Sexual health and wellness is defined as a state of physical, emotional, mental, social, and spiritual dimensions in relation to sexuality. Sexual intimacy has always been stigmatised and people are not willing to talk about their sexuality openly.
In the current scenario, Pandemic has not only affected the mental health but has also aggravated sexual health problems amongst the individuals. One of the primary reason is increasing stress due to factors such as jobs, work life balance, financial challenges, and lack of socialization and relationship conflicts among others. Stress directly affects our hormones and mood and takes away a person’s libido thereby affecting the quality time of the couple. It can also cause an individual to indulge into smoking or alcohol consumption which in turn can adversely affect sexual performance. These can lead to problems such as Premature Ejaculation, Erectile Dysfunction, reduced libido, and male fertility. A man should be strong physically, mentally and spiritually. A balanced sexual life allows an individual to have healthy relationships, planned pregnancies and disease and prevention. Hence, it is essential to be well informed about all aspects of sexual health and what it takes to have a fulfilling sexual life.
According to a 2017 study by the Department of Urology Tulane University School of Medicine, New Orleans, 20% of men across all age groups battle ED in India and 30% of them are younger than 40. Most of the times, it is experienced due to an underlying cause that can be treated. But no cure is possible until men accept the problem and stop shying away from asking for help.
What is Erectile Dysfunction?
Erectile Dysfunction (ED), also known as impotence, is a condition in which a man experiences difficulty in getting or maintaining an erection during sexual performance. It is one of the most common health condition affecting middle-aged, older men and now even the younger generation. Most men are not aware about the emerging concepts and potential therapies for ED management because of which the health condition remains untreated for years. In order to get cured of ED, the first and foremost step is to come out in open and talk about the condition with your doctor as they can prescribe the right treatment ranging from lifestyle changes to medication to surgery.
What can Trigger ED?
Medical conditions, such as hypertension, diabetes mellitus, cardiovascular disease (CVD), and psychological conditions such as depression and anxiety, contribute to sexual dysfunction in men. CVD and hypertension cause narrowing and hardening of the arteries, leading to reduced blood flow to the corporal bodies, which is essential for achieving an erection. Diabetes is a common etiology of sexual dysfunction because it can affect both the blood vessels and the nerves that supply blood to the penis. Poor lifestyle habits like obesity, smoking, drinking alcohol is associated with the development of ED.
Reasons and causes for ED?
There is not enough blood flows into the penis- Many health issues can reduce blood flow into the penis, such as hardened arteries, heart disease, high blood sugar (Diabetes) smoking and alcohol.
The penis cannot trap blood during an erection- If blood does not stay in the penis, a man cannot keep an erection. This issue can happen at any age.
Nerve signals from the brain or spinal cord do not reach the penis- Certain diseases, injury or surgery in the pelvic area can harm nerves to the penis.
Diabetes can cause small vessel disease or nerve damage to the penis- Having high sugar levels for a period of time can damage your blood vessels and nerves, including the ones that supply your penis
Cancer treatments near the pelvis can affect the penis' functionality- Surgery or radiation for cancers in the lower abdomen or pelvis can cause ED. Treating prostate, colon-rectal or bladder cancer often leaves men with ED. Cancer survivors should see a Urologist for sexual health concerns.
Drugs used to treat other health problems can negatively impact erections- Patients should talk about drug side effects with their primary care doctors
Is ED common in young men? If yes, what are the causes?
It is said that ED is the most common condition affecting middle-aged and older men in their 40’s and 70’s but it is also affecting the younger generation who are in their late 20’s and 30’s.
Many factors that contribute to ED can occur at any age. These include physical and emotional factors — both of which are important for sexual activity
Some contributing factors include:
Having anxiety, depression, or feelings of shame or guilt about sexual activity.
Experiencing significant stress related to sex or other problems like relationships, job stress
Smoking
Drinking alcohol in excess
Using drugs
Obesity
Lack of physical activity
Usage of workout supplements, testosterone boosters, or over-the-counter erectile aids
At any age, making adjustments such as lowering levels of stress and exercising more frequently can help improve erectile problems and boost overall health.
Causes
These vary widely and can include psychological, neurological, and lifestyle-related factors. ED can also be a side effect of some medications. Stress, anxiety, sleep disturbances, Obesity, Chronic Kidney Disease, high blood pressure and lifestyle factors can contribute to ED at any age, while physical factors are more likely to play a role for older adults. Physical causes include conditions that affect the vascular system, the nervous system, or the hormone system.
In many cases, ED is caused by factors such as an unhealthy diet, high level of stress, lack of exercise, and smoking. By addressing these issues, people can often improve or resolve their ED symptoms.
Challenges
1. Erectile dysfunction- If you are having trouble in getting or maintaining an erection that is firm enough to have sex, you may be suffering from erectile dysfunction (ED). Since erectile dysfunction occurs when there is not enough blood flow to the penis to sustain an erection, factors that can be linked to physical conditions such as vascular disease, thyroid imbalances, diabetes and hypertension. It can also be caused by psychological conditions such as anxiety, stress and depression.
Solution- Make an appointment with your doctor to test for and rule out an underlying medical cause. There are a number of effective treatments, including oral medications to correct ED.
2. Premature ejaculation- If you ejaculate before or immediately after initiating sexual activity, you could be experiencing premature ejaculation. While it’s best known as a nuisance to younger men who are just beginning to explore a sexual relationship, on the contrary, it can happen in males amongst all age- groups.
Solution - Most men can learn to control premature ejaculation without medication or medical intervention. Meeting with a sex therapist can help simplify the process.
3. Delayed ejaculation- Delayed ejaculation occurs when you have troubled climax during intercourse, or after prolonged sexual stimulation. It can be caused by nerve damage or thyroid disease
Solution- Treatment for delayed ejaculation depends on the cause. In many cases, working with a sex therapist can help resolve the problem.
4. Low testosterone- Testosterone levels peak at 18 and begin to decline as we age. Even with a natural decline over time, most men make enough testosterone throughout their lives to avoid sexual problems. If you’re experiencing a lack of desire, feeling low, and have concerns about your testosterone level, a simple blood test will uncover whether or not you’re running low.
Solution: Taking supplements as prescribed by the doctor.
5. Low Libido- While most men don’t want to discuss it, low sexual desire is a common concern. The disinterest may stem from fear, anxiety or stress related to another sexual issue (such as premature ejaculation). It can also be related to relationship troubles or other psychological issues. Medical conditions, such as diabetes, kidney disease, depression also contributes to the low libido problem.
Solution- Talking to your doctor, taking medications, and communicating to your partner can help in improving the condition
How ED can be treated?
Lifestyle modifications is usually considered to be the first-line therapy for ED, and this can be beneficial. Therefore, men must make the necessary lifestyle changes like exercising, consuming a good diet, limiting alcohol intake, and should quit smoking.
ED can be treated at any age, treatment depends on your overall health and the underlying cause of the problem. Despite the benefits of good lifestyle changes, other methods of treatments maybe required for curing the condition. This includes penis pumps, injections, surgery, vacuum devices, implants, and testosterone replacement therapy:
Vacuum Devices: A vacuum constriction device (VCD) is an external pump with a band on it that a man with erectile dysfunction can use to get and maintain an erection.
Penis pumps, surgery, and implants: Penile implants are devices placed inside the penis to allow men with ED to get an erection and is recommended in case other treatments don’t work. Vascular reconstructive surgery is also one way that helps improve blood flow to the penis.
Injectable for ED: Injection or a suppository, is a drug that makes the blood vessels expand. This boosts blood flow throughout the body, including the penis, thereby helping in having an erection.
Testosterone replacement therapy: Inadequate production of testosterone is not a common cause of erectile dysfunction. But, when ED does occur due to decreased testosterone production, testosterone replacement therapy may improve the problem
Alternatively, there are many ways your doctor can help you treat it. But you may want to consider complementary or alternative therapies, such as nutritional supplements, herbal remedies, acupuncture, and talk therapy. However, ensure that you consult a doctor before availing any of these options for the correct guidance and treatment.
By Dr. Ashish Sabharwal, Senior Consultant Urologist, Andrologist and Robotic Surgeon, Indraprastha Apollo Hospital, New Delhi, Director, Blue Ribbon Prostate Clinic, New Delhi, National Board Certified (Urology), Fellowship in Endourology and Robotic Prostate Surgery, Jackson Health System, Miami, USA
