As a practicing Doctor in Kenya, I have been consulted many times by patients experiencing erectile dysfunction (ED). Erectile dysfunction (Impotence) is so common affecting about 50% of men over 40 years of age and hence reducing quality of life. It becomes more common after the age of 65 years. You will be surprised by men over 80 years of age still looking to be sexually active visiting clinicians to treat their ED. What I have noted to be interesting is that even young men experience some form of erectile dysfunction due to drugs especially Miraa or Khat in our communities. Some of the people who chew khat report that they experience stronger emotional feelings when under the influence but down there they can’t perform. Some young men especially in our campuses use sildenafil commonly known as Viagra or the blue pill to just boost their confidence due to the immense pressure to sexually perform due to higher expectations from our ladies as a result of watching pornographic materials and such, this is a worrying trend since the drug has serious cardiovascular risk!
Erectile dysfunction is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Penile erection is a complex thing involving many systems and including psychological and physical sexual stimuli in order to achieve it. Any disruption of all these systems can lead to erectile dysfunction hence the thorough history, examination and tests by the doctor to try and find the cause.
Your doctor will take an extensive sexual, medical and psychosocial history and then do a physical examination in trying to find the cause of the erectile dysfunction. It is important for the partner to be present too. History will dig in to their sexual life, any life stressors and depression, foreplay before sexual encounter, anxiety, if they have experienced any problems before and so much more. The doctor will take your blood pressure since there is a strong correlation between hypertension and erectile dysfunction. Your genitalia will be examined.
Erectile dysfunction is divided into two broad categories: – Organic and psychogenic. Most cases involve both psychological and organic causes leading to the erectile dysfunction. There are many causes of ED, the most common causes include hypertension, diabetes, heart diseases, neurological disorders, endocrine conditions such as thyroid disorders and hypogonadism, prostate diseases, sleep apnea, trauma to the genitalia, depression, smoking, inactivity, obesity and certain drugs including recreational drugs.
Laboratory testing for erectile dysfunction include blood tests for haemoglobin, biochemistry, hormonal status and lipid profile, Prostate specific antigen levels and urinalysis of your urine. Imaging studies might be done to assess the vascular status of your genitalia using ultrasound.
Management of erectile dysfunction include psychosexual counselling if there is no organic cause found, oral medication such as sildenafil (Viagra or the blue pill) prescribed only by your doctor since the drug carries a cardiovascular risk which the doctor usually access. Injected, implanted or topically applied medications can also be used. For management, your doctor will advise accordingly depending on the history, examination and tests findings.
Optimal management of hypertension, diabetes and heart diseases is important in erectile dysfunction. Lifestyle modification to improve vascular function is also important such as maintaining ideal weight, not smoking and regular exercise.
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