ERECTILE DYSFUNCTION

Dr. Sudhish Sehra

• Men survives the earthquake, experiences the horror of illnesses and
all of the tortures of the soul. But the most tormenting tragedy of all
time is, and will be, the tragedy of the bedroom

-TOLSTOY
• Sexual dysfunction refers to a range of
problem occurring during any phase of the
sexual response cycle that prevents an
individual from experiencing satisfaction
from the sexual activity.

• Researches suggests that females are more

prone of sexual dysfunctions compared to
males.

• It's is a topic that many people are hesitant

to discuss.
Sexual dysfunction Prevalence
• Sexual dysfunctions are highly prevalent, affecting about 43% of women and 31% of men.

• Hypoactive sexual desire disorder has been reported in approximately 30% of women and 15% of
men in population-base studies.

• Associated with a wide variety of medical and psychologic causes.

• Erectile dysfunction (ED), also known as impotence, is the inability to get and maintain an erection.

• Erectile dysfunction is a very common, particularly in older men. It is estimated that half of all men
between the ages of 40 and 70 will have it to some degree.

• The global prevalence of ED is 3-76.5%

 Sexual Impulse

Neurotransmitters
Normal pathway Release of NO and Chemical mediators
to erection
Smooth muscle relaxation

Tumescence

Venous Occlusion

Rigidity

Erection
Who is Affected by
sexual dysfunction

• Sexual dysfunction can affect any age,

although it is more come in those over
40 because it is often related to a decline
in health associated with aging
Sexual dysfunction - Types
• Erectile disorder- It is the inability to get or keep an erection firm enough to have sexual
intercourse

• Premature ejaculation- also known as rapid ejaculation, an ejaculation which occur sooner or too
early.

• Hypoactive sexual desire disorder- persistently and recurrent deficient, or absent, sexual thoughts
and fantasies for sexual activity.

• Orgasmic problems such as delayed ejaculation, persistant genital pain while having sexual
activity ( a/k/a Dyspareunia )
 Sexual dysfunction - Causes
Erectile dysfunction is a symptom caused by

• Emotional

• Psychological, stress, anxiety and depression.

• Marital and relationship problems.

• Lifestyle factors ( Alcoholism and drug abuse )

• Medical conditions ( Heart diseases, Stroke )

It is temporary and can easily be cured.

It's essential to recognize that sexual dysfunction is a common issue.
Sexual Dysfunction - Seeking help is important
• HCP doctors
• Therapists
• Counsellors
• Treatment - Drugs, Medication, LSM
Assessment
• A through history ( medical, sexual, and psychosocial)

• Has there been a previous period of normal function

• Has the failure occurred with more than one partner

• Does the erection before foreplay ?

• Does erection occur on waking or in response to

masturbation ?

• Is there any evidence of alcohol or drug abuse ?

• Are there any possible effects of any medication

The International Index
of Erectile Dysfunction
Questionnaire ( IIEF-5 )
Test for erection during
REM sleep

It is normal for a man to have five to six erections

during sleep, especially during rapid eye
movement (REM).Their absence may indicate a
problem with nerve function or blood supply in
the penis. There are two methods for measuring
changes in penile rigidity and circumference
during nocturnal erection: Snap gauge and strain
gauge
Treatment for Erectile Dysfunction

 General measures
 Psychosexual therapy
 Drug therapy
 Vaccum devices
 Surgical treatment
ERECTILE DYSFUNCTION TREATMENT ALGORITHM

1st line – Lifestyle changes, Hormonal issues

2nd line – Oral medications and counselling

3rd line – Penile injections and vaccum devices

4th line – Implants and Vascular surgeries

Sexual Dysfunction -
Communication
• Open and honest communication with
partners and HCP about sexual
concerns.
• Healthy communication can lead to
better understanding and support.
 PDE-5 INHIBITORS

DRUGS FOR Sildenafil

ERECTILE
DYSFUNCTI Tadafil
ON
Vardenafil
PENILE INJECTIONS

1) Intra-cavernosal Injections
• Alprostadil ( PgE1 analogue )
• Papaverine

2) Intra-urethral Injections
• Alprostadil ( PgE1 analogue )