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MALE SEXUAL DYSFUNCTION
ERECTILE DYSFUNCTION


Semir A. S. Al Samarrai

 

Introduction:

Erectile dysfunction (ED and Impotence) is main complaint in male sexual medicine.

Definition

Erectile dysfunction has been defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.

Diagnosis

Erection is a neurovascular phenomenon under hormonal control. It includes arterial dilatation, corporal smooth muscle relaxation of the both cavernous corpora of the penis, and activation of the corporal veno-occlusive mechanism.
Erectile dysfunction is a benign disorder, it affect physical and psychosocial health and has a significant impact on the quality of life of sufferors and their partner and families 

Epidemiology

Recent epidemiological data shown an overall prevalence of 52% erectile dysfunction in non-institutionalised. 40 to 70 year-old men in one area in the USA.
Specific prevalence for minimal, moderate, and complete erectile dysfunction were 17.2 %, 25.2 % , and 9.6% respectively.

Risk Factors:

Erectile dysfunction shares common risk factors with cardiovascular disease (e.g. lack of exercise, obesity, smoking, hypercholesterolaemia, metabolic syndrome).
Men who began exercising in midlife had a 70% reduced risk for erectile dysfunction compared to sedentary men and significantly lower incidence of erectile dysfunction over an 8 years follow up period of regular exercise (MMAS)(4).
Significant improvements in body mass index (BMI) and physical activity, as well as in erectile function, were observed in the lifestyle intervention group, the change were highly correlated with both weight loss and activity levels (5).

Management of Erectile Dysfunction:

Advances in basic and clinical research in erectile dysfunction during the past 15 years led to the development of several new treatment options for this disease, including new pharmacological agents for intracavernous, intraurethral, and more recently, oral use (6,7,8). An increasing number of men are seeking help for erectile dysfunction due to the great media interest in erectile dysfunction and the availability of effective and save oral drug therapy. However, there are many physicians evaluating and treating erectile dysfunction without appropriate background knowledge and clinical experience. Thus, same men with erectile dysfunction may receive small evaluation or not enough before treatment and will therefore not receive treatment for any underlying disease that may be causing their erectile dysfunction. 

References:

1. Lue TF, Tanagho EA. Physiology of erection and pharmacological management of impotence. J Urol 1987 May;137(5):829-36. [no abstract available]

2. Feldman Ha, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male aging Study. J Urol 1994 Jan;151(1):54-61.

3. Wespes E. [Ejaculation and its disorders.] Encyclopedia Medico-Chirurgicale, Nephrologyie-Urologie, 18-710, Paris, 1992 [Article in French].

4. Derby CA, Mohr BA, Goldstein I, et al. Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk? Urology 2000 Aug;56(2):302-6.

5. Esposito K, Guiliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 2004 Jun;291(24):2978-84.

6. Goldtein I, Lue TF, Padma-Nathan H, et al; Sildenafil Study Group. Oral sildenafil in the treatment o erectile dysfunction.1998. J Urol 2002 Feb;167(2 Pt 2):1197-203. [no abstract available].

7. Hellstrom WJ, Gittelman M, Karlin G, et al; Vardenafil Study Group. Sustained efficacy and tolerability of vardenafil, a highly potent selective phosphodiesterase type 5 inhibitor, in men with erectile dysfunction: results of a randomized, double-blind, 26-week placebo-controlled pivotal trial. Urology 2003 Apr;61(4 Suppl):8-14.

8. Brock GB, McMahon CG, Chen KK, et al. Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J Urol 2002 Oct;168(4 Pt 1):1332-6.

Correspondence:
Prof. Dr. SEMIR AHMED SALIM AL SAMARRAI
Professor Doctor of Medicine-Urosurgery, Andrology, and Male Infertility
Dubai Healthcare City, Dubai, United Arab Emirates.
Mailing Address: Dubai Healthcare City, Bldg. No. 64, Al Razi building, Block D,
2nd floor, Dubai, United Arab Emirates, PO box 13576
Email: fmcalsam@emirates.net.ae