I am Dr. Chandra Mohan Batra. I am a senior consultant Endocrinologist. I am going to talk to you about Erectile Dysfunction in men. Erectile dysfunction is the inability of a man to get and keep an erection for enough time in sexual intercourse. If erectile dysfunction is present in once in a while then it can be just psychological and you should not be worried about it but if you have a consistent problem then you should start worrying about it because it can cause a lot of stress, can cause a lot of relationship problem with your wife, it can be a marker of serious medical disease like heart disease, kidney disease, liver disease. So it should be taken seriously if it is consistent. When we take the history of patient of erectile dysfunction we ask him whether he has a desire to have sex which is called libido. Lack of libido is a serious problem.
It means that the patient has some hormonal deficit or some serious problem which is causing erectile dysfunction. Whereas lack of erection also signifies cardiac problem or a neurological problem or a vascular problem which is causing him not to have an erection and lack of discharge or a premature discharge usually concludes a psychological problem. So once you have the history of the patient then you ask him about the drugs he is taking because drugs form a very important cause of erectile dysfunction. Drugs like antidepressants and antipsychotics- they are very important causes of erectile dysfunction. So drugs have to be ruled out. Then we have to ask the patient whether he is suffering from any psychological problem or not. If he is suffering from the psychological problem then that can be the cause of his erectile dysfunction. So what are the causes of erectile dysfunction?
The causes of erectile dysfunction can be a hormonal problem, can be a vascular problem, it can be a psychological problem, it can be a neural problem or neurogenic problem. So in all cases, these things have to be taken into consideration to examine the patient. When we examine the patient, we will look for all the pulses to look out for the vascular problem. We do all the reflexes and we see the jerks to see if there is any neurological problem existing. If there is a neurological problem we address it. If he doesn't have all these problems then we think of a psychological problem and ask him about the history or whether he can sleep properly at night, whether he is depressed all the time, if he has a psychological problem then we can address that.
Treatment of erectile dysfunction depends on its cause. The causes hormonal, we give testosterone therapy. The cause is a psychological, we send the patient to a psychiatrist for psychological counseling and psychiatric therapy. If the cause is either neurologic or vascular we try Sildenafil. Sildenafil is a drug which is also called as Viagra. Viagra acts by increasing the blood supply of the penis causing it to become rigid. If that also fails then we have other therapy called vacuum pump and prosthesis available. The prosthesis can be of two forms- rigid and flexible type.