Erectile dysfunction is a multidimensional but common male sexual dysfunction that involves an alteration in any of the components of the erectile response, including organic, relational and psychological. Defined as difficulty in getting or keeping an erection firm enough for sexual activities, it affects people of all ages but is especially prevalent in men aged 40-70.

Image Credit – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027992/

More worrying is the recent discovery by researchers that the problem is on the rise and affects 15% of the world’s population yearly. Over 150 million men worldwide were estimated to have been affected by erectile dysfunction in 1995, projected to rise to 320 million by 2025.

Erectile Dysfunction is directly associated with Cardiovascular Disease. Men with erectile dysfunction have an increased risk of all-cause mortality odds ratio and cardiovascular mortality. Additionally, they are 1.33-6.24-times more likely to have benign prostatic hypertrophy than those without the problem and 1.68-times more likely to develop dementia.

How can men overcome erectile dysfunction?

Understanding the pathophysiology of erectile dysfunction is essential to understand the problem better. Penile erection occurs after sexual stimulation when nitric oxide is released from non-adrenergic noncholinergic nerve fibers. Acetylcholine is released from parasympathetic cholinergic nerve fibers in the CNS. the result of the ensuing signaling pathways is increased cyclic GMP (cGMP) concentrations, decreased intracellular Ca2+ levels, and smooth muscle cell relaxation, causing blood to fill the lacunar spaces in the corpora cavernosa and erection of the penis. The process is reversed as cGMP is hydrolyzed by phosphodiesterase type 5. Erectile dysfunction occurs when these processes are interrupted due to physical, psychological, or stress factors.

Image Credit – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027992/

How to overcome erectile dysfunction

– Exercising

– Alcohol Abstinence

– ED Medications

Exercising

Physical activity has proved to be a protective factor against erectile problems, primarily due to vascular dysfunctions. Exercising, especially in the form of Kegels, targets the muscles of your pelvic floor, found in the pelvic floor of the pelvis. The pelvic floor comprises a group of ligaments and muscles that, in addition to keeping the muscles in place, grants stability to the organs in and around it.

Factors like age, obesity surgery, long duration of sitting, a sudden increase in activity levels, and stress impact the tightness of the floor and compress the artery providing blood to the penis, subsequently initiating erectile problems. Alternatively, if the pelvic floor is weak, the outflow of blood isn’t prevented, and an erection can’t be maintained.

Image Credit – https://www.healthymale.org.au/news/male-pelvic-floor-muscles-erectile-dysfunction

In a study conducted to evaluate the importance of exercising in ED conditions, a systematic review was performed of research articles specifically investigating physical activity as a possible treatment of erectile dysfunction. The review included research about the dysfunction from physical inactivity, obesity, hypertension, metabolic syndrome, and cardiovascular diseases. All available studies from 2006 through 2016 were checked for the predetermined inclusion and exclusion criteria to analyze the levels of physical activity needed to decrease the problem of ED.

Ten articles met the inclusion criteria, all suggesting various levels of physical activity needed to decrease the symptoms of erectile dysfunction for men diagnosed with the problem. The results of the review provided sufficient research evidence for conclusions regarding the levels of PA necessary to decrease

The study concluded that 40 minutes of aerobic exercise of moderate to vigorous intensity four times per week and weekly exercise of 160 minutes for six months contributes to decreasing erectile problems in men with ED caused by physical inactivity, obesity, hypertension, metabolic syndrome, and cardiovascular diseases.

Before initiating the exercises, it is important to ascertain with your physiotherapist whether your problem is due to a weak pelvic floor or an overactive pelvic floor and start exercising based on the information.

Alcohol Abstinence

Alcohol interferes with the messengers in the brain that tell the penis to fill with blood. It can also happen because alcohol can reduce the production of testosterone. Animal studies have proved that acute alcohol administration can activate the cAMP pathway, positively affecting erectile function. In contrast, chronic alcohol administration can change the ultrastructures of the corpus cavernosum and suppress Nitric Oxide expression, leading to erectile problems.

(A) Changes in plasma alcohol concentration after alcohol administration. (B) ICP/MAP percentage changes during cavernosal nerve electrical stimulation after alcohol administration. *Significant difference from the control group (p<0.05). ICP/MAP: intracavernosal pressure/mean arterial pressure.

Image Credit- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419118/

In a study conducted to determine the relationship between erectile problems and alcoholism, one hundred and four subjects with alcohol use disorder and complaints of ED meeting the inclusion and exclusion criteria were recruited into the study after taking written informed consent. The subjects were assessed at baseline and after three months of abstinence from alcohol with IIEF-5 and a specially designed pro forma. Wilcoxon signed-rank test was used to evaluate the change in ED after three months of abstinence. A Chi-square test was done to assess the associations, and binary logistic regression was done to determine the significance of variables after three months of abstinence Improvement in ED occurred after three months of abstinence from alcohol. Its association between sociodemographic and clinical variables was assessed and found to be correlated.

Of the 104 subjects, 88.5% showed improvement in the problem after three months of abstinence. Wilcoxon signed-rank test showed significant improvement in ED after three months of abstinence. A significant association was found between age, alcoholic liver disease, total duration of drinking, and the number of standard drinks per day with ED after three months of abstinence.

The study concluded that in the absence of other systemic conditions, abstinence from alcohol could solve the problem of erectile problems to a significant extent.

ED Medications

Medications or ED pills belong to the phosphodiesterase-5 inhibitor group of medications and work on inhibiting the phosphodiesterase enzyme that relaxes muscles and increases blood flow to the penile region for achieving and sustaining erection.

Viagra or Sildenafil Citrate is one of the most common ED pills used to manage erectile functions and has an impressive success rate of more than 70%. In addition to Viagra or Sildenafil, other ED drugs available in the United States include avanafil, tadalafil, and vardenafil, all of which improve blood supply to the penis in combination with sexual stimulation and help in achieving a quality erection. Viagra is the brand version of Sildenafil Citrate, but generic Sildenafil is also available by Kamagra Australia and is a cost-effective version of the drug.

Despite the availability of several ED pills of various forms, Sildenafil remains the most popular medication. In a clinical study conducted to determine the efficacy and safety of Sildenafil, in a 24-week dose-response study, 532 men were treated with oral Sildenafil (25, 50, or 100 mg) or placebo. In a 12-week, flexible dose-escalation study, 329 men were treated with Sildenafil or placebo, with dose escalation to 100 mg based on efficacy and tolerance. After this dose-escalation study, 225 of the 329 men entered a 32-week, open-label extension study. In the last four weeks of treatment in the dose-escalation study, 69 percent of all attempts at sexual intercourse were successful for the men receiving Sildenafil, compared with 22 percent for those receiving placebo. Headache, flushing, and dyspepsia were the most common adverse effects in the dose-escalation study, occurring in 6 percent to 18 percent of the men. Ninety-two percent of the men completed the 32-week extension study.

The study concluded that Sildenafil is an effective, well-tolerated medication for erectile dysfunction. Other studies have mentioned the efficacy of Tadalafil and Vardenafil being equivalent to Sildenafil, but further research is required before arriving at definite conclusions.

Key points

Medications are some of the most effective ways of dealing with Erectile Dysfunction.
Apart from medications, exercise, and alcohol abstinence are equally crucial in dealing with the problem.
Viagra and other Sildenafil ED pills like Kamagra are popular ED pills preferred by a large percentage of the ED population.
Physician advice and prescriptions are required before using medications for Erectile Dysfunction.