Erectile Dysfunction (ED)

Erectile dysfunction (ED) is the inability of a man to achieve or maintain an erection sufficient for his sexual needs or the needs of his partner. Most men experience this at some point in their lives, usually by age 40. Erectile dysfunction tends to be more common and severe with age.

Erectile dysfunction may be caused by a variety of diseases. It may also be the initial presenting symptom for certain illness like diabetes mellitus. Erectile dysfunction may progress from mild to moderate to severe. Severe or complete erectile dysfunction is crippling and cause emotional and relationship problems.

Erectile dysfunction is treatable and is not an inevitable consequence of aging.

There are many underlying physical and psychological causes of erectile dysfunction. Reduced blood flow to the penis and nerve damage are the most common physical causes. Underlying conditions associated with erectile dysfunction include the following:

  • Psychological conditions like anxiety, stress, depression
  • Spinal and pelvic trauma
  • Pelvic surgery and radiation therapy
  • Penile deformity like Peyronie’s Disease
  • Diabetes mellitus, hypertension, high cholesterol
  • Medications for hypertension and depression
  • Hormonal disorders like low testosterone


The first line treatment for erectile dysfunction is oral medication with a phosphodiesterase 5 inhibitor such as Sildenifil (Viagra), Vardenifil (Levitra) or Tadalafil (Cialis). This medication is taken only as and when necessary and is effective in about 80% of patients. They vary slightly in terms of mechanism of action, time of onset, duration of action and side-effects.

The second line treatment for erectile dysfunction (not responsive to oral medication) is injection therapy. Using a thin syringe and a very tiny needle, a drug called prostaglandin E1 is injected into the shaft of the penis. It may cause a slight pain at the point of injection. Within 10 to 15 minutes, the penis will become erect.

The third line treatment involves implanting a synthetic mechanical device into the spongy tissue of the penis. This device has three parts – the inflatable rods, the balloon reservoir and the pump. Surgery involves making a small cut at the junction between the penis and scrotum and inserting the three-piece device into the penis. When needed, the pump is activated and fluid flow from the reservoir into the inflatable rods, resulting in turgidity and rigidity of the penis. When not in use, the pump is squeezed differently and fluid flows back to the balloon reservoir and the penis becomes soft again.