Erectile dysfunction (ED) is a prevalent condition characterised by the inability to achieve or maintain an erection sufficient for sexual intercourse. 

This condition can significantly impact quality of life and often indicates underlying health issues. Understanding the multifactorial nature of ED is crucial for effective diagnosis and management. 

DEFINITION AND PREVALENCE 

ED is a penile disorder affecting erection by preventing adequate blood flow to the erectile tissue. It can result from physical, psychological, or combined factors. It is the most reported sex-related condition among men aged 40 to 70, with prevalence increasing with age and comorbid  health conditions. 

AETIOLOGY AND TYPES 

Vascular: The most common type, vascular ED, involves blood vessel issues in the penis and is often linked to cardiovascular diseases, atherosclerosis, hypertension, and hyperlipidaemia. 

Neurogenic: Neurogenic ED results from nerve damage preventing signal transmission from the brain to the penis due to pelvic trauma, spinal cord injuries, neurological diseases, or pelvic surgeries. 

Hormonal: Hormonal imbalances, particularly testosterone deficiency, can lead to ED. Thyroid disorders also fall under this category. Psychogenic: Psychogenic ED arises from psychological factors such as stress, anxiety, depression, or relationship issues, often requiring psychological counseling or therapy. 

SYMPTOMS AND DIAGNOSIS 

Symptoms include difficulty achieving or maintaining an erection, reduced rigidity, and needing extensive stimulation. Diagnosis involves medical and sexual history, physical examination, and targeted laboratory tests, including: 

• Blood tests (CBC, lipid panel, liver and kidney function, thyroid function, testosterone levels)
• Urinalysis
• Penile Doppler ultrasound
• Penile biothesiometry
• Vasoactive injection tests
• Magnetic resonance angiography.

MANAGEMENT AND TREATMENT 

Lifestyle changes like more exercise, quitting smoking, managing weight, and healthy eating are first-line interventions. Oral medications such as phosphodiesterase type 5 inhibitors (sildenafil, vardenafil, tadalafil, avanafil) are commonly prescribed. Intracavernosal injections with alprostadil or combination therapies provide alternatives. 

Device-based therapies like penile low-intensity focused shockwave therapy (LiSWT) and vacuum erection devices enhance penile blood flow.  

Penile implants offer a surgical solution for severe cases. Testosterone  replacement therapy is beneficial for documented testosterone deficiency. Psychogenic ED often requires therapy, counseling, and psychiatric medication. Partner communication and support are critical. 

CONCLUSION 

Erectile dysfunction requires a comprehensive approach to diagnosis and treatment. Early identification and management improve outcomes and quality of life. Clinicians should suspect underlying health issues in ED patients and adopt a holistic treatment approach, including lifestyle changes, medication, devices, hormonal treatment, and psychological support.

References available on request.