Indian Express
12 March 2011

Impotence or erectile dysfunction and low libido are very common problems and a cause of considerable distress. In amajorityofcases,thesecanbetreated after a proper evaluation under expert guidance.Butherearecertainfactsone should know, writes Dr Ritesh Gupta.

1. How common is it to have problems in achieving erection?
This is a common problem that increases with advancing age. As many as 40 per cent of men at the age of 40 years have experienced some for of it. But the problem should not be considered a part of normal aging and needs proper evaluation and management.

2. What are the common causes?
This may be a fallout of a variety of diseases – the main causes being diabetes,nervedisease,vasculardisease, spinal cord injury, injury or surgery of hip bones, thyroid disorders and hormonal disorders affecting male reproductive hormones. In addition, certain drugs like those used in treatment of high blood pressure (beta blockers,diuretics),anti-allergicsand others can also cause this problem.

3. Is it true that psychological reasons are involved?
Though psychological factors and interpersonal relationships can cause erectile problems, a persistent difficulty will mean an underlying medical disorder. Nevertheless, the treatment does involve attention to psychologicalandbehavioralfactors.

4. What is the relation between erectile dysfunction and diabetes and heart disease?
Nearly 70 per cent of diabetics have erectile dysfunction, and many of themcouldbehelpedbyproperevaluation and management. The presence of erectile dysfunction may be an indicator of underlying coronary artery disease. The narrowing of small penile arteries by deposition of cholesterol and other substances may precede the occurrence of same process in coronary arteries of heart.
That is why an optimum evaluation for detection of occult coronary artery disease should be done.

5. How can one know the underlying cause of erectile dysfunction?
A systematic and scientific approach can identify the underlying cause in a majority of cases. This includes carefulhistoryandphysicalexamination by an expert and appropriate investigations if needed.

6. What investigations are done for erectile dysfunction?
The investigations usually involve blood levels of hormones related to male reproductive function. These mainly include hormones like testosterone, prolactin, thyroid stimulating hormone and others. In addition, tests for blood sugar and cholesterol are also helpful in identification of the contributing factors. A Doppler study may sometimes be done to assess the augmentation of penile blood flow.

7.What is the cause of low libido?
Reduction in libido can occur transiently because of stress or psychological factors. However, it may also indicate an underlying disorder like thyroid disease, testosterone deficiency (hypogonadism) or prolactinoma (increased levels of a hormone called prolactin).

8. How can the disorder be treated?
Treatmentinvolvescorrectionofhormone deficiencies, treatment of underlying disorders like diabetes, hypertension and increased cholesterol,regularphysicalexercise, stopping smoking and limiting alcohol intake.

9. Are there oral medicines for treatment?
Drugs like Sildenafil, Tadalfil and others are helpful but but these should be taken only under medical supervision. Patients who are on medication for blood pressure and heart disease need to take special caution and their medicines may require alteration.

10. What are the options if there is no response to oral medicines?
Inpatientswhodonotrespondtothe oral therapy, injectable therapies, vacuum devices and penile implants are sometimes advised. Rarely, microvascular surgery of the penis may be required to restore blood flow.

The author is a Senior Consultant and Specialist, Male Hormonal Disorders at Fortis-C-DOC Centre of Excellence for Diabetes, Obesity, Metabolic Diseases and Endocrinology, New Delhi