Erectile dysfunction (ED) is a common and often distressing condition that affects men of all ages. In India, it is estimated that over 30 million men experience some degree of erectile dysfunction, and the numbers are on the rise. ED has profound mental consequences and can hamper a man’s overall well-being. It can also affect their self-esteem and relationships. While it is thought to occur only in older men, it can also affect younger men. The symptoms of erectile dysfunction include being unable to get an erection or being able to have an erection, but not having it last long enough for sexual intercourse.

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Causes for ED

Certain diseases and conditions

Having a diagnosis of these conditions can lead to erectile dysfunction:

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Type 2 diabetes
Heart and blood vessel disease
Multiple sclerosis
Chronic kidney disease
High blood pressure
Atherosclerosis
Peyronie's disease
Injury to the prostate, penis, spinal cord, bladder, or pelvis.
Recovery post-surgery for bladder cancer

Medications

ED can also be a side effect of many commonly prescribed and consumed medications. These include:
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Blood pressure medicines
Antiandrogens, used for prostate cancer therapy
Antidepressants
Sedatives
Appetite suppressants
Medications for ulcers

Psychological and emotional issues

Mental conditions can either lead to the development of EDs or make already existing EDs worse. These issues include:
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Depression
Anxiety
Fear of sexual failure
Stress and pressure of sexual performance
Stress in general
Guilt about certain sexual activities
History of sexual abuse

Health-related factors or lifestyle behaviours

Certain activities can also contribute to ED, such as:
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Smoking
Drinking too much alcohol
The use of drugs
Being overweight
Lack of physical activity

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Erectile dysfunction can diagnosed by a general surgeon (with or without a specialisation in urology). The process of diagnosis is comprehensive and aims to assess various areas of an individual’s life. The doctor will take a medical and sexual history and may take a physical exam, a mental status examination, and laboratory and imaging tests.

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While there is stigma around erectile dysfunction in India, there are various treatment options that are available. Early intervention can play a crucial role in timely treatment.

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Treatment for ED in India

Lifestyle Modifications

Before considering medical interventions, it is important to consider lifestyle factors that may contribute to erectile dysfunction. Making lifestyle changes can help with managing ED.

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Diet

A healthy diet that includes plenty of fruits, vegetables, whole grains, and lean protein (fish) can improve blood flow and overall health. The Mediterranean diet has also been found to reduce the risk of developing ED.

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Exercise

Regular physical activity can help maintain a healthy weight, improve cardiovascular health, lower stress, raise testosterone levels, and enhance blood circulation, all of which are essential for erectile function. Factors such as obesity, inactivity, and cardiovascular disease which cause ED can also be managed by aerobic exercises. These include running, walking, swimming, and even cycling.

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Kegel Exercise

Kegel exercises refer to pelvic floor muscle training (PFMT) exercises. They concentrate on the pelvic floor muscles that support the urethra, bladder, bowel, as well as other pelvic organs. They encourage healthy bladder control and sexual function by holding your organs firmly in place.

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Quitting Smoking

Smoking can damage blood vessels, which can then cause a reduction in the blood flow to the penis. Smoking cigarettes can also reduce the availability of nitric oxide in the body, which is needed for erections. Quitting smoking is one of the most important steps in managing ED.

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Limiting Alcohol Consumption and Avoiding Substance Abuse

Excessive alcohol consumption and drug use can contribute to erectile dysfunction. Reducing or eliminating these substances can help improve sexual health.

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Stress Management

Chronic stress and anxiety can be a predictor of ED. Techniques like yoga, meditation, and counselling can be helpful in managing stress to improve mental and sexual well-being.

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Improving Sleep

Maintaining adequate sleep schedules can help improve erectile dysfunction. This is because adequate sleep increases or maintains testosterone levels.

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Weight loss

Men who are overweight or obese might be more likely to experience ED. Thus, losing weight through diet, exercise, or even bariatric surgery might lead to improvements in ED.

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Oral medications

Disclaimer: Please do not take these medications without consulting a medical healthcare professional first.

Oral medications are often the first-line treatment for erectile dysfunction in India and around the world. These medications work by enhancing the effects of nitric oxide, a chemical that relaxes the muscles in the penis and increases blood flow. Oral medications are effective in most men, they are easy to use, are accessible in Indian pharmacies, and have minimal side effects. However, the use of certain oral medication might not be suitable for some men with a history of high blood pressure or any other heart issues. It also requires planning sexual activity around the timing of medication.

One of the most well-known and widely used medications for erectile dysfunction is Sildenafil (Viagra). It is generally taken 30 minutes to 1 hour before sexual activity and can be effective for up to 4-5 hours. It is available in various dosages and has a good safety profile.

Certain supplements including Virilex, Eract, Vitamin D and Vitamin B12 are also prescribed by a medical healthcare professional to support overall health and wellbeing.
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A Vacuum Erection Device (VED)

It consists of a plastic tube that is placed over the penis, and a pump that creates a vacuum, drawing blood into the penis to produce an erection. To maintain the erection, a constriction ring is then placed at the base of the penis. The benefits of using a VED are that they are non-invasive and thus have no side effects. However, they require manual manipulation, causing discomfort or bruising. They might not be as effective as oral medication for some individuals.

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Intracavernosal Injections (ICI)

Intracavernosal injections involve the direct injection of medication into the erectile tissue of the penis. Alprostadil, a vasodilator, is the most commonly used medication for this purpose in India. This treatment option is typically reserved for cases where oral medications are ineffective or not tolerated. They have a rapid onset (within 5-20 minutes) and can be self-administered with training. However, since it requires an injection into the penis, it can be uncomfortable, leading to pain, prolonged erections, and scarring.

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Penile Implants

Also known as penile prosthesis, these are surgically implanted devices that can provide a long-lasting solution for erectile dysfunction. They provide a reliable and long-lasting solution to ED, allowing for spontaneous erections. It is also more effective for severe cases of ED. However, it does involve surgery and can be more expensive compared to other treatment options. The two types are:

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Semi-rigid Rods: These implants consist of bendable rods that are surgically placed within the penis. They allow for an erection when the penis is manually bent into position.

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Inflatable Implants: Inflatable implants consist of a fluid-filled reservoir implanted in the abdomen or scrotum, a pump placed in the scrotum, and inflatable cylinders in the penis. By squeezing the pump, the cylinders fill with fluid, creating an erection.

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Hormone therapy

It is usually recommended for men with erectile dysfunction caused by low levels of testosterone. Testosterone replacement therapy (TRT) involves the administration of testosterone through injections, patches, gels, or implants. It can help improve sexual function in men with low testosterone levels and is not suitable for men with normal levels of testosterone. They can also have side effects including mood swings, fluid retention, and changes in blood count.

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Psychological Counselling

Psychological factors, such as anxiety, depression, and relationship issues, can contribute to erectile dysfunction. In such cases, counselling or therapy with a qualified psychologist or counsellor can be highly beneficial. Therapy can help address underlying emotional issues that may be affecting sexual performance and provide strategies for coping with stress and anxiety. Couples counselling can also be considered to explore the impact of ED on the relationship.

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Sex therapy

This is a short form of counselling with 5-20 sessions. This can explore sexuality, and sexual communication skills, and try to reduce the pressure to perform during sexual activity.

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Erectile dysfunction is a common condition that can have a significant impact on a man's self-esteem and overall quality of life. Fortunately, there are numerous treatment options available in India to address this issue, ranging from lifestyle modifications and oral medications to more invasive procedures like penile implants. The choice of treatment should be tailored to the individual's specific needs, preferences, and underlying causes of ED.

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It's important for men experiencing erectile dysfunction to consult with a healthcare professional to determine the most appropriate treatment plan. They can help assess the underlying causes of ED, provide guidance on lifestyle changes, and recommend the most suitable treatment options to restore sexual function and improve overall well-being. The team of experts at Rocket Health can help provide a holistic treatment plan. You can book your session here.

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