causes are:
- Blood vessel problems: the most common cause in men over 40. The arteries to the penis are narrow, so they are often affected early by the same changes that affect the heart.
- Diabetes: high blood sugar damages both the blood vessels and the nerves involved in an erection. ED is much more common in men with diabetes, and often starts earlier.
- High blood pressure and high cholesterol, and some of the medicines used to treat them.
- Low testosterone, which often also causes low sex drive, tiredness and low mood.
- Smoking, alcohol, weight gain and lack of exercise.
- Stress, anxiety and depression, including performance anxiety, which can start after a single bad experience and then feed on itself.
- Prostate surgery, pelvic surgery, spinal problems or injury to the nerves.
In many men there is more than one cause. A physical problem can lead to anxiety, and the anxiety then makes the physical problem worse.
ED and your heart
Because the arteries to the penis are smaller than those to the heart, they can show signs of narrowing a few years before heart symptoms appear. For this reason, new ED in a man over 40, especially with diabetes, high blood pressure, a smoking history or a family history of heart disease, is a good reason to have your heart health and blood sugar checked as well. Treating ED is a chance to look after your overall health, not just this one symptom.
When to see a urologist
Consider booking a consultation if:
- the problem has lasted more than two or three months
- it started after starting a new medicine, after surgery or after an injury
- you also have low sex drive, curvature or pain with erections, or urinary symptoms
- you have diabetes, high blood pressure or heart disease
- you are tempted to buy tablets online or over the counter without a prescription
Please do not self-medicate. ED tablets are effective and safe for most men, but they can interact dangerously with some heart medicines, particularly nitrates used for chest pain, and products sold online are often not what they claim to be.
What happens at the consultation
The consultation is private and unhurried. Your urologist will ask about your symptoms, general health, medicines and lifestyle, and do a short examination. Simple tests are usually enough to start with: blood sugar (HbA1c), cholesterol, testosterone and sometimes other hormone levels. A few men need further tests, such as a penile Doppler ultrasound to check blood flow. Your partner is welcome to come along if you both wish.
Treatment options
Treatment depends on the cause and on what suits you. Options include:
- Lifestyle changes: stopping smoking, cutting down on alcohol, regular exercise, weight loss and better sleep can improve erections on their own and help other treatments work better.
- Treating the underlying condition: better control of diabetes, blood pressure and cholesterol, reviewing medicines that may be contributing, and treating low testosterone where tests confirm it.
- Oral medicines (PDE5 inhibitors such as sildenafil and tadalafil), prescribed after checking they are safe for you.
- Counselling or sex therapy, alone or alongside other treatment, particularly where anxiety or relationship stress plays a part.
- Other options for men who do not respond to tablets, such as vacuum devices, penile injections and, for a small number of men, a penile implant. Your urologist will explain the benefits and risks of each.
Read more: When to see an andrologist: male infertility, ED and low testosterone and Diabetes and your bladder.
Consult a urologist in Koramangala
Dr Bivek Kumar (MCh Urology, FRSM) is a Consultant Urologist and Andrologist at Superhealth Hospital, Koramangala, beside Nexus Mall. He sees men with erectile dysfunction, low testosterone and other men’s health concerns in a confidential setting, and consults in English, Hindi, Kannada and Bengali.
OPD: Monday to Saturday, 9 am to 6 pm
Appointments: +91 90329 59964
This article is for general awareness only and is not a substitute for medical advice. Please consult your doctor about your own health.