Erectile dysfunction becomes increasingly more common as men grow older. Those who are younger than 40 years of age, the incidence is about 1 – 10%, among 40 – 69 years of age are found at 15 – 40% and at around 50 – 100% of those who are more than 70 years old.  Undoubtedly, it can affect men both physically and mentally resulted in decreased self-confidence during sexual activity and marital problems.                 Dr.Karan Rimthephathip, our urologist at Bangkok Hospital Hua Hin shares that erectile dysfunction is an inability to achieve or maintain the erection adequately for satisfactory sexual performance. The risks include some underlying diseases such as coronary artery disease, diabetes, high blood pressure, hyperlipidemia, depression and obesity. The risks are also related to alcohol, smoking, lack of exercise and inadequate rest. Patients who have had pelvic surgery, spinal surgery, prostatectomy, urethral surgery along with injuries of the spine, pelvic floor and male genitalia are also prone to have the condition. The use of medications such as blood pressure pills, medications for psychiatric conditions such as schizophrenia and depression, along with prostate conditions may also contribute as one of the causes of erectile dysfunction. Causes of Erectile Dysfunction are categorized into 4 types, as follows

1. Anomalies in penile blood vessel found about 70% includes – The arteries that enter the genitals are clogged causing insufficient blood flows to the penis – Abnormality of venous compression causing the impaired retention of blood in the genitals – Abnormality from both arterial blockage and abnormal venous compression
2. Nervous system disorders from the disorders in the brain, accident, spinal cord disorders, along with pelvic surgery and degeneration of the genital nerves from diabetes mellitus.
3. Testosterone disturbances which may occur with other symptoms such as decreased sex drive and erection; especially in the morning. The symptoms also include fatigue and lack of work concentration. This may be found along with hyperthyroidism or hypothyroidism
4. Emotional and psychological conditions. In the past, it was believed that 90% of the patients with erectile dysfunction were caused by psychological conditions. Currently, it has proven to be more physical rather than psychological, however, the mental states that affect sexual performance are often found in young patients and can be found with stress, depression, schizophrenia or may be caused by psychiatric drugs

Examination and Diagnosis The doctor will thoroughly interview for your medical history including sexual activities, illnesses, past surgeries and underlying diseases. The physical examination will focus on an evaluation of genital abnormalities, the size of the testicles and prostate gland in some cases. The doctor will then advise for necessary laboratory tests such as blood sugar, lipid profile, liver and kidney functions, prostate cancer screening and testosterone levels. Moreover, the doctor may recommend additional examinations such as penile Doppler ultrasound to find abnormalities in the veins of the genital especially in patients with severe dysfunction to see the functions of the arteries and veins in the genitals to find causes and options for the proper treatment. How to treat erectile dysfunction The urologist will start by advising to control your risks such as blood sugar, lipid, blood pressure level and to cut down your smoking and drinking along with encouraging for enough sleeps and regular exercises for a weight loss. Moreover, the doctor will adjust medications that may affect erection. For the patient with psychiatric disorders, the urologist will consult with the psychiatrist for optional treatments. In patients with testosterone disturbances, the doctor will recommend testosterone replacement which is currently available in injection, oral medicine and ointment forms.             Topical Treatments include

1. Oral Medication which are required to be taken about 30 – 60 minutes before sexual intercourse. However, the medicines in this group may cause side effects such as palpitation, headache, light flashes, nasal congestion and etc.
2. Vacuum Device; a plastic tube-shaped device to place over the penis. The air is then pumped out to create a vacuum space around the penis to draw in blood flow by the negative pressure. When a proper erection is achieved, a rubber band is applied at the base to lock in the blood and maintain the erection. The caution is not to leave the band on for too long as it may cause abnormal congestion in the penis.
3. Shockwave Therapy is a treatment using sound waves which pass through erectile tissue to help produce new blood vessels in the penis to maintain the erection. For patients with impaired blood flow to the penis, this option will improve and treat the erectile dysfunction in those with diabetes or in patients who respond to oral medications but do not wish to take them regularly. The treatment is to apply low-intensity shockwave from outside into the penis which takes place once a week for 6 consecutive weeks. It is a noninvasive therapy from which the patient does not feel any pain during the procedure and there are no side effects during or after receiving the treatment. It can also be used in conjunction with treatments by drugs.
4. Injecting Drugs by self-administered injections of a drug directly into the genital 5 – 10 minutes prior to sexual intercourse which is help to produce an erection around 1 hour, and patients use this technique under the supervision of a specialist doctor.
5. Surgical Treatment is the last option for the erectile dysfunction treatment which is surgical implants for the penis are available. There is a penile prosthesis or a pump-style prosthesis, the doctor will suggest this method when other treatments do not work.

                Moreover, Dr. Karan also shares that some men or their spouse may not feel that the erectile dysfunction affect their lives. However, such problem may be an indicator for other diseases such as diabetes, high blood pressure, hyperlipidemia and other risk factors. Therefore, it is recommended that if you have erectile dysfunction, you should have a thorough physical examination and proper advice from specialist. ************************************************************************** For more information and booking an appointment, please contact : Tel: 032-616-880 (7.00 – 19.00 hrs.) Out-Patient Department, ground floor Tel. 032-616-800 Call Center, Bangkok Hospital Hua Hin Line : @bangkokhuahin or https://lin.ee/5tso2l0