Erectile Dysfunction: Symptoms, Causes, Diagnosis, and Treatment

A Comprehensive Guide to Erectile Dysfunction: Symptoms, Causes, Diagnosis and Treatment

Erectile Dysfunction (ED), also known as impotence, is a common male health issue in which a male is either unable to attain or subsequently maintain an erection for a sufficiently long time to allow successful sexual intercourse. The condition is rarely discussed but is very common and affects 52% of the male population between 40-70 years in the UK. The risk is three-fold high for older men, although young men also experience it. Other estimates have noted that 10% of men are always suffering from it on a long-term basis.

Despite its correlation with age, it is not considered normal for any age group and is a sign of some underlying disease or health conditions. Alongside the physical and biological causes, it is also linked to psychology and mental well-being. However, keep in mind that occasional failure in achieving or maintaining an erection is normal, and 20% of sexual intercourse normally ends as a failure. When this figure crosses 50%, it's time to worry and take the help of sexual health experts to find the cause and prescribe treatment. 

Losing erection for a few days and weeks is also not counted as ED, and the erection problem lasting for at least 6 months is counted as clinical ED requiring treatment. Many causes of ED resolve spontaneously; however, the clinical ED needs the attention of reproductive health experts for diagnosis and treatment.

What does Erectile Dysfunction mean?

Erectile dysfunction is the physiological failure of the erection process, which causes the penis to become erect for sexual intercourse. The erection is a complicated process requiring physical, visual, sensory and psychological stimulation. If anyone of these factors is compromised, the result will be erection failure.

The erect penis is the basic requirement of sexual intercourse that lasts 4-15 minutes (5-7 minutes on average) for most couples. The ED leaves a man unable to enjoy normal sex, leading to social inadequacy, uselessness and relationship problems.

What is the other term for Erectile Dysfunction?

The other term for erectile dysfunction is “impotence”. Impotence means a state of being impotent. It means the inability of a male to perform sexual functions and satisfy his sexual partner. It is a broader term and is used for sexual failure due to ED and due to the failure of sensory mechanisms responsible for orgasm. Although it is common in men, being impotent is used as an abuse and severely compromises men's emotional health, social standing and relationship confidence.

How does Erectile Dysfunction happen?

Erectile dysfunction is the failure of the erection process. Erection is a complex process and starts during sexual arousal. During sexual arousal, the local stimulation through the touch or the central stimulation through the brain begins stimulating the local nerves in the penis. This stimulation causes the relaxation of the corpora cavernosa, the tubular and spongy structures which run along the length of the penis to relax. Thus the blood rushes in these tissues and fills the empty spaces, causing an erection. Any factor that compromises this process, e.g., problems with blood circulation, physical injury to the penis and, more specifically, the erectile tissues, lack of interest in the sex, emotional and mental stress, injury to the local nerves, diseases of blood vessels and circulation etc., will result in the ED.

Various risk factors increase the risk of ED, e.g., anxiety, diabetes, hypertension, stress, use of antidepressant drugs, obesity, heart and circulatory diseases, hormonal imbalances, the use of blood pressure drugs, several lifestyle risk factors, hypercholesterolemia, hypothyroidism, ageing, kidney diseases, relationship problems, sleep disorders, heavy alcoholism, epilepsy, liver diseases, smoking or using other tobacco products, pelvic injuries, pelvic surgeries, relationship problems (e.g., performance and body image anxiety) and diseases like Parkinson’s disease, multiple sclerosis and Peyronie’s disease (result in the formation of scar tissues in the penis). Reducing exposure to these risk factors is important to prevent ED.

How long does Erectile Dysfunction last?

Erectile dysfunction lasts as long as the underlying cause responsible for it lasts. Depending upon the cause, it lasts from a few months to a few years. Some factors like severe physical injury or surgeries cause permanent damage to the penis and permanent impotence. In contrast, factors like hormonal imbalances and mental health issues resolve within a few months. Some factors disappear with time. For example, a study involving 810 noted that 29% of the patients observed visible improvement within 5 years. It was attributed to the natural healing processes occurring in the body.

Who is more susceptible to Erectile Dysfunction development? 

The susceptibility to ED depends upon exposure to the causes and risk factors. Age is an unavoidable risk factor, and it comes with various other risk factors like diabetes, heart disease, circulatory problems, blood pressure, diabetes etc. From a population average of 10%, the risk increases to 35.5% between 50-59 years and 68.8% between 60-69 years. Most of the causes and risk factors are associated with age. However, diabetes (particularly type 2) also occurs at a young age, increasing the risk of diabetes by 3-5 times. Exposure to mental and psychological diseases can occur at any age. However, older adults have low emotional resilience and are more likely to experience more severe symptoms.

Is Erectile Dysfunction a common problem?

Yes, ED is a very common problem and affects one-tenth of the total men in the UK, with increasing risk towards advancing age. The incidence is likely to be underreported as talking about sexual health and sexual health taboo is s social taboo even in advanced societies. Various survey studies have revealed different figures. One such survey study by Dr Jim and his colleagues in 2018 in the UK found that 41.5% of men reported experiencing some form of ED, and 7.5% reported having severe ED. Men in the ED group were older and were exposed to other lifestyle factors like alcohol, smoking, lack of physical exercise, obesity and different chronic conditions like diabetes, hypertension etc. 

What are the Signs and Symptoms of Erectile Dysfunction?

The common signs and symptoms of ED are;

1. Having trouble getting and maintaining an erection for successful sexual intercourse. 
2. Premature ejaculation (ejaculation within one minute of the penetration)
3. Delayed ejaculation (inability to ejaculate when desired and an unwanted delay lasting 30-60 minutes)
4. Anorgasmia (the inability to achieve the orgasm or an orgasm of too low intensity)
5. Inability to get an erection after sufficient stimulation 
6. Psychological issues like a lack of interest in sexual partners, reduced sexual desire, fear of physical intimacy, depression, lower self-esteem and feelings of guilt or embarrassment
7. Pain and numbness in the penis are also noticeable, particularly if the cause is a physical injury or damage to the local nerves.

What can be done to manage the symptoms of ED?

There is nothing like a simple trick to cure ED. It needs a comprehensive program involving biological and psychological management. The best way to manage the symptoms of ED is the management of the existing diseases and health conditions make healthy dietary choices, choose healthy lifestyle habits and cooperate with the doctor for better disease management. Work with the healthcare provider to treat and manage chronic conditions like heart disease and diabetes etc., go for regular screening through blood tests and regular checkups, limit the use of alcohol, stop smoking, avoid illegal and unnecessary use of drugs, do regular exercises and visit the psychiatrist for treatment of mental health issues like depression and anxiety.

If the symptoms persist despite all these precautions or are increasing in intensity, go to the urologist for more advanced treatment options like injections, vacuum devices and surgical options. It is important to be open to the sexual partner about the problem, take them into confidence and employ their help wherever possible. A cooperative and caring partner helps overcome emotional distress and depression, often the major cause of erectile dysfunction.

How long must a man experience symptoms before it is considered ED?

A man should experience symptoms for at least six months before classifying the condition as ED. Occasional loss of erection or losing erection for a few days or weeks is considered normal, and there is nothing to worry about. However, if the symptoms persist continuously for 6 months or more and the symptoms increase in severity, and no management practices are working, the clinical ED is the case. You need to go to the sexual health expert for the diagnosis and treatment.

Can reduced sexual desire be a symptom of ED?

Yes, a continuous low libido and interest in sex are the common issues experienced during the ED. It is the byproduct of depression and feeling of inadequacy which results from ED. The fear of poor performance and the response from the sexual partner makes a man fearful of sexual intercourse and intimacy. Both factors occur interchangeably, and if one is present, it induces the other factor.

Can prescription medications cause symptoms of ED?

Yes, many prescription medications cause erectile dysfunction as a side effect. Different prescription drugs cause ED as a side effect. These drugs are used to treat some other health issues, but they interfere with the blood circulation, nerves or the levels and production of male reproductive hormones causing ED. These drugs cause ED directly or increase the risk of ED caused by other factors. Common medications having ED as a potential side effect are;

• Diuretics (the drugs that increase the urine output) like loop diuretics and thiazide diuretics. These drugs decrease the blood supply to the penis, causing ED.
• Antihypertensive drugs (these drugs are used to treat hypertension and reduce the blood pressure and thus the blood flow in the penis)
• Antihistamines (these are the drugs used during an allergic reaction and cause numbness and low blood supply).
• Antidepressants (cause soothing and lower blood pressure)
• Drugs used to treat Parkinson’s disease
• Drugs used for cancer chemotherapy, e.g., for prostate cancer. These drugs cause the local death of the cells.
• Anti-seizure drugs (used for epilepsy)
• Hormone therapy
• Histamine H2-receptor antagonists (the drugs used for gastric and intestinal ulcers)
• Non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen and ibuprofen.
• Proton pump inhibitors (PPIs) like pantoprazole and omeprazole.
• Muscle relaxants and tranquillizers (these drugs depress the functioning of the nervous system).
• Local anaesthetic drugs like lidocaine, benzocaine, lignocaine etc. (these drugs numb the local nerves causing the loss of function and ED).
• Antiarrhythmics (the drugs used to treat irregular heartbeat and cardiac irregularities).
• Various miscellaneous drugs, e.g., atropine, digoxin, finasteride, lipid-lowering drugs, metoclopramide, codeine, morphine etc.

Besides these prescription drugs, various other recreational drugs, abused drugs and substances like opiates, nicotine, methadone, marijuana, cocaine, heroin, barbiturates (nervous system depressants), amphetamines and alcohol etc., also depress the nervous mechanisms responsible for the erection and cause ED. The ED is often not mentioned among the side effects of these drugs on the user manuals and patent leaflets, but their use is a strong risk factor for ED. These drugs cause damage to the local blood vessels, often causing a prolonged and occasionally irreversible ED.  

What are the Risk Factors that Cause Erectile dysfunction?

Several risk factors increase the risk of ED, particularly when some primary cause is present. It is important to note that having one or more risk factors does not necessarily mean that a man will develop ED, but rather that his risk is higher than those without these factors. The common risk factors are;

Anxiety

Anxiety means a mild to severe feeling of worry, uneasiness and fear. Anxiety causes ED in several ways. The incidence of depression in people with ED has been reported to be 37%. 

It negatively impacts psychogenic erections, which are related to mind and vision and the way the brain processes the physical erotic stimulus. Therefore, chronic anxiety disrupts communication between the brain and the penis, which is vital for increased blood flow and erection. It increases the risk of various factors directly responsible for ED, e.g., obesity, alcoholism, hypertension, hypercholesterolemia and heart diseases. The therapeutic management of anxiety through drugs also causes ED, as anti-stress drugs often cause ED as a side effect. 

Chronic anxiety and stress, particularly after some psychological or physical trauma, cause the development of a more dangerous condition, the post-traumatic stress disorder (PTSD), which is also associated with a high risk of ED. It causes various lifestyle changes that contribute to the ED, like adopting a more sedentary lifestyle, using drugs, smoking and excessively using alcohol. The connection between ED and anxiety is not linear. It initiates a complicated cascade with anxiety causing ED and ED causing more anxiety, and the process continues. To stop this cycle and restore sexual functions, a patient should consult a psychologist and sexual health expert. Once the cause of anxiety is removed, erectile functions begin to improve. 

Diabetes

Diabetes is a chronic illness that develops when the body is either not producing enough insulin or is unable to use insulin properly for the regulation of blood glucose levels. It results in higher levels of glucose in the blood. ED is very common in aged men with diabetes (particularly type 2 diabetes), and the prevalence of ED in people with diabetes is 3-5 times higher than the people without diabetes. Higher blood glucose levels for a long time cause diabetic neuropathy (damage to the nerves) and vasculopathy (damage to the blood vessels). The erection is a function of nerves and blood supply, so both factors directly compromise erectile functions. As type 2 diabetes also occurs at a young age, ED develops much earlier in people with diabetes than in the general population. 

The prevalence of ED in people with diabetes is very high and ranges between 35-90% and depends upon cultural and socioeconomic factors. It develops in the initial stages of diabetes, and poor erection is often the main complaint reported by diabetic people. As ED is associated with severe negative impacts on the quality of life, the early detection and treatment of ED in diabetic people are very important to avoid more complications. The risk of ED with diabetes becomes particularly high if other risk factors are present. 

Suppose a patient notes any changes in the frequency of urination and the duration and intensity of the erections. In that case, it is one of the signs of diabetes-associated ED and should be consulted immediately with the urologist. It is often difficult for many people, but reluctance is the worst thing to do as it prevents timely intervention. Eating well-balanced and diabetes-friendly diets helps control diabetes and lowers hyperglycemia's damaging impact on the nerves and blood vessels. Such a diet also improves mood and reduces stress, the other two important risk factors of ED. So, keeping the glucose under control improves metabolic health and guards your sexual health and sexual relationships.

Depression 

Depression is a mental health disorder characterized by persistent sadness and disinterest in previously enjoyable and rewarding activities. Depression is a part of life; however, living with chronic depression is very difficult as it compromises mental and emotional well-being and damages sexual life. 

How both of these conditions are related to each other? Chronic depression compromises the coordination between the brain and the body, and a depressed person responds poorly to physical and psychogenic sexual stimuli. It also loosens the emotional bond with the partner, making the sexual experience less pleasurable and even painful in extreme cases. According to the NIH database, 43.7% of people living with chronic depression experience issues with erection and their overall sexual life, and 40% of people taking antidepressants experience a noticeable decline in sexual functions. Both are linked to each other in reverse order, too, and a study found that 38.16-64.97% of people with ED showed symptoms of chronic depression. 

The most important antidepressants identified as the cause of ED are the selective serotonin reuptake inhibitors (SSRIs), e.g., paroxetine, sertraline and fluoxetine, serotonin and norepinephrine reuptake inhibitors (SNRIs) like duloxetine and venlafaxine, and tricyclic antidepressants (TCAs) like doxepin, imipramine and amitriptyline. If there are signs of ED, the following signs help to confirm that depression is part of the problem;

• Sex is not more pleasure, and it'd be hard to concentrate on the sexual activities
• The ED has developed after some stressful life events like loss in business, loss of job, death of loved one and any relationship or family tragedy
• Other signs like stress, frustration and anxiety also accompany the ED. 
• There are negative thoughts about self. 

Hypertension

Hypertension means increased blood pressure in the blood vessels, and 31% of the total male population in the UK experience it. This issue negatively influences all functions in the body, including sexual functions. Hypertension is among the major causes of erectile failure. The incidence is particularly high for people of advanced age with hypertension, as a study noted that 24.53% of people with hypertension have severe ED, and the incidence is even higher in elderly men. 

To understand the relationship, recall the mechanism of erection. To achieve an erection, the erectile tissues in the penis should relax to allow blood to flow into the penis. Chronic hypertension reduces the ability of these erectile tissues to relax, thus causing insufficient blood flow in the organ and lower quality of erection. Hypertension also negatively impacts hormone levels, particularly testosterone, the male hormone essential for erection and sexual arousal. Besides being a direct cause, some drugs used to treat hypertension also cause ED. These include the diuretics that lower the force and energy of blood in the penis and cause zinc deficiency, which the body needs to make testosterone and the beta-blockers that damage the nervous mechanisms responsible for erection and reduce the ability of the blood vessels in the penis to dilate and take in blood. The beta blockers make a person depressed and sedated and decrease interest in sex. So, healthy lifestyle choices and cooperation with the doctor help a person to have a better erection and sexual health. 

Stress

Stress is the state of mental tension and worries caused by a difficult situation. Everyone experiences stress in one form or the other at some point in their life. The human body feels stress and uses it to cope with environmental dangers. But, being stressed all the time (chronic stress) negatively influences body functions, including reproductive functions like erection and a study in the International Journal of Hypertension found that 46.34% of men with chronic stress have some degree of ED. 

Stress negatively influences psychological and physical health. Experiencing chronic stress causes many issues and symptoms which cause problems in the bedroom, like chest pains, constipation and diarrhoea, headache, trouble sleeping, irritability and low mood. Also, recall that a person needs proper sexual arousal to achieve an erection. If a person is stressed, he will find a lower sexual desire and lack any excitement related to the sexual process. Even if a stressed person manages to achieve an erection, maintaining it becomes very difficult. Stress doesn't come alone and activates a huge spiral of events causing ED, the ED causes more stress, and the vicious cycle continues.  

Handling the stress due to ED is complicated and needs properly sorting out the problem. If the ED is due to temporary stresses like preparation for an exam, shifting the home or attending an important event, the best thing is to wait until the stressful event passes. If stress is a part of lifestyle, a more proactive approach is needed. 

Antidepressants

Antidepressants are prescription drugs for anxiety, depression and related mental health issues. Besides treating these conditions, these drugs cause various side effects, including erectile dysfunction. The exact mechanism of how antidepressants cause ED is not known. However, many experts believe these drugs influence the serotonin levels in the body. This so-called "happy hormone" is known to influence mood and also has a role in creating and maintaining erections in the body. Its deficiency or excess causes ED.

Five major types of antidepressants currently used and their impact on erectile functions are;

Selective serotonin reuptake inhibitors (SSRIs): These are the most popular drugs used for the purpose and include paroxetine, citalopram, sertraline, fluoxetine and Escitalopram. All SSRIs are known to cause some degree of ED. The degree of ED caused by each drug is not the same. For example, 76% of people complain of ED after using paroxetine, while sertraline and fluoxetine have a lower risk. 

Serotonin and norepinephrine reuptake inhibitors (SNRIs): The SNRIs include desvenlafaxine, duloxetine and venlafaxine. These drugs work similarly to SSRIs, but unlike SSRIs, they are also effective for nerve pain. Their negative effects on the erectile are similar to the SSRIs, and up to 70% of people experience ED symptoms after using them. 

Benzodiazepines: These sedative drugs calm the brain's brain and cool down its nervous functions. The drugs in this category are diazepam, Lorazepam, Clonazepam and Alprazolam. Besides depression and anxiety, these drugs are also effective for insomnia, seizures and panic disorders. These drugs cause ED or worsen the ED due to other causes. Men taking these drugs are 2-3 more likely to experience ED than men not taking them.

Tricycle antidepressants (TCAs): These drugs are less commonly prescribed because they are associated with more side effects than other drugs. These drugs work better if you have chronic pain in addition to depression and anxiety. The commonly prescribed TCAs like doxepin, imipramine and amitriptyline are linked to ED and 30% or more people using these drugs experience ED.

Antipsychotics: Common antipsychotic drugs like risperidone and haloperidol are associated with ED, and various studies have noted these effects are reported by 30-70% of the users. These drugs block dopamine and increase the levels of prolactin. High prolactin levels cause ED. Fortunately, not all antipsychotics disturb erectile functions, and some, like quetiapine (Seroquel), olanzapine ( Zyprexa) and aripiprazole (Aristada), are not associated with ED and are often given as substitution antidepressants if the patient reports ED. 

These are not the only drugs that cause ED, and the patients must inform the doctor if they experience such effects after using any drug. If a person experiences ED after taking antidepressants, these steps should be practised before going to the doctor. 

• Wait, because sometimes, the effects are temporary and disappear after some days of use. Wait for some weeks as the body adjusts to the drug. 
• Consult the doctor to change it, particularly if the current drug is not working again with signs of depression and anxiety, causing more side effects like ED. Many safer drugs (like Buspirone) are not only associated with milder or no side effects but are also known to improve erectile functions. 
• Add erectile function improvement drugs to the current treatment regime if the currently used drugs are working well against anxiety and depression. The patient needs to consult the doctor for adding drugs like tadalafil (Cialis), sildenafil (Viagra) and bupropion (Aplenzin, Forfivo XL).

Obesity

Obesity is abnormal and excessive fat accumulation in the body that poses a serious risk to health. An obese person has a BMI of 30 or more. Obesity causes ED by inducing various negative changes and generalized inflammation in the body. Various mechanisms are proposed to understand how it influences erectile functions.

Diabetes is a risk factor for many metabolic diseases like hypertension, atherosclerosis, cardiovascular diseases, hypertension, hypercholesterolemia and diabetes mellitus. All these factors influence the blood supply into the penis, thus the erection. Atherosclerosis directly results in the hardening and narrowing of the blood vessels, reducing the blood supply to the penis. Obese people have a 5 times higher risk of developing diabetes, and half of those with diabetes report having ED. 

Obesity compromises vascular health and causes damage to the inner lining of the blood vessels (the endothelium). This damage compromises the ability of the blood vessels to supply enough blood to achieve and maintain an erection. The damage to the endothelium reduces the ability of the blood vessels to dilate and comprise the blood supply. 

Obesity is linked to low levels of testosterone, the male hormone important for libido and erection. A large amount of fat in the body reduces the levels of this hormone as the abdominal fat has an enzyme called the aromatase that converts this testosterone into oestrogen and reduces its levels. Obesity also results in lower levels of sex hormone-binding globulin (SHBG), the blood protein responsible for carrying testosterone in the blood. However, the weight loss does not fully restore testosterone levels, and testosterone needs to be taken from external sources. 

Obesity is linked with various other negative changes in the body, including inflammation, oxidative stress, leptin resistance and insulin resistance. All these changes negatively influence overall body functions, including erection. 

So, reducing body weight through appropriate lifestyle and nutritional changes and maintaining an ideal BMI of 18.5-24.9 helps improve erectile functions. The research has noted that losing 10% of body weight in 2 months results in the improvement of erectile functions and achievement of healthy and satisfactory relationships, which are the ultimate requirement of a happy life.

Heart disease

Heart disease is a disease affecting the heart and the blood vessels. ED is one of the early signs of an ongoing or expected heart disease, and a study has found that 67% of heart patients developed ED more than three years before developing symptoms of heart disease. So, if a person is diagnosed with heart disease, he will have a compromised erectile function, and these functions can only be restored by proper treatment. 

Any adverse cardiovascular health event often accompanies damage to the smooth muscles and the endothelium of the blood vessels. The damage to the endothelium results in impaired blood supply to the penis, resulting in ED. The development of heart diseases meant that the person had sustained exposure to cardiac risk factors like hypertension, hypercholesterolemia, hyperglycemia, atherosclerosis and arteriosclerosis, all of which negatively influence erectile functions. That is why the ED often precedes adverse cardiac health events. Having ED doesn't necessarily mean that a person has heart disease. The experts recommend that if a person develops ED without any visible cause, like physical trauma or emotional disturbances, it is better to be screened for heart disease before treatment. 

Another association between ED and heart diseases is that both of these issues share many common risk factors like diabetes, smoking, excessive use of alcohol, hypertension, hypercholesterolemia, advanced age, obesity and lower testosterone levels. Sometimes the diagnosis and screening of the ED are used to diagnose and prevent cardiovascular diseases. The monitoring of ED is a non-invasive and low-cost tool and is an efficient alternative to various other cardiac health biomarkers. 

Often, the development of ED during the treatment of heart diseases results in the discontinuation of treatment by the patients, resulting in severe repercussions for the disease outcomes. Besides being a direct cause of ED, some drugs used for heart diseases, like beta blockers and diuretics, negatively affect erectile functions. In contrast, other drugs, like nebivolol and renin-angiotensin-aldosterone system inhibitors, are safer. The relationship between ED and heart health is more complex than currently known, and many drugs used to treat ED also increase the risk of heart disease. 

Like many health conditions, adopting a healthy lifestyle decreases the risk of heart disease and ED. Some important things to consider are moving towards a plant-based diet by adding more fruits and vegetables to the diet, adopting a healthy lifestyle with adequate physical exercise, maintaining a stress-free daily routine, creating and maintenance of a healthy sleep pattern, and taking the advice of health professionals in case of any complexity.

Hormonal imbalances 

The hormones influencing erectile functions are testosterone, prolactin and cortisol. The endocrine system regulates the production of all hormones, so endocrine disorders are also responsible for erectile dysfunction (ED). 

Lower testosterone levels: Testosterone is the primary masculine hormone. It influences the libido, development of secondary sexual characteristics in men, sperm production and muscle and bone mass. The testes produce it, and its levels should be 250-1000 ng/ dL for optimum functions. A general decline in testosterone production is observed with advancing age, particularly after 40-45 years. Some men note these changes as low as after 35. Lower testosterone causes the development of a condition known as andropause (like menopause in women), characterized by a general decline in reproductive functions and ED. Besides this primary hypogonadism, several secondary factors also cause hypogonadism and low testosterone levels like testicular cancer, testicular injuries, mumps, radiation poisoning and genetic diseases (like Klinefelter's Synonym, Turner's syndrome etc.). 

Increased prolactin and cortisol: Cortisol is the stress hormone released by the body in response to any stress. Both testosterone and cortisol are produced from the same precursor molecules, so whenever the body is under stress, it shifts the balance away from testosterone production and towards cortisol production. Therefore, chronic stress causes lower testosterone levels and ED. Likewise, increased levels of prolactin hormone also cause ED by suppressing testosterone concentration. The overproduction of prolactin (due to hypothyroidism and other causes) reduces the production of gonadotropin-releasing hormone (GnRH), which controls testosterone production, thus causing lower testosterone levels and erection dysfunction. The treatment options are hormone replacement therapy, using drugs like phosphodiesterase 5 inhibitors, intracavernosal injections, etc. Improving lifestyle risk factors like poor nutrition and maintaining a stress-free lifestyle.

Blood pressure medications 

Different blood pressure medications are used to treat hypertension and hypotension. Sometimes, ED occurs as a side effect of the blood pressure drugs like beta blockers, loop diuretics, thiazide diuretics etc. These drugs disrupt the blood supply to the penis, making an erection difficult. Some other blood pressure drugs, like angiotensin receptor blockers, ACE inhibitors and alpha-blockers, are rarely associated with ED. 

The research has also noted that psychological factors play a more important role in developing ED due to these drugs than the biological effects of these drugs. For example, a man taking blood pressure drugs is likely to be worried about his health, and also, he is also more likely to be aware of its bad effects on the erection and will recognize such effects earlier. 

Nevertheless, the development of ED due to these drugs is one of the major factors responsible for leaving these drugs as 70% of people taking blood pressure drugs to stop using them due to these side effects, thus, becoming exposed to adverse effects of hypertension. 

Loop diuretics and beta blockers are the first drugs the doctor prescribes if exercise and diet fail to control hypertension. If a patient taking these drugs experiences ED, he/she should continue to use them until the blood pressure is under control. If the ED is too serious, consult the doctor for combination therapy or shift to other blood pressure drugs that do not cause the ED. The blood pressure drugs not likely to cause ED are the ACE inhibitors like captopril, Lisinopril, and benazepril, and less than 1% of the users experience ED. Similarly, calcium channel blockers like verapamil and Amlodipine and the angiotensin II receptor blockers (like Losartin) are also safe. Alpha-blockers are not only safe; some studies have noted that they (like doxazosin) even cause improvement in erectile functions. 

The patients should discuss with the doctor about including ED drugs in the combination therapy like avanafil, vardenafil, sildenafil and tadalafil. However, these drugs should be used only if the blood pressure is under control as they are dangerous with uncontrolled blood pressure. They are also unsafe for men taking drugs for heart diseases and alpha-blockers. Also, remember that ED is one of the complications of the ageing process, which causes sustained negative changes in the body. So, the patients should accept everything as they are and don't indulge in blame games and handle their health problems as correlated to each other.

Lifestyle factors

Lifestyle refers to a person's way of living. Lifestyle is often observed as the cause of almost every health condition, and the ED is not an exception. Many lifestyle factors predispose men to the ED, and correcting them is a useful way to manage the ED. Some common lifestyle risk factors causing ED are;

Obesity: Obesity is not a lifestyle but a consequence of a poor lifestyle. It is one of the leading risk factors of ED. A BMI of 30 or greater compromises sexual health. Reducing weight improves sexual health. It is observed that having a 10-inch larger waist increases the risk of ED by as much as 50%. 

Sedentary lifestyle: One of the major consequences of a sedentary lifestyle is poor vascular health which causes ED. So, regular exercise and physical activities are the cheapest ED management methods. A review noted that a 14-86% improvement in erectile functions occurred depending upon the intensity and duration of exercises.  

Stresses: The impact of stresses on human life is wide-ranging and covers health's emotional, physical and mental domains. High levels of stress cause the body to enter a fight or flight mode, and the focus of physiology shifts away from sex which is essentially a leisure activity. Given that the stimulus of an erection comes from the mind, a stressed brain is the worst thing to have during sexual intimacy. So, finding useful techniques to reduce stress, like regular exercises, reducing exposure to stressful things like news and learning and practising relaxation techniques like mindfulness meditation and deep breathing, is helpful. 

Poor relationships: The causes of poor relationships are many, including egos and some genuine issues. Giving the relationship a chance and keeping things going is important, as relationship breaks are dangerous for your sexual well-being. Keep yourself in touch with your partner. Even if you cannot achieve an erection, it is still important to keep the blood flowing in the penis. 

Poor eating habits: Eating habits directly influence vascular health and, thus, the ability to achieve and maintain an erection. Poor habits like on-and-off eating throughout the day, eating excessive and unhealthy fats, drinking fizzy and sugary drinks, using food as comfort etc., begins to show their effects as a person passes the youth. A healthy habit is to start improving the eating habits in youth.

Poor sleeping patterns and sleep deprivation: Poor sleep and sleep deprivation often result from lifestyle factors and stresses. It is also a consequence of sleep disorders like nocturia (the need to woke up at night to urinate), insomnia and obstructive sleep apnea (obstruction of breathing during sleep). Sleep disturbances and deprivation cause a 3.34 times higher risk of ED than in people with normal sleep.

Other habits like porn addiction and smoking also disturb erectile functions. Poor addiction increases the resistance to normal erotic stimuli, and a porn-addicted person is likely to be refractory to sexual arousal. Similarly, smoking causes ED by comprising vascular health.

Can smoking or excessive alcohol consumption contribute to ED?

Yes, both smoking and excessive alcohol consumption contribute to the development of ED. 

Smoking: Smoking using cigarettes and various other smoking products causes damage to the circulatory system, disrupting the supply of blood to the penis, which is required for erection. More than 7000 dangerous chemicals have been detected in tobacco smoke. Among these, at least 250 are harmful to human health, including 69 known carcinogens. Different smoking chemicals cause the construction and narrowing of blood vessels, thus compromising the flow of blood throughout the body, including the penis. It is also a risk factor for various other health conditions responsible for ED, like diabetes, hypertension, heart disease, atherosclerosis and poor oxygen supply to the body. 

Consequently, the risk of developing ED in smokers is 2.5 times higher than in non-smokers. 

Additionally, no tobacco product is known to be safe for health, and even menthol cigarettes are unsafe for health and erection functions. Nicotine is responsible for constricting blood vessels, so using nicotine vapes is also unsafe. 

Besides this, cigarette smoking causes increased risk of various other diseases which compromise overall health, including sexual health, like lung cancer, cancers of the stomach, liver, throat, bladder, stroke, type 2 diabetes, rheumatoid arthritis, osteoporosis, cataracts and chronic obstructive pulmonary disease (COPD). 

The research has found that smokers experiencing ED experienced some improvement after quitting smoking. Most (>50%) of the people find benefits in as low as six months. However, the exact timing depends upon various factors like the duration and frequency of smoking in the past, the presence or absence of other health diseases like diabetes or heart disease etc. Sometimes, chronic smokers do not gain an erection even after quitting smoking and treatment through ED drugs is required. 

Alcohol: Alcohol negatively influences the brain, nerves, blood vessels and hormone levels, all of which are important for erection. Heavy alcoholism in a single day causes an acute attack of these abnormalities, causing acute ED. It disrupts the flow of information between the brain and other body parts causing low sensitivity of the penis to the erotic stimulus. Alcohol also has a diuretic effect means, which causes an increase in urine output and dehydration. The dehydration causes the production of another hormone, angiotensin, which causes the blood vessels to narrow, disrupting the blood supply to the penis. Alcohol also suppresses testosterone levels, the hormone essential for libido and erection. Testosterone deficiency decreases nitric oxide production, the molecule responsible for erection. 

Chronic heavy users also experience dysfunction of the autonomic nervous system, the system which controls unconscious and involuntary functions. Moderate to heavy drinking is also associated with an increased risk of cardiovascular diseases and hypertension. 

Alcohol also causes various other sexual health issues, which as low sexual drive, poor sexual arousal, difficulty in achieving orgasm and delayed ejaculation, which negatively influence erectile functions. The ED sometimes persists even after leaving the alcohol as the alcohol withdrawal syndrome develops as a person seeks to avoid drinking suddenly. Various symptoms of alcohol withdrawal syndrome, like hypertension, anxiety, nausea, vomiting, confusion, irritability etc., also contribute to the development of ED. These effects are short-term in most cases, and a study found that 88.5% of drinkers note improvement in erectile functions after 3 months of quitting alcohol drinking.

Are there any lifestyle changes that can help prevent ED from developing in the first place?

Yes, there are many lifestyle changes that prevent ED from developing. These lifestyle changes are helpful if a person is suffering from ED and prevent the symptoms from occurring in the future. Some promising lifestyle changes are;

1. Start waking today: Missing the regular walk during a rough routine is normal. However, spending half an hour daily on a walk is worth it, and studies have noted that 30 minutes daily walk significantly reduces the risk of ED. It is also found that moderate but regular walking helps restore sexual functions, including ED, in middle-aged men with moderate obesity. 
2. Eat healthily: Eating a healthy meal regularly reduces the risk of diseases and health issues. Therefore, using balanced and nutrient-rich diets containing seafood, whole grains, vegetables, fruits, and nuts and avoiding red meats, processed foods, and sugary drinks also help prevent ED. 
3. Be conscious about vascular health:  Higher levels of triglycerides, blood sugar, cholesterol and persistent hypertension cause damage to the arteries in the penis and brain, leading to ED. Coordinate with the doctor to know if vascular health is good through regular checkups. Regular checkups allow the detection of these issues at an earlier stage and make appropriate lifestyle changes timely. 
4. Lose weight: Excessive fat is not only difficult to carry but also harms sexual health, and men with a 42-inch waist size have a 50% higher risk of ED than another man with a 32-inch waist size. So, achieving and maintaining an ideal weight and BMI is an excellent defence against ED, as obesity also interferes with hormones and causes a higher risk of diabetes and cardiovascular diseases. 
5. Regular workout: Most of the workouts target the biceps for aesthetic beauty; however, targeting the pelvic floor muscles helps during erection by helping the blood to stay in the penis. So, pelvic strengthening exercises like kegel exercises are a great way to avoid ED in the future. 

How is Erectile Dysfunction diagnosed?

Erectile dysfunction is diagnosed through sexual and medical history, physical and mental health examinations, laboratory tests, imaging tests, and other health tests. 

Sexual and medical history: Some information related to the history helps the doctor to diagnose the ED. The important things to note are the frequency of ED, the confidence of successful erections, frequency of successful erections, scoring the sexual desire (libido), how often a person can achieve orgasm, the past or current use of over-the-counter or prescription drugs and history of lifestyle risk factors like smoking, alcoholism, drug addiction etc. The doctors also probe past sexual activity. 

Physical and mental health examination: The doctors ask questions about past or current issues with emotional well-being. Often a questionnaire is provided, which has to be filled out by both of the partners. During a physical examination, the healthcare professionals note the sensitivity of the penis to the touch, the presence of curvature or bend on the penis or any other abnormal shape. The abnormal hair growth and breast enlargement, which are the signs of hormonal imbalances, are noted. Similarly, the history of blood pressure and monitoring of pulse in the ankles and wrist is made to see if there are any issues with the blood circulation.

Laboratory tests: Some laboratory tests that help doctors are hormonal tests, kidney function tests, tests for diabetes, blood cholesterol and fats (lipid panel). The blood profile also helps in diagnosing some causes like infections. 

Imaging techniques: The Doppler's ultrasound helps detect problems with the blood flow in the penis. It uses a handheld device (probe) passed over the penis, and the colour images on the computer screen show the direction and speed of the blood flow. The Urologist or the radiologist interprets the results. Sometimes, the doctors inject medicines to induce erection and monitor the blood flow. 

Miscellaneous tests: Besides these tests, some other tests are useful. These are the nocturnal erection test (nocturnal penile tumescence) which uses a ring-like Plastic device wrapped around the penis or an electronic monitoring system to judge the quality of the erections during the night. Normally, there are 3-5 erections during sleep. Their absence means that some physical cause is responsible for the loss of erection. If erections are present, the ED is due to some emotional or psychological factors. 

What medical professionals can diagnose ED?

A specialist doctor called the Urologist is concerned with the Diagnosis of the ED after a thorough analysis of sexual and medical history, clinical signs and symptoms, and exposure to the lifestyle risk factors. A urologist deals with all the diseases affecting the urinary tract of men, women and children and the diseases of the male reproductive system. Some causes of ED need examination by other health professionals. For example, hormonal imbalances need an endocrinologist, ultrasonography needs a radiologist, and the diagnosis and management of psychological factors need a psychologist. Due to the taboo surrounding sexual health, many men find it difficult to consult these professionals or admit they have any such issues. This behaviour complicates the treatment. 

What questions will a healthcare provider ask during an ED evaluation?

Diagnosing any health condition starts with taking a history of the case. It involves asking specific questions to the patient about the condition before proceeding to the tests. The doctors don't expect exact definitive answers, but the guesswork is helpful for the doctor to make a presumptive diagnosis. Some common questions asked by the doctor are;

• Describe the condition. This question means the patient has to explain why he thinks he has ED and how he comes to this conclusion.
• What is the severity of the symptoms? It means the patient has to explain how severe the symptoms are. The patient needs to explain the frequency of failed sexual intercourse due to the ED or if the erections are totally absent. 
• For how long have you been experiencing symptoms? It means the patient has to explain the probable time when the symptoms have started and if they are continuous or interrupted by periods of normal erection.
• Is the severity of symptoms increasing or decreasing? It means the patient has to explain if the symptoms are worsening with the passing days or if they are stable and improving. 
• Have any such problems occurred in the past? The patient has to explain if he had experienced any such symptoms in the past and, if yes, how severe they were and how they resolved.
• The history and exposure to other diseases. The patient has to explain if he had or is having other concurrent diseases like heart disease, vascular diseases, nervous disease, diabetes and hypertension etc. 
• The current and past use of any drugs. The patient needs to explain if he is or had been using any drugs in the past and if yes, the nature, dosage and duration of using these drugs. 
• Information about the lifestyle risk factors. The doctor will also be interested to know about your exposure to various lifestyle risks factors like excessive smoking, alcoholism, use of any addictive drugs, lifestyle, dietary preferences and practices, history of sleep disorders and sleeping patterns, diabetes, sedentary lifestyle and other lifestyle-related health issues like hypercholesterolemia, hypertension etc. 
• The questions about sexual life. The doctors also ask questions about the sex life. For example, about the sexual partners, the presence of sexually transmitted infections in the past, the nature of sexual partners, using any ED drugs in the past and whether sexual life is smooth or had broken, and also about some violent sexual experiences in the past. 
• Experiencing any injuries of external genitals like testes and penis in the past. 

The doctor also asks questions about psychological and emotional issues like relationship issues, experiencing domestic violence, divorce, any traumatic events in the recent past, financial strains, any family health issues, the death of any loved ones in the recent past and many other mental health risk factors.

Are there any medical tests or exams that are typically done to diagnose ED?

Yes, some laboratory tests that help the doctors are hormonal tests, kidney function tests, tests for diabetes, blood cholesterol and fats (lipid panel). The blood profile also helps in diagnosing some causes like infections. Similarly, the doctors also use physical examination and ultrasonography to diagnose the condition.  

Can a healthcare provider diagnose ED based solely on a patient's symptoms?

Partially yes, sometimes, the symptoms are enough to diagnose the simple and uncomplicated cases of ED. However, for complicated cases, the healthcare provider needs to use advanced tests. For example, the damage to the local nerves, blood vessels, and erectile tissues is sometimes unclear on physical examination and requires detailed lab tests like ultrasonography and blood tests. The patients are sometimes reluctant to share all symptoms and hide some aspects like STIs. In these situations, the doctors rely on the information provided by tests more than that explained by the patient. 

The psychological and mental health issues also do not cause apparent physical signs, and the psychologist has to probe them through specific questions. Such complications are likely to be experienced by older adults, and for young people with uncomplicated issues, the physical symptoms are enough for the doctor to make a presumptive diagnosis. 

Can a man self-diagnose ED?

No, it is not recommended that a man with ED uses any self-diagnostic methods or tools to self-diagnose the condition. These methods provide some hints about the problem, but they often need to be more accurate, and the person is also likely to misinterpret the results. 

Various self-testing methods are used, and some are available online. For self-diagnosis, the first and most important thing is to identify the signs and symptoms of ED. An inability to achieve or maintain an erection during most sexual sessions, with accompanying issues like low self-esteem, anxiety, depression, stress and relationship difficulties, are the initial signs to be noted. After that, the patient also needs to check the presence of risk factors like obesity, high cholesterol, diabetes, Heart disease, high blood pressure, emotional stress, physical inactivity, smoking and history of sexual abuse etc. 

Once a presumptive diagnosis is confirmed, some self-diagnosis tests are available. 

NPT test: It meant the nocturnal penile tumescence test and was a widely used test. It is based on the idea that men with normal erections experience several erections during the night, while men with ED will not experience any such erections. In this test, various Stamps in the form of a role are applied in the penile shaft for the whole night. As the penis becomes erect during the night, this role of stamps breaks apart. However, if a man has ED, the role will remain intact. This test doesn't has any side effects or health effects. However, it is discredited by the medical community due to its inaccuracy. It is also ineffective in some cases, like relationship and emotional issues. During these issues, the man will have nighttime erections but will have difficulty having erections during actual sexual intercourse. This test is insufficient, as nighttime erections are often missing in people with normal erectile functions. 

SHIM test: SHIM means sexual health inventory for men. This self-diagnosis method has better accuracy than the NPT test. This test involves filling out a questionnaire having the question that are designed to assess reproductive health and erection functions. Doctors use it, but it is also useful for home testing. The questionnaire is offered by many online sources that help diagnose the condition. However, they do not confirm the condition, and the person has to use the other more precise methods as asked by the doctor.

What are Erectile Dysfunction Treatments?

Once the cause of ED is established, the doctor prescribes the required treatment. The treatment options available at the disposal are;

1. Drugs: Many drugs are available which help control the symptoms of ED. The phosphodiesterase five inhibitors (PDE5 inhibitors) are the most commonly used ones. These drugs stimulate the blood flow into the penis or increase the stability of nitric oxide, which is responsible for erection. The common drugs available are sildenafil (Viagra), avanafil (Stendra), vardenafil (Staxyn, Levitra) and tadalafil (Cialis). 

Some drugs are also available as penis suppositories or self-injections, administered at the side or base of the penis. An example is alprostadil (Edex, Caverjet). Alprostadil is rarely used alone and, in most cases, is combined with other drugs like Trimix (papaverine, phentolamine). 

The patient also needs to consult with the doctor or pharmacist to know what symptoms are caused by some drugs he is taking and talk about the replacement drugs. Some drugs like Cialis are to be used regularly, while the others like Viagra are used before sexual intercourse

1. Hormone replacement therapy: If the cause established is testosterone deficiency, testosterone replacement therapy is prescribed. Various types of testosterone supplements are available which need to be prescribed by the doctor. 
2. Psychological therapy (talk therapy): This therapy is used to treat psychological causes like anxiety, depression, stress, PTSD etc. The patient must discuss major factors like anxiety, depression, feelings about sexual intercourse and relationships, relationship issues and any subconscious conflicts with the psychologist. A relationship counsellor is helpful if there are issues with the relationship. Relationship counselling helps a man to connect emotionally with his partner. 
3. Vacuum pumps: In this treatment, a vacuum is created to cause an erection. The vacuum devices draw blood into the penis, causing an erection. The different parts of a vacuum pump are a plastic tube wrapped on the penis, a pump that draws air out of the tube and creates a vacuum, and an elastic ring moved on the penile base while removing the plastic tube. The elastic ring helps maintain erections by holding the blood and preventing it from escaping into circulation. It should be left in place for 30 minutes.

Alternative and natural methods to treat erectile dysfunction: Many other methods are available to treat ED, like exercises, foods, dietary supplements and herbs, surgery, and traditional treatments like acupuncture and implants. 

Exercises: Kegel exercises are very effective yet simple exercises which help manage ED by strengthening the pelvic floor muscles. The procedure is as follows;

• Identify the pelvic floor muscles. For this purpose, stop urination in the middle. The muscles that helped during this activity are the pelvic floor muscles. 
• After identification, contract these muscles and then relax consecutively for 3 seconds, and repeat this exercise 10-20 times per day and at the frequency of 2-3 sessions each day. 
• Start practising while in the lying position. With practice, try to reach the target of doing it standing or sitting.

1. Natural remedies: Various natural remedies are available and are marked by various sources. However, health agencies do not approve of these remedies, and limited research data is available to support their use. These include;

• L-arginine is an amino acid that opens up the veins (vasodilation) and is thought to increase the blood flow into the penis. Nevertheless, the results of the studies are conflicting. It causes side effects in some users, like stomach cramps, hypertension, high blood sugar, and nausea and is unsuitable with ED drugs like Viagra. It should be used thus only after consulting the doctor.
• Dehydroepiandrosterone (DHEA) is a raw material of the sex hormone estrogen and testosterone. Its falling levels in old age are associated with decreased erection and overall reproductive functions. The results of studies are conflicting, and its excessive use is also associated with side effects like irregular heartbeat, acne, headache and fatigue.
• Propionyl-L-carnitine: it's used alongside ED drugs that benefit ED. Mild side effects are reported in people, like diarrhoea, nausea, skin rash and heartburn. 
• Ginseng: It is obtained from the plant Panax ginseng, and some chemicals in this plant promote erectile functions. The results of the studies are moderate, and broader studies are needed. Side effects like insomnia, headache, hypertension, low blood glucose and increased heart rate can occur. 
• Ginkgo: It increases the blood flow into the penis and promotes erection. The evidence is mostly self-reported, and scientific data is limited. It causes side effects like constipation, palpitations, stomach upsets, bleeding disorders and dizziness.
• Yohimbine: It is obtained from the tree's bark and is one of the aphrodisiacs means the foods that stimulate sexual desire. It is available as a supplement and a prescription drug like yohimbine hydrochloride. Benefits are mostly self-reported, and side effects occur, like hypertension, anxiety, stomach upsets, seizures and heart attacks. 
• Horny goat weed (Botanical name Epimedium grandiflorum): It is traditionally known to promote fertility. An active ingredient in this weed, icariin promotes nerve healing. Some mild side effects like dry mouth, irregular heartbeat, nausea and vomiting are reported. 

1.  Home remedies: These include the methods that can be tried at home and are effective when combined with other methods. These include;

• Exercise: It improves stamina, blood flow and mood and helps regulate blood pressure. It helps in ED by improving overall health. 
• Healthy diet: A healthy diet promotes overall health. Eating a balanced diet containing all essential nutrients help prevent the issues like obesity, atherosclerosis, arteriosclerosis, hypertension, hypercholesterolemia and heart disease. 
• Reducing alcohol usage and smoking: Limiting alcohol usage to just two drinks for men and one daily for women helps protect overall health. Similarly, smoking is another common risk factor for ED and causes ED by compromising the blood flow into the penis. 
• Stress management: Stress due to any issues like relationship issues, financial strains, diseases, and workplace issues damage reproductive wellbeing. The patients need to learn stress management skills. 
• Some traditional treatments: Some traditional options like yoga and acupuncture are helpful. They do not help directly but provide indirect help by reducing stress.

What Medicines are Used to Cure Erectile Dysfunction?

Various medicines are available to treat ED. These medicines work by increasing the blood flow into the penis, making attaining and maintaining erections easier. Most of these drugs are phosphodiesterase five inhibitors (PDE5 inhibitors) and help in erections by inhibiting PDE5, the enzyme which ends erections. The following drugs are used;

• Avanafil: The common brand is Stendra. It increases the blood flow into the penis and needs to be taken 15-30 minutes before sexual intercourse with or without food, as asked by the doctor. The recommended dose at the start is 100 mg which the doctor should decide on as it is a prescription drug. 
• Sildenafil: The most common brand is Viagra. It is taken 30-60 minutes of sexual intercourse. The starting dose is 25-50 mg, which can be increased to 100 mg by the doctor as it is also a prescription drug.
• Tadalafil: The common brand is Cialis. Besides ED, it is also used to treat benign prostatic hyperplasia (BPH). Starting dose is 2.5 mg which can be increased up to 20 mg. As it is available in low dosages, it is advised to be used daily. It is a pharmacy drug and is available over the counter. 
• Vardenafil: The common brands are Staxyn and Levitra. It needs to be used before 1 hour of sexual activity. The initial dose is 10 mg, which the doctor can increase, and not more than one pill should be taken daily. 
• Alprostadil: This drug improves circulation in the penis by dilating the blood vessels. The common brands are Prostin, Edex and Caverjet. It is available as a suppository (which is placed on the penile opening) or as injections which are administered directly into the penis as asked by the doctor. 
• Testosterone replacement therapy: This therapy replaces testosterone in case low testosterone levels are the reason. The endocrinologist decides the dosages, and it typically involves using intramuscular injections, testosterone gels, long-acting pellets given subcutaneously and testosterone sticks. 

Are there side effects from Erectile Dysfunction Medicines?

Yes, ED drugs have many potential side effects, and safe use can minimize these side effects. The common side effects are, 

• Headache: It is the most common side effect and is due to due to changes in the blood flow. Changing the drug is not likely to work, and it goes away after some days. However, if it persists, consult the doctor.
• Body aches: Lower back pains are noted, which are managed by the OTC drugs. 
• Digestive disturbances: Indigestion and diarrhoea are observed in some users. Minor dietary modifications are helpful to manage these effects. However, if they don't work, the patients should go for OTC drugs or consultations. 
• Flushing: It is a sudden yet temporary redness on the skin. These are mild but sometimes become severe and develop rashes. These flushes become more severe due to exposure to heat, alcoholism and eating spicy and hot foods. These are not, however, serious causes of concern. 
• Nasal congestion: It is caused by changes in the circulation, is temporary, and resolves spontaneously. If it persists, the patient needs to consult the doctor. 
• Dizziness is due to higher levels of nitric oxide in the body. It is mild but causes a severe disturbance. However, severe dizziness causing fainting should be taken as an emergency. 
• Sensory disturbances:   Some people note changes in vision (blurred vision) and a temporary loss of hearing. ED drugs are not recommended if a person already has such issues, and a severe loss means there are other issues. 
• Painful and prolonged erections (priapism): Any painful erection that lasts more than 4 hours should be treated as a hospital emergency as it leads to permanent damage to the erectile tissues of the penis. 

The list must be completed, and the patients must read the patent leaflet for more information. In short, inform the doctor about any unexpected issues. 

Can Erectile Dysfunction be prevented?

Yes, many strategies help prevent and delay the onset of ED. The key to success is making healthy lifestyle choices and properly managing existing health conditions. A patient must work with the doctor to manage chronic conditions like kidney and liver diseases, heart diseases and diabetes. The following prevention strategies are useful;

• Stop smoking, avoid or at least minimize the use of alcohol and restrict the use of illegal and addictive drugs. 
• Go for regular screening of health issues and routine checkups.
• Spend at least 30 minutes daily on physical activities and exercises. 
• Learn the techniques to manage stress, recognize the presence of emotional and mental health issues and get help immediately. 

 

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