Erectile Dysfunction: Causes, Diagnosis, and Treatment Options

Erectile Dysfunction II

Hello, Dr.
Hsu.
Thank you for taking the time to respond.
However, I do not have much life stress or emotional fluctuations, and I have experienced erectile dysfunction symptoms prior to this, although they were not obvious.
Recently, I have noticed a significant decline in my ability to achieve an erection, which has caused me considerable concern.
I have realized that my sexual function is not very good; during masturbation, I ejaculate quickly, and even with strong sexual stimulation, my erection softens within three minutes.
Additionally, I have noticed that my semen is consistently a brownish color rather than white.
Is this normal? Although I have been taking traditional Chinese medicine to improve my sexual function, the situation remains the same.
Previously, I consulted a Western medicine doctor for mild erectile dysfunction, but the responses were always related to psychological or mental issues, lifestyle habits, or recommendations to reduce masturbation.
However, I truly do not feel that there is any significant barrier in this regard (I typically masturbate about three times a month).
Therefore, I would like to ask you, Dr.
Hsu, how is such a condition generally examined, treated, and diagnosed? What medications might be prescribed, and what would the costs be? Thank you.

A-Bang, 20~29 year old female. Ask Date: 2009/04/15

Dr. Xu Weikai reply Urology

Hello, the so-called stress is not necessarily related to life circumstances; sometimes, it can stem from concerns about erectile hardness, which can exacerbate psychological barriers to achieving an erection.
Recently, the Taiwanese star Wang Jianming experienced issues due to excessive stress.
The more one worries about it, the worse the performance can become.
The color of semen is generally transparent, white, or slightly yellow.
Brown semen is less common and should be checked for potential issues caused by vascular bleeding.

For an objective assessment, a nocturnal penile tumescence test can be used to measure penile pressure during erections.
Additionally, blood tests for glucose, cholesterol, and triglycerides can be conducted, along with an electrocardiogram and chest X-ray to rule out cardiac factors.
In other words, a thorough examination is very time-consuming and involves many tests.

For medication, if one is generally lazy, prescriptions like Viagra may be issued.
If a more detailed differentiation is needed, medications can be prescribed based on psychological, neurological, or vascular factors.
The cost will depend on the type of medication.
If there are any areas that are not fully explained, feel free to ask again for further discussion and research.

Sincerely,
Director of Urology,
Hsu Wei-Kai,
Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2009/04/15

More Info

Erectile dysfunction (ED) is a common condition that affects many men at some point in their lives. It can be caused by a variety of factors, including physical, psychological, and lifestyle-related issues. Understanding the underlying causes, diagnosis, and treatment options is crucial for managing this condition effectively.

Causes of Erectile Dysfunction
1. Physical Causes:
- Vascular Issues: Conditions such as atherosclerosis (hardening of the arteries) can restrict blood flow to the penis, making it difficult to achieve or maintain an erection.

- Neurological Disorders: Diseases like multiple sclerosis or Parkinson's disease can affect nerve signals from the brain to the penis.

- Hormonal Imbalances: Low testosterone levels can lead to decreased libido and erectile dysfunction.

- Chronic Conditions: Diabetes, hypertension, and obesity can contribute to ED by affecting blood flow and nerve function.

2. Psychological Causes:
- Anxiety and Depression: Mental health issues can significantly impact sexual performance and desire.

- Stress: Work-related stress or personal issues can lead to temporary or chronic ED.

- Relationship Problems: Issues with a partner can also contribute to erectile dysfunction.

3. Lifestyle Factors:
- Smoking and Alcohol Use: Both can impair blood flow and contribute to ED.

- Sedentary Lifestyle: Lack of physical activity can lead to obesity and related health issues.

- Medications: Some medications can have side effects that include erectile dysfunction.

Diagnosis of Erectile Dysfunction
To diagnose ED, a healthcare provider will typically conduct a thorough medical history and physical examination. They may ask about:
- Duration and severity of the symptoms.

- Any underlying health conditions.

- Medications currently being taken.

- Psychological factors, including stress or anxiety levels.

Additional tests may include:
- Blood Tests: To check hormone levels, blood sugar, and cholesterol.

- Urinalysis: To assess for diabetes or other underlying conditions.

- Ultrasound: To evaluate blood flow to the penis.

- Psychological Assessment: If psychological factors are suspected.

Treatment Options
1. Lifestyle Modifications:
- Quitting smoking, reducing alcohol intake, and increasing physical activity can improve erectile function.

2. Medications:
- Phosphodiesterase type 5 inhibitors (PDE5 inhibitors): These include medications like Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil). They work by increasing blood flow to the penis and are often the first line of treatment.

- Hormone Therapy: If low testosterone is identified, hormone replacement therapy may be considered.

3. Psychotherapy:
- Counseling or therapy can help address psychological factors contributing to ED.

4. Vacuum Erection Devices:
- These devices create a vacuum around the penis, drawing blood into it and causing an erection.

5. Penile Injections or Implants:
- In cases where other treatments are ineffective, injections or surgical implants may be options.

Follow-Up and Costs
Follow-up is essential to monitor the effectiveness of the treatment and make necessary adjustments. The costs of treatment can vary widely based on the type of medication, therapy, and healthcare provider. PDE5 inhibitors can range from $30 to $100 per dose, depending on the brand and whether you have insurance coverage.

Conclusion
Erectile dysfunction can be a complex issue with multiple contributing factors. It is essential to approach this condition holistically, considering both physical and psychological aspects. If you are experiencing symptoms of ED, it is advisable to consult a healthcare provider who can guide you through the diagnostic process and recommend appropriate treatment options tailored to your specific situation.

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