Lack Of Libido And Erectile Dysfunction (“Impotence”)

INTRO
Goodmorning folks, its another beautiful Monday morning, what makes it more beautiful is that its a holiday, oh what makes it even moreee beautiful is that IT IS BLOG-DAY!!! I'm really excited about this one because i didn't think i was gon make it due to circumstances beyond my control (if you really want to know that circumstances, ask and i'll tell you in pigin in the comment section, I nor want make my oyinbo friends wey dey come my blog read wetin we dey see for this Country, I nor wan shame my Country abeg lol)….Well thankfully there was a turn around and at about 6pm last night i finally started writing + typing and i didn't finish till like 12am »Bless my soul« :-)

Moving on, You know somehow there's always an inspiration for these weekly topics, this week the inspiration came from an “advert” i saw on the roadside the other day while on transit lol, it read “Erectile dysfunction, premature ejaculation, lack of libido, pass exams without stress, cheat without getting caught, make quick money, success ring, Do-as-i-say, catch husband etc call 080________”. I giggled for a minute and wondered if its the same medicine used for “Do-as-i-say” that's used for “Erectile dysfunction”….must be nice. So while seated there and laughing alone i told myself “Yea girl, why don't you dive into this topic for your blog?”

You know, back in the day in Medical School when topics like these came up we ladies would giggle and side eye the boys as if…………..*sigh*

Meanwhile, there's this thing of men being literally being scared of “soft drinks”, for them its like the fear of soft drinks is the beginning of wisdom……. I approve!!!

Moving on from all those stories, You guys sit back, grab your cup of coffee, hot chocolates, icecream (hey ladies!) and let's get schooled about erectile dysfunction. Lack of libido and Erectile dysfunction is a problem that has caused severe friction in relationships and marriages even to the point of causing break ups and divorces.

DEFINITION
By definition, Lack of libido is a loss of sexual desire leading to erectile dysfunction(ED). The National Institute of Health(NIH) consensus Development Conference on Impotence defined impotence as “male erectile dysfunction, that is, the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.

BACKGROUND
Erectile dysfunction(ED) affects 50% of men older than 40 years, exerting substantial effects on quality of life. This common problem is complex and involves multiple pathways. Penile erections are produced by an integration of physiologic processes involving the central nervous, peripheral nervous, hormonal and vascular systems. Any abnormality in these systems, whether from medication or disease has a significant impact on the ability to develop and sustain an erection, ejaculate, and experience orgasm.

WHAT ARE THE CAUSES? (ETIOLOGY)
ED usually has a multifactorial etiology : Organic, physiologic, endocrine, and psychogenic factors are involved in the ability to obtain and maintain erections. In general, ED us divided into 2 broad categories, Organic and psychogenic. Although most ED was once attributed to psychological factors, pure psychogenic ED is infact uncommon; however, many men with organic etioligies may also have associated psychogenic component.

Conditions that may be associated with ED include diabetes, hypertension, and coronary artery disease as well as neurologic disorders, Endocrine disorders, Benign prostatic hyperplasia(prostate disease), and depression. In fact, almost any disease may affect erectile function by altering the nervous, vascular, or hormonal systems. Various diseases may produce changes in the smooth muscle tissue of the male organ or influence the patient's psychological mood and behaviour.

Conditions associated with reduced nerve and endothelium function (e.g aging, hypertension, smoking, excess cholesterol in blood, and diabetes) alter the balance between contraction and relaxation factors that influence erection in an individual. These conditions cause circulatory and structural changes in penile tissues, resulting in arterial insufficiency and defective smooth muscle relaxation thus leading to ED. In some patients, sexual dysfunction may be the presenting symptom of these disorders.

Given the multiplicity of possible etiologic factors, it may be difficult to determine how much any given factor is contributing to the problem. A thorough evaluation is necessary for correct identification of the specific cause or causes in any given individual.

Vascular Diseases
Vascular diseases account for nearly 50% of all cases of ED in men older than 50years. These diseases include atherosclerosis, peripheral vascular disease, myocardial infarction(MI) , and arterial hypertension. Vascular damage may result from radiation therapy to the pelvis and prostate in the treatment of prostate cancer. Both the blood vessels and nerves to the penis may be affected. Data indicate that 50% of men undergoing radiation therapy lose erectile function within 5 years after completing therapy; fortunately, some respond to medications.

Trauma
Trauma to the pelvic blood vessels or nerves can also result in ED. Bicycle riding for long periods has been implicated as an etiologic factor; direct compression of the perineum by the bicycle seat may cause vascular and nerve injury. On the other hand, bicycling for less than 3 hours per week may be somewhat protective against ED. Some of the newer bicycle seats have been designed to diminish pressure on the perineum.

Diabetes Mellitus
Diabetes is a well-recognized risk factor for ED, with approximately 50% of diabetic men experiencing this condition. The etiology of ED in diabetic men probably involves but vascular and neurogenic mechanisms. Evidence indicates that establishing good glycemic control can minimise this risk.

Abnormal cholesterol levels
A study done documented an inverse correlation between ED risk and high density lipoprotein(HDL) cholesterol levels but did not identify any effect from elevated total cholesterol levels. Another study involving male subjects aged 45-54 years found a correlation with abnormal HDL cholesterol levels but also found a correlation with elevated total cholesterol levels. The former study included a preponderance of older men.

Respiratory diseases
Men with sleep disorders commonly experience ED. It is recommended that in adult male patients, ED should be considered when a sleep disorder – especially sleep apnea syndrome is suspected and vice versa.

Endocrine disorders
Low testosterone levels from any cause adversely affects libido and erectile function. Hypothyroidism is a very rare cause of ED.

Penile conditions
Fibrosis and curvature of the penis may impede blood flow in the penis and lead to erectile dysfunction eg in Peyronie disease.

Mental health disorders
Mental health disorders, particularly depression, are likely to affect sexual performance. Other associated factors, both cognitive and behavioural, may contribute. In addition, ED alone can induce depression.

Its been indicated that there's a higher rate of sexual dysfunction in veterans with post traumatic stress disorder(PTSD) than in veterans who did not develop this problem.

Prostate Surgery
Prostate surgery for benign prostatic hyperplasia has been documented to be associated with ED in 10-20% of men. This association is thought to be related to nerve damage. Newer methods of prostate surgery have rarely been associated with ED.

Radical prostatectomy for the treatment of prostate cancer poses a significant risk of ED.

Medications
ED is an adverse effect of many commonly prescribed medications including some antihypertensives.

Inactivity
Exercise and lifestyle modifications may improve erectile function. Weight loss may help by decreasing inflammation, increasing testosterone, and improving self esteem. Patients should be educated to increase activity, reduce weight, and stop smoking as these efforts can improve or restore erectile function in men without other diseases.

Smoking
Cigarette smoking has been shown to be an independent risk factor.

DIAGNOSTIC CRITERIA(DSM-5) FOR ERECTILE DISORDER
DSM-5 classifies erectile disorder as belonging to a group of sexual dysfunction disorders typically characterised by clinically significant inability to respond sexually or to experience sexual pleasure.

Sexual functioning involves a complex interaction among biologic, sociocultural, and psychological factors. Thus in addition to the criteria for erectile disorder, the following must be considered:

• Partner factors (eg, partner sexual problems or health issues)

•Relationship factors(eg, communication problems, differing levels of desire for sexual activity, or partner violence)

•Individual vulnerability factors (eg, history of sexual or emotional abuse, existing psychiatric conditions such as depression, or stressors such as job loss)

•Cultural or religious factors (eg, inhibitions or conflicted attitudes regarding sexuality)

•Medical factors (eg, an existing medical condition or the effects of drugs or medications)

CLINICAL PRESENTATION
In assessing a patient with erectile dysfunction(ED), the first step is to gather the following information:

•Sexual history
~Do you have difficulty obtaining an erection?
~ Is the erection suitable for penetration?
~How hard is the erection, on a scale of 0-100?
~Have u ever had a traumatic sexual experience?
~Can the erection be maintained until your partner has achieved orgasm?

~Does ejaculation and orgasm occur?
~Approximately how long are you able to have intercourse before ejaculating?

~Do you and your partner experience sexual satisfaction?

~Do you use any type of contraceptives, such as condoms?

~Do you experience nocturnal or morning erections?

~Does pain or discomfort occur with ejaculation?
~Do you have premature (early) ejaculation?
~Is penile curvature a problem?
~How frequently do you have sexual activity? Is it typically spontaneous or planned?

~If your erections were functional, what would be your preferred frequency of intercourse? Do you and your sexual partner agree on this issue?

~Is adequate foreplay occurring? Is your sexual partner satisfied with the sexual experience?

•Medical and Surgical history
•Medication and non-prescription drug history
•Psychological history
Physical examination
A physical examination is necessary for every patient, with particular emphasis n the genitourinary vascular, and neurologic systems. This entails :

~ Blood pressure
~Peripheral pulses
~Sensation
~Status of the genitalia and prostate
~Size and texture of the testes
~Any penile abnormalities such as curved penis etc

TREATMENT AND MANAGEMENT
•Pharmacologic therapy
•External Erection-Facilitating Devices
~Constriction devices
~Vacuum devices
~Placement of penile implants
•Surgical intervention
•Counselling and Psychological Care
Sexual counselling is the most important part of treatments for patients with sexual problems. Men by their nature are frequently reluctant to discuss their sexual problems and must be specifically asked. It is helpful that a good rapport be maintained between the doctor and patient to allow for free flow of information, communication and dialogue. Regardless of any subsequent therapy, the emotional aspects of the disorder must be addressed. Ideally, the patient's partner should be involved in counselling, but even if this is not possible, the time spent may help resolve or at least clarify the problem and certainly helps determine which of the other options would be most beneficial and appropriate.

Regardless of the etiology of ED, a psychological component is frequently associated with the disorder. The ability to achieve erection is intimately connected to a man's self esteem and sense of worth. Pure psychogenic ED is generally evident when a man reports that he has normal erections some of the time but is unable to achieve or to maintain a full erection at other times. Once the man has doubt regarding sexual performance, he loses his confidence; thus, further attempts to have sexual relations provoke anxiety.

In many instances, the couple must work together to resolve the problem, although in some cases, the relationship itself may be responsible for the problem. Referral to a sex therapist may be helpful after adequate counseling and psychological help. Few words of encouragement from the doctor can be of great help.

PREVENTION
Optimal management of risk factors for ED (diabetes, hypertension, heart disease etc) may prevent the the development of ED. Similarly, because attaining and maintaining a firm erection requires good vascular function, it is reasonable to assume that lifestyle modifications to improve vascular function (eg, smoking cessation, maintenance of ideal body weight, and regular exercise) may prevent or reverse ED. »PREVENTION IS BETTER THAN CURE«

This is a very wide and extensive topic but i'm sure we've been able to go to town it in a nutshell. Its a problem most men have but shy away from telling their physicians about. It is important that one creates a very good rapport with their physician and feel comfortable sharing their challenges with the doctor, making sure informations are provided willingly and correctly as this will help your physician extrapolate where the problem is coming from and appropriate referrals made if need be. Partners should also endeavour to stick with their partner and loved one who's experiencing ED as this helps them go through this better, I mean..ED is an ego and self esteem destroyer so not sticking with him makes the matter worse and can tip him into depression. Don't forget to stay away from the risk factors of ED, that means you have to check your blood pressure regularly and for those already hypertensive you have to maintain good control, for the smokers i know its hard to cut off abruptly but you can start from somewhere, all other risk factors should be handled accordingly. To anyone out there experiencing the topic above please don't shy away from talking about it, see a physician today and get help.

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»ED = Erectile Dysfunction «
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Once again its yours truly……..Dr Ima xxx