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Erectile dysfunction: We’re going out on a limp here
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Erectile dysfunction: We’re going out on a limp here

While hypertension, high cholesterol and smoking can all lead to erectile dysfunction, physical and psychological causes play a part too
While hypertension, high cholesterol and smoking can all lead to erectile dysfunction, physical and psychological causes play a part too
Photo by Anantha Subramanyam K

Recently, a 55-year-old man walked into a private hospital in Mumbai complaining of erectile dysfunction, or ED. He reported experiencing gradual difficulty in achieving and maintaining an erection over the past four years. The doctors found out he was on medication for hypertension and high cholesterol – and also smoked 10 cigarettes every day.

The man then underwent counselling for quitting smoking and increasing physical activity to lower cholesterol. The doctors also advised a planned medication treatment for hypertension and a proper diet chart.


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They said it was a “herculean task” to get the man to change his unhealthy lifestyle despite using medication and counselling. But when he found there was some change for the better, he was finally motivated to quit smoking. Gradually, the doctors reduced his medication and positive reinforcement also helped address his ED.

What is erectile dysfunction?

“Erectile dysfunction is the inability to get or hold on to an erection required for intercourse,” says Dr Rajan Bhonsle, professor and head of department, sexual medicine, KEM Hospital and Seth GS Medical College, Mumbai. “The other term for erectile dysfunction is impotency. Infertility and impotence are different.

“In the medical fraternity, we call impotency erectile dysfunction. The word impotent or impotency is often referred to [in a] derogatory [way], which should not be the case. Erectile dysfunction is not a disease. It is a symptom involving other factors like the physical and psychological health of a person. ED may also happen if a man is fatigued, under stress or under the excessive influence of any substance.”

How common is erectile dysfunction?

Erectile dysfunction is a common medical problem, according to a 2002 article published by the Boston University School of Medicine (Sexual Medicine). It is seen mostly in men above 40 with mild to severe complications, the article says. Also, about 5% to 10% younger men (below the age of 40) have issues of ED.

smoking and erectile dysfunction

Causes of erectile dysfunction

Dr Sanjay Kumavat, consultant psychiatrist and sexologist, Fortis Hospital, Mulund, Mumbai, lists the following causes of erectile dysfunction:

  • Psychogenic: ED may be caused by stress, anxiety and depression. Its onset can be sudden and acute
  • Vascular: ED is a condition where the penile blood vessels, which supply blood to the penis, are blocked or damaged
  • Hormonal: Lack or deficiency of testosterone and thyroid hormones
  • Neurogenic: Traumatic injury to nerves supplying penile musculature
  • Metabolic: Diabetes and other conditions like heart diseases and blood pressure
  • A deficiency in vitamin B complex may also contribute to the development of erectile dysfunction.

Smoking is also a risk factor. “Cigarette smoking is very commonly associated with erectile dysfunction,” says Dr Sulaiman Ladhani, chest physician, Masina Hospital, Mumbai. “The more you smoke, the more [your] chances of erectile dysfunction.” 

How to fix or treat erectile dysfunction

Treatments for ED range from non-invasive to invasive methods. “The treatment mostly aims to enhance erectile function, improve circulatory health and quality of life,” says Dr Vishnu Vardhan Reddy, senior consultant urologist, Kamineni Hospitals, Hyderabad. He lists the following treatment methods:

  • Psychotherapy and counselling: to overcome stressful situations, resolve conflicts or depression
  • Testosterone therapy is advised when low testosterone level is detected during blood tests
  • Penile injections
  • Intraurethral medication — works by helping the blood flow into the penis
  • Vacuum erection devices
  • Penile implants. Two types of prosthesis are available: rigid and flexible
  • Surgery to bypass penile artery damage for some younger men with a history of severe pelvic trauma. Penile vascular surgery is not recommended for older men with hardened arteries.

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