Masterclass Series — Erectile Dysfunction

Objectives of the Class

1. Educate Yalians, married and prospective Husbands and wives understand Erectile dysfunction.
2. Prevention and treatment options for Erectile Dysfunction

INTRODUCTION

Erectile dysfunction (ED) affects 50% of men older than 40 years, exerting substantial effects on quality of life. This common problem is complex and involves multiple pathways. Penile erections are produced by an integration of physiologic processes involving the central nervous, peripheral nervous, hormonal, and vascular systems. Any abnormality in these systems, whether from medication or disease, has a significant impact on the ability to develop and sustain an erection, ejaculate, and experience orgasm.

DEFINITION

Male erectile dysfunction is the inability to achieve, maintain and sustain an erection sufficient for satisfactory sexual performance.”

Erectile dysfunction is when a man can’t get an erection to have sex or can’t keep an erection long enough to finish having sex.

ED is different from ejaculation problems. ED tends to affect the psychological and emotional well being of men. Some men who have this problem are often shy to complain because of loss of self-esteem associated with this condition thus resulting in late presentation that delays early treatment.

Some men do prefer to seek remedy to this condition by patronizing African traditional herbal practitioner.

Erectile dysfunction is commonly seen among men with hypertension, diabetic mellitus and psychosis when it is often related to the disease as well as the medications. Other known causes of Erectile dysfunction are sickle cell hemoglobinopathy patients who develop priapism. It is common among married men and those with significant alcohol ingestion and cigarette smoking.

Above are the common causes

Is erectile dysfunction just a part of old age?

Erectile dysfunction doesn’t have to be a part of getting older. It’s true that as you get older, you may need more stimulation (such as stroking and touching) to get an erection. You might also need more time between erections. But older men should still be able to get an erection and enjoy sex.

Feelings that can lead to erectile dysfunction include

• Feeling nervous about sex, perhaps because of a bad experience or because of a previous episode of impotence
• Feeling stressed, including stress from work or family situations
• Being troubled by problems in your relationship with your sex partner
• Feeling depressed
• Feeling so self-conscious that you can’t enjoy sex
• Thinking that your partner is reacting negatively to you i.e Partner factors (eg, partner sexual problems or health issues)
• Relationship factors (eg, communication problems, differing levels of desire for sexual activity, or partner violence)
• Individual vulnerability factors (eg, history of sexual or emotional abuse, existing psychiatric conditions such as depression, or stressors such as job loss)
• Cultural or religious factors (eg, inhibitions or conflicted attitudes regarding sexuality)
• Medical factors (eg, an existing medical condition or the effects of drugs or medications)
• Psychological factors account for many cases of Erectile dysfunction. NOTE
• Trauma — Trauma to the pelvic blood vessels or nerves can also lead result in Erectile dysfunction . Bicycle riding for long periods has been implicated as an etiologic factor; direct compression of the perineum by the bicycle seat may cause vascular and nerve injury. On the other hand, bicycling for less than 3 hours per week may be somewhat protective against Erectile dysfunction. Some of the newer bicycle seats have been designed to diminish pressure on the perineum.

Signs and symptoms

Problems in your relationship with your sexual partner can also cause erectile dysfunction. Improving your relationship may help your sex life. If you decide to seek therapy, it will probably be most effective if your sex partner is included. Couples can learn new ways to please one another and to show affection. This can reduce anxiety about having erections. ⁠⁠⁠

• Erections that are too soft for sexual intercourse.
• Erections that are too brief for sexual intercourse.
• An inability to achieve erections.
• Mood changes
• Anxiety

Diagnosis & Tests

How is erectile dysfunction diagnosed?

Your doctor will probably start by asking you some questions and doing a physical exam. Samples of your blood and urine may be tested for diseases and disorders. Other tests may also be needed. Your doctor will determine which tests are right for you

The first step in the management of Erectile dysfunction is a thorough history that includes the following:

• Sexual history
• Medical history
• Psychosocial history

TREATMENT

How is erectile dysfunction treated?

The treatment for erectile dysfunction depends on what is causing it.

Treatment options for Erectile dysfunction include the following:

• Sexual counseling, if no organic causes can be found for the dysfunction
• Oral medications
• Injected, implanted, or topically applied medications
• External vacuum and constriction devices
• Surgery

Suggested measures for preventing Erectile dysfunction include the following:

• Optimal management of diabetes, heart disease, and hypertension
• Lifestyle modifications to improve vascular function (eg, not smoking, maintaining ideal body weight, and engaging in regular exercise)
• Exercise and lifestyle modifications may improve erectile function. Weight loss may help by decreasing inflammation, increasing testosterone, and improving self-esteem. Patients should be educated to increase activity, reduce weight, and stop smoking, as these efforts can improve or restore erectile function in men without comorbidities. Precise glycemic control in diabetic patients and pharmacologic treatment of hypertension may be important in preventing or reducing sexual dysfunction.

Note that there are four phases of male sexual response cycle

1. Desire
2. Erectile Ability or arousal
3. Orgasm
4. Relaxation

Folks with Erectile dysfunction can achieve 1 and sometimes 2 but can’t proceed to 3

Erectile Team
THANK YOU FOR PAYING ATTENTION

Questions and Comments

Question:

Are you saying people with Erectile dysfunction can’t have sex?

Answer:

They can depending on the severity of Erectile dysfunction. Based on definition, For some who can achieve erection they won’t be able to maintain it to satisfactory level.

Question:

How do you estimate an erection that is too brief for sexual intercourse.

Answer:

Depends on individuals experience, foreplay , psychological factors. Penis erects via blood vessels filling its sac. based on studies, it takes average of 5.4 min range of about 5 to 12 min during commencement of penetrative sex i.e what a lay man calls R1. A penis void of Erectile dysfunction should be in erect position during foreplay, penetration to orgasm by so doing it earn his respect and leadership status.

Question:

Do we have cases of Erectile dysfunction among young men, bcos you say it occurs among adult of over 40yrs.

What’s d different between Erectile dysfunction & ejaculation problems., are they related, ?

Answer:

Yes. Even men in their 20s experiences Erectile dysfunction but mostly psychogenic. Sexual behavior and penile erection is also controlled by the Brain i.e hypothalamus, cerebral cortex and limbic system

Question:

Abeg is over erectionism a dysfunction?

Comment — Which one is over erectionism again o ? Dr this student don read pass syllabus o

Answer:

Some folks have priapisim common among people with sickle cell anemia or excessive use of aphrodisiac i.e herbs or conventional drugs. I have once treated patient who had painful erection for 3 days.The unfortunate thing is that most patients with who undergo surgery for priapism may hardly recover from Erectile dysfunction. Also important to note that patient who lose their penis during accident can be assisted with prosthetic penis i.e artificial

Question:

Is it true that sometimes, the kind of woman, her shapes, colour or sizes determine man’s erection?

Comment — True, Curvy tells your brain she’s fertile and hence you are just attracted. But what do I know sef, Dr Stoph has the perfect answer.

Comment — I believe this is all in the mind.

Question:

Is there any correlation between Erectile dysfunction and fertility?

Second question is not directly related to Erectile dysfunction but still relates. Is Erectile dysfunction a side effect of Vasectomy?

Answer:

A little view on the first question.

When we are looking at erectile dysfunction, we looking at an inability to attain an effective erection, with the staging explained earlier, Erectile dysfunction lacks ejaculation which is the time when the expulsion of semen takes place. This is basically more to the excitement or attainment of sexual satisfaction for the partners, while fertility is a different game altogether; fertility has to do with the quality and health status of the sperm cells.

Having understood the two, the correlation between them starts here, fertility has a high dependence on physiological health, this accounts for why a lot of teenage pregnancies occur, when the mind says wow, I know am okay and going to enjoy this to the last drop, the body is relaxed and all chemistries work perfectly such the slightest shot gives us a baby, for the individual experiencing an Erectile dysfunction, his mental state isn’t balanced such fertility is hampered.

That explains why expectant couples are usually advised to not focus their mind on getting pregnant but to enjoy themselves, the pregnancy naturally gets in.

Answer:

Is there any correlation between Erectile dysfunction and Infertility. Though Erectile dysfunction and infertility are different, Erectile dysfunction may interfere with one’s fertility status depending on its severity. A man may have issues with erection but can still get the wife pregnant howbeit with some difficulty. What one needs to get pregnant is to be able to bring the sperm and the ovum together for fertilization to occur. So, a man may not be able to maintain erection long enough for his own sexual satisfaction but once he ejaculates into the vagina fertility may not be a concern all things being equal. Having said that, the psychological problems a couple may face from non-satisfactory sex may reduce the frequency of sex and this may in turn affect fertility as regular sex of @ least 3 times a week is required for pregnancy to occur.

Vasectomy is the male form of permanent contraception synonymous with tubal ligation in the female. Vasectomy and Tubal ligation are both commonly practiced overseas. The side effects of a well performed vasectomy are minimal and does not include Erectile dysfunction.

The choice of contraception depends on d couple. A man may decide to spare his wife of the stress of a tubal ligation and have a vasectomy instead as a demonstration of his love for her. Having said that, it’s important to note that the failure rate of vasectomy is much lower than a tubal ligation therefore I will recommend u have it done as a better family planning option

Comment :

Thank you Dapolise and everyone that answered my questions. You are all amazing. I now get the correlation .One last one from your response, i’ve always know vasectomy to be reversible and thus not permanent. You said a vasectomy is permanent, could you pls shed more light. Gracias

Answer:

Thanks TMPT (would actually like to know what TMPT stands for). Yeah, let’s say the word permanent is used here loosely. Fine, there have been reports of some surgeons carrying out a re_anastomosis of the sperm ducts in a bid to reverse the process but then subsequent results in terms of tubal patency have been quite poor. This is due to fibrosis that occurs along d duct following the procedure. So, it goes beyond just joining the tubes together anatomically; the functionality of such fibrosed tube must be considered as well. Wherever you go today, before the urologist carries it out, he tells u the near impractical reversibility of the procedure before informed consent is obtained. Some may claim they have successfully reversed the procedure but such claims have not been subjected to proper verification in the light of available evidence.

Comment:

Doctor, kudos. Job well done. Well researched, and I think u passed it across in an appealing manner.

Some of us would have wished to give u support but u know how busy call duties can be.

Thumbs up bro! Una do well.

Question:

Do you advice you male patient to do a vasectomy as a method of family planning?

Comment :

So guys be careful of using excessive drugs to impress ur wives. You can risk priapism. For men above 50 years, cause of Erectile dysfunction is Organic i.e Vascular- Diabetes, Hypertention, Hormonal.Hypogonadism Some medications causes Erectile dysfunction i.e some Drugs used for treatment of hypertension. Women married to men who are Diabetic, Hypentensive Beware

Comment :

Dr Lekan and the supporting Dr’s, I appreciate you O. People wey never talk before talk on top this matter. I painstakingly went through the chats. I once met a man at Ibadan, he bought 3 different ‘agbo’ herbs that came his way and I was wondering! Masterclass people, una do well o

Question:

My question is this: can masturbation increase chance of being a victim?

Comment :

Except when masturbation becomes addiction i.e porn addicts. Masturbation is initiated by thought process, which causes massive flow of some chemicals dopamine in the brain. Recent research in the US showed that chronic masturbation makes dopamine receptors that were once sensitive less sensitive and normal physical stimulation from a partner does not Dopamine to stimulate d receptors. Chronic masturbation may also predispose to premature ejaculation because the brain would have been used to short duration experienced when d individual is alone.

About Dr Lekan

Lekan Ogundare ‘Dr Stoph’ is a Medical doctor and a Life Strategist . He is passionate about promoting good health(SDG3) and helping others succeed in the community. This Public health advocate has made strong impact in the health sector via provision of free Antiretroviral therapy and support for people living with HIV. He is the founder/CEO of Game Changers Initiative (GCI) a non-profit organisation set up to unlock the innovative skills of youngsters for positive impact in Africa. E-mail: lekandarey@gmail.com Facebook: Lekan Oludare Twitter : @realstoph

Instagram: @realstoph

Originally published at rlcfellowsnigeria.wordpress.com on December 27, 2016.