Erectile Dysfunction - assessing and managing patients

[madman]

KEY POINTS

● Erectile dysfunction in men is common, especially after the age of 40 years.

● Underlying health conditions predispose men to erectile dysfunction.

● Dispelling the stigma and having open conversations about erectile dysfunction with men is essential in addressing treatment and management.

● There are several pharmacologic and nonpharmacological treatments available to treat erectile dysfunction.

● Nurses play a vital role in treating and managing erectile dysfunction in men





INTRODUCTION

Sexual health is an important aspect of an individual’s life. As men move through the phases of aging, sexuality, and sex can take on different forms. For many men, their sexuality is defined by their ability to perform in the proverbial bedroom, which includes their ability to obtain erections to have sexual relations with their partner. Erections for men are an essential aspect of their sexual identity regardless of sexual orientation. When obtaining or maintaining erections becomes difficult, men often face multiple complex emotions. They often choose not to disclose this issue to anyone, including their healthcare provider, due to embarrassment or feeling inferior.

Erectile dysfunction (ED) is a condition in which a male cannot get or keep an erection firm enough for satisfactory sexual intercourse.1–4 ED can be short-term or long-term. An individual is considered to have ED when1,3,4


● The individual can obtain erections sometimes, but not every time they want to have sex.

● The individual can obtain erections, but the erection does not last long enough for fulfilling or satisfactory sex.

● The individual is unable to get an erection at any time




ED is a common problem among men in the United States (US). The prevalence of ED increases with age, with the estimates suggesting that it affects around 50% of men over the age of 40 years.1,5,6 The National Institutes of Health estimate that affects about 18 million men in the US alone.5 The prevalence of ED is also higher among those who have certain health conditions such as diabetes, hypertension, and cardiovascular disease.1,5,7,8 ED is not a normal part of aging and can be treated by the individual consulting with a health care provider and addressing the underlying medical conditions predisposing them to the symptoms.2,6

Because of the prevalence of ED in the US, nurses must become aware of the implications associated with ED and learn how to help treat men affected by this condition. Nurses maintain the skills and expertise to readily address the disorder by understanding the phenomena associated with this health condition.




*Stigma of ED

*Psychological Effects of ED

*Effects of Pornography on ED

*Sexual Preference and ED

*Race and ED

*Age and ED

*Causes of ED

*Assessing for ED

*Pharmacologic Treatment of ED

*Nonpharmacological Treatment of ED

*Partner Participation in the Treatment of ED

*Nurse’s Role in the Management of ED




SUMMARY

Nurses must become aware of ED because it is a common condition that can significantly affect men’s physical and emotional health. Nurses play a vital role in assessing and managing patients with ED, including educating them about the causes and treatment options available. Nurses can help patients overcome this condition’s stigma by being knowledgeable about ED and empowering them to seek the care they need.

ED is often a symptom of underlying conditions such as cardiovascular disease, diabetes, and hypertension. Nurses familiar with ED can recognize this connection and refer patients for further evaluation and treatment. ED can be an early warning sign of these conditions in some cases, allowing for earlier diagnosis and intervention to improve outcomes. Nurses can work collaboratively with other healthcare providers to manage these underlying conditions, which can, in turn, improve ED symptoms and the overall quality of life for patients.

Furthermore, ED can be a source of emotional distress and relationship issues for men and their partners. Nurses knowledgeable about ED can provide counseling and support to patients and their partners, helping them cope with the psychological impact of this condition. By being compassionate and nonjudgmental, nurses can create a safe and supportive environment for patients to discuss their concerns and seek the care they need.

In conclusion, ED is a common condition that can significantly impact men’s physical and emotional health. Nurses knowledgeable about ED can play a crucial role in assessing and managing patients with this condition, identifying underlying medical conditions, and providing emotional support to patients and their partners. By being aware of ED and its implications, nurses can help improve outcomes and quality of life for patients affected by this condition

 

[madman]

Causes of ED

ED is a complex condition with multiple causes. The pathophysiology of ED involves a complex interplay of physiologic, psychological, and lifestyle factors that can interfere with the normal physiologic processes that result in an erection. Physiologically, an erection occurs when the spongy tissue in the penis fills with blood, causing it to become stiff and erect. This process is controlled by the nervous system and involves the release of nitric oxide, a chemical that relaxes the blood vessels in the penis and allows blood to flow into the penis.4,19–21

The most common causes of ED include vascular problems, such as atherosclerosis or hypertension; neurologic problems, such as nerve damage from diabetes or spinal cord injuries; hormonal imbalances, such as low testosterone levels; and psychological problems, such as stress or anxiety.4,19–21 Vascular issues can lead to ED by causing a decrease in blood flow to the penis, making it difficult to achieve or maintain an erection. Neurologic problems can cause ED by disrupting the nerve signals necessary for an erection. Hormonal imbalances can also cause ED by disrupting the balance of hormones essential for sexual function. Psychological problems can cause ED by causing anxiety disorders or stress, making it difficult to relax and become sexually aroused.

In most cases, ED is caused by a combination of factors. The underlying pathophysiology of ED involves the inability of the penile vessels to dilate and fill with blood to achieve and maintain an erection. This can be due to structural changes in the vessels, dysfunction of the smooth muscle cells, or a combination of both. Diagnosis of ED typically begins with a thorough history and physical examination and may include further testing such as blood tests, psychological evaluation, nocturnal tumescence, and rigidity testing.3,7,21–23
Often ED is accompanied by concomitant sexual disorders. Healthcare providers must be aware of these disorders and evaluate them with ED. Some of the most common sexual conditions that accompany ED include4,19–21


● Premature ejaculation: This is a condition in which a man ejaculates earlier than he or his partner would like. It can be a separate disorder or happen in conjunction with ED.

● Delayed ejaculation: This is a condition in which a man takes a longer time to ejaculate than he or his partner would like. It can be a separate disorder or happen in conjunction with ED.

● Low libido: Also known as hypoactive sexual desire disorder, a condition in which a man has reduced interest in sexual activity.

● Anorgasmia: This is the inability to achieve orgasm; it can be a separate disorder or happen in conjunction with ED.

● Peyronie’s disease: This is a condition in which scar tissue forms inside the penis, causing it to bend or curve during an erection.

● Male hypogonadism: This is a condition in which the body does not produce enough testosterone, which can lead to a decreased sex drive and ED.


Awareness by the health care provider of these potential underlying and concomitant health conditions contributing to or causing ED is essential in ensuring that the individual’s care is maximized through a holistic approach to their condition.

 

[madman]

*In most cases, ED is caused by a combination of factors. The underlying pathophysiology of ED involves the inability of the penile vessels to dilate and fill with blood to achieve and maintain an erection. This can be due to structural changes in the vessels, dysfunction of the smooth muscle cells, or a combination of both.