Andrology Conditions

What are common andrological conditions?

Normal Male Sexual Function

How does an Erection happen?

Erection is a psychological phenomenon in which the man’s penis raises from its natural level.

For a normal erection to happen,

  • The man must be sufficiently stimulated psychologically.
  • His nerves which carries the signal of initiating an erection, must be intact and in good health.
  • The blood vessels in the penis which carries the blood, must be healthy.
  • Pelvic muscles must be toned enough to lift the penis up when the blood fills the penis.

The penis comprises two spongy tissue tubes, called “corpora cavernosa” surrounded by a tough fibrous-partially elastic outer casing, called “tunica albuginea”. When a man is aroused sexually, the blood vessels of the corpora cavernosa relax and open up and blood rushes in through the cavernosus arteries to fill the spongy tissues. The spongy tissues expand to accommodate the extra blood. The veins running over the outer case of the penis then compress obstructing the outflow of blood from the penis. As the blood is entrapped in the penis under high pressure, the penis swells within the outer casing, giving an erection. The pelvic muscles especially ischiocavernosus and bulbospongiosus also play a significant role in getting a good erection. Contractions of these muscles produce an increase in intracavernous (intrapenile) pressure and enhance penile rigidity (firmness). Erection is reversed when muscles in the penis contract, stopping the inflow of blood and opening outflow channels, and the penis becomes flaccid (soft).

How does Ejaculation occur?

Sexual stimulation and friction provide the impulses that are delivered to the spinal cord and into the brain. Ejaculation is a reflex action controlled by the central nervous system. It is triggered when the sexual act reaches a critical level of excitement. It has two phases.

  • In the first phase, the vas deferens (the tubes that store and transport sperm from the testes) contract to squeeze the sperm toward the base of the penis and the prostate gland and seminal vesicles release secretions to make semen. At this stage, the ejaculation is unstoppable.
  • In the second phase, muscles at the base of penis contract every 0.8 seconds and force the semen out of the penis in up to 5 spurts.

Disorders of Male Sexual Function

There may come a time in any of our lives when our erections, which have often been frequent throughout our lives, begin to take a nosedive. Perhaps this has already begun to happen to you, in which case don’t worry: it genuinely is a fairly frequent problem.

What is erectile dysfunction (ED)?

“It is man’s inability to achieve or maintain an erection, suitable for satisfactory sexual intercourse.”

ED is also called impotence. It is the inability to engage in sexual intercourse. This condition can negatively impact any intimate relationship, not forgetting one’s psychological well-being too.

How Common is ED?

According to research, 150 million men suffer from erectile dysfunction and the number is doubling by 2025.

  • 1 out of 5 men may have an erectile problem.
  • 1 out of 10 men may be completely incapable of erection

A survey showed that men over the age of 40 may experience at least one in five erectile problems and almost one in ten men is completely incapable of erections. With increasing age, each person is more likely to have erectile problems.

Causes of ED

ED can be caused by many physical or psychological factors. Some important causes are:

Nerve Damage

A proper nerve system is essential for normal erection. Men with neurological disorders may face ED. Common causes are:

  • Spinal cord trauma
  • Multiple sclerosis
  • Diabetic neuropathy
  • Pelvic surgery (prostate, bowel)
  • Parkinson’s disease
  • Alzheimer’s disease

Poor Blood Flow

Poor blood flow affects suitable erection. Common causes include:

  • Atherosclerosis (narrowing of the arteries)
  • Diabetes
  • High blood pressure
  • Smoking

Urological problems

Certain urological problems may lead to ED.

  • Peyronie’s disease
  • Pelvic trauma
  • Pelvic floor dysfunction
  • Incontinence

Interference by drugs, alcohol and medicines

  • Alcohol and drug abuse
  • Medicines used to treat Hypertension (High blood pressure), High cholesterol, Depression and psychiatric disorders, Prostate cancer can lead to ED

Metabolic problems interfering with blood vessel function (endothelial dysfunction)

  • Diabetes, Obesity, Sleep apnoea
  • Hypertension (high blood pressure)
  • High cholesterol, Smoking, Thyroid gland disorders
  • Acromegaly (a condition caused by too much growth hormone)
  • Cortisone excess
  • Hypogonadism (a condition where the testes are not able to make enough testosterone [androgen deficiency] and/or sperm [spermatogenesis])

Psychosocial causes

  • Performance anxiety
  • Sexual attitudes and upbringing
  • Relationship problems
  • Employment and financial pressures
  • Depression
  • Psychiatric disorders

ED- Common Questions:

Is ED a normal attribute of ageing?

No, erectile dysfunction has nothing to do with ageing.

Is ED preventive?

By keeping healthy lifestyle and timely check on other health conditions you have, you can easily prevent erectile dysfunction.

Is ED hereditary?

No, erectile dysfunction is not hereditary.

What is PELVIC FLOOR REHABILITATION (PFR)?

PFR is a therapy to reinforce your pelvic floor muscles which play a significant role in sustaining an erection. The experienced pelvic floor therapist, with the help of specialised equipment ensures stronger muscles especially ischiocavernosus and bulbospongiosus. These muscles lead to stronger erections and better ejaculations with the increase in Ejaculatory time.

What treatment options are available for ED?

The various treatment options are Oral Medications, Penile Injection Treatment, Low Intensity Shock Wave Lithotripsy, P-shot, External Devices, Penile Prsothesis

What is Low Intensity Shock Wave Lithotripsy (LI-ESWT)?

LI-ESWT is a novel modality that has recently been developed for treating ED. Li-ESWT induces tissue regeneration, neo-angiogenesis and improve endothelial function, thereby improving penile circulation. Apart from ED, it also benefits patients with Peyronie’s Disease and Chronic Prostatitis

what is PRP treatment

The PRP treatment or platelet rich plasma treatment as it is sometimes known, is a completely natural procedure that is non-surgical and painless. It involves the injection of platelet rich plasma into the shaft of the penis, once it has been sufficiently numbed. This attracts stem cells and growth factors that kick-start tissue growth in the nerves and blood vessels, that in turn improves the size and quality of your  erections, thereby benefiting patients with ED as well as Peyronie’s Disease.

What external devices are available for erectile dysfunction?

Vaccum Erection Device is one such external device which is FDA approved and is easy and safe to use. In the process, tubular tubes or Vacuum devices are placed over the penis. As air is tapped out of the cylinder, and the pressure build-up helps to draw blood into the penis. This helps the penis to enlarge A rubber ring is then set around the bottom of the penis to maintain the erection.

What is a penile prosthesis?

A penile prosthesis is a pair of malleable (bendable) rods or inflatable rods (that may be inflated and deflated manually) that is surgically inserted into the penis. The Inflatable devices allow erections to happen by a mechanism of compressing on a special part by the device. Men disappointed with other treatments might opt for penile prosthesis implantation.

HOW TO IMPROVE ERECTIONS NATURALLY

  1. Eat a healthful diet
    Following the Mediterranean diet could help maintain erectile function. A Mediterranean diet consists of:
    • plenty of fruit and vegetables
    • nuts
    • whole grains
    • legumes, such as lentils, peas, and beans
    • olive oil
    • a moderate intake of fish
    • a moderate amount of alcohol, such as a glass of wine with a meal
    • a low intake of dairy and meat
    • a low intake of candy

    According to The National Institute of Diabetes and Digestive and Kidney Diseases, certain foods should be avoided to achieve better erections:

    • foods high in saturated fat
    • foods high in sodium
  2. Get regular exercise– exercise increases blood flow to the penis as well as to the rest of the body. People should aim to get a minimum of 30 minutes of exercise every day (it could be cycling, running, lifting weights).
  3. Lifting weights-Working out major muscles of the back, chest and legs by lifting weights under proper guidance can increase testosterone levels and in turn enhance erections.
  4. Communicate with sexual partner Emotional and psychological factors can affect sexual performance. If there is no underlying health condition affecting erectile function, mental and emotional factors may be the cause. These could include issues such as:
    • unhappy or traumatic previous sexual experiences
    • a lack of attraction to a partner
    • feeling anxiety or a pressure to perform well sexually
      Talking to a sexual partner about any issues may help improve erectile function and relieve the pressure a person may be feeling. Seeing a sex therapist, with or without a partner, may also help people resolve any issues.
  5. Limit alcohol intake
    Alcohol reduces sexual sensitivity and makes it more difficult to get and keep an erection. Excessive alcohol consumption can reduce sexual response. Over time, this may lead to erectile dysfunction. Limiting or avoiding alcohol may help improve erectile function.
  6. Sleep well
    Disrupted sleep, a lack of sleep, and sleep disorders reduce testosterone levels and can affect sexual function. At least 7-8 hours of sleep at a stretch is suggested.
  7. Reduce stress
    Stress causes the release of cortisol, which is a hormone that helps regulate blood pressure and circulatory systems. Chronic stress affects the male reproductive system and leads to changes in testosterone, erectile dysfunction and impotence. Managing and reducing stress may help improve erectile function. A person may find that the following can help:

    • getting regular physical activity
    • having a social support network
    • getting good quality sleep each night
    • trying relaxation and mindfulness techniques
    • Meditation 10-15 min daily- improves concentration and ability to control. It also helps in achieving better erections.

  8. Limit smoking-
    Smoking harms the blood vessels and has link to heart and blood vessel disease. It can reduce blood flow to the penis and increase the chance of erectile dysfunction. Reducing or quitting smoking may help improve erectile function.
  9. Weight loss- Losing weight (in overweight individuals) can help by reducing estrogen levels and increasing testosterone levels and thereby better erections can be achieved.
  10. Take supplements- Taking certain supplements may help improve erections. According to one 2020 review, the following may help improve sexual function:

    • sage, passionflower, l-theanine, and bitter orange, to reduce anxiety (if that is affecting erectile function)
    • l-citrulline, l-arginine, and Panax ginseng, to boost nitric oxide and potentially increase erection size and lubrication
    • yohimbe and Citrus aurantium, to help sexual arousal

For more details on other andrological disorders please click on the individual conditions mentioned above

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