Erectile dysfunction is an erectile response where relational, organic, and psychological alteration affects the normal operation of male sexual organs (Yafi et al., 2016). The disease is evident in men where sexual functions, as well as overall quality of life, are significantly affected. Cardiovascular disease and metabolic syndrome are known symptoms of erectile dysfunction as one's comprehensive history, and physical exam is taken into consideration as an auxiliary aid. Diagnosis, treatment, and management of erectile dysfunction start through hormone evaluation, where epidemiology and morbidity are identified to determine sugar metabolism and lipid levels. Appropriate medical therapies are taken into consideration once erectile dysfunction etiology is established to determine the specific subtype of the disease.
Epidemiology
Different populations and settings are taken into context when exploring the epidemiology of erectile dysfunction. The disease is more prevalent to older men than younger men, and thus age, emotional function, and health status define vulnerability and infection rate. According to Chiang, Kam, Yau & Ng (2017), there is a 52% of mild erectile dysfunction of men aged 40-70 years as the prevalence increases with age. However, socio-economic and cultural variables such as hypogonadism, depression, alcohol and drug use, and smoking couples up as part of factors that increase the prevalence of erectile dysfunction for aging men.
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Morbidity
Sex is an important activity in people's lives as both men and women subjected to sexual engagement. As 26 to 90 percent of men and women aged between 70 -90 years actively engaged in sexual activity, erectile dysfunction is a problem that affects approximately 45% of US men. However, sexual activity in aging men and women vary due to relationship satisfaction, sleep satisfaction, attitude, alcohol intake, physical and mental health as well as marital status that facilitate a holistic approach towards treatment. For instance, the mortality rate for men with complete ED is higher as compared to none/minimal ED with 1.60 CI and 1.29 CI respectively. The mortality rates, causes and level of erectile dysfunction depend on age. However, men suffering from erectile dysfunction and cardiovascular disease are vulnerable to stroke, cardiovascular death, heart failure and heart attack.
Pathophysiology
The contraction of the penis is regulated by a combination of endothelium-derived contracting factors (endothelins and prostaglandin), intrinsic myogenic control, and adrenergic control. A Nitric acid is released from non-adrenergic noncholinergic nerve fibers and acetylcholine, causing penis erection that is stimulated through sexual activity with an increase in cyclic GMP. Blood fills lacunar spaces as muscles relax, leading to compression of the subtunical venues. Any interruption on the process, whether on the reversed procedure, causes erectile dysfunction as the penis remains in its flaccid state during smooth muscle contraction (Hatzimouratidis et al., 2016). Erectile dysfunction occurs due to causes such as psychogenic, nonendocrine, endocrine, and hypogonadism.
Clinical presentation
Clinical presentation and identification of pathogenetic factors define or suggest a possible solution to diagnosis and successful treatment of erectile dysfunction. Common clinical presentation is done through physical examination where a patient is required to answer questions regarding his medical history for treatment recommendation or practitioner to determine how to diagnose erectile dysfunction. However, tests are done for those having chronic health conditions, which include physical examination on testicles and penis to determine the sensation of nerves, blood tests, urine tests, ultrasound, and psychological examination.
Diagnosis and management
The management of erectile dysfunction is performed through a systematic correctable etiology involving lifestyle modification, first-line therapies, and second-line therapies (Chiang, Kam, Yau & Ng, 2017). Both Vacuum erection devices and PDE5 inhibitors are used as first-line therapies as intracavernosal injection with vasoactive substances and intraurethral suppository of prostaglandin E1 used as second-line therapies. Lifestyle modification is used by physicians who establish reversible risk factor contributing to patient’s erectile dysfunction. These factors include a poor diet, endocrinopathies, medications, anxiety, and low exercise. Also known as nonsurgical intervention, first-line therapies such as PDE5 inhibitors, vacuum erection devices, intraurethral suppository, and intracavernosal injection are used to create a sexual revolution and manage erectile dysfunction. However, second-line therapies are based on surgical intervention, such as penile implants, and penile revascularization are used to manage erectile dysfunction ( Arcaniolo, Autorino, Balsamo & De Sio, 2017 ).
References
Arcaniolo, D., Autorino, R., Balsamo, R., & De Sio, M. (2017). Optimum Use of Second Line Treatment Options for Erectile Dysfunction. In Practical Tips in Urology (pp. 157-177). Springer, London.
Chiang, L. K., Kam, C. W., Yau, K. C. M., & Ng, L. (2017). Characteristics of patients with erectile dysfunction in a family physician-led erectile dysfunction clinic: Retrospective case series. Family Medicine and Community Health , 5 (1), 85-91.
Hatzimouratidis, K., Salonia, A., Adaikan, G., Buvat, J., Carrier, S., El-Meliegy, A., ... & Khera, M. (2016). Pharmacotherapy for erectile dysfunction: recommendations from the Fourth International Consultation for Sexual Medicine (ICSM 2015). The journal of sexual medicine , 13 (4), 465-488.
Yafi, F. A., Jenkins, L., Albersen, M., Corona, G., Isidori, A. M., Goldfarb, S., ... & Tan, R. (2016). Erectile dysfunction. Nature reviews Disease primers , 2 (1), 1-20.
