Hattat Erectile Dysfunction Diagnosis and Treatment Center

Erectile dysfunction, frequently referred to as impotence, is the persistent or recurrent inability to attain or maintain an erection sufficient to complete sexual intercourse or another chosen sexual activity. It is a common problem which affects at least one in every ten men. Regrettably, only about 10% of sufferers actually receive treatment. The number of men suffering erectile dysfunction increases with age. It is important to remember that over the last few years there have been major advances in the treatment of erectile dysfunction and the majority of sufferers can now be treated effectively.

Physical causes

The process of achieving an erection is complex and problems may occur for a variety of reasons. These problems can be psychological, physical, or a combination of the two. Physical causes of ED are related to a breakdown or damage to the sequence of events that lead to an erection. This sequence involves nerve impulses in the brain, spine, and penis as well as the subsequent response in the muscles, fibrous tissues, veins and arteries in and near the corpora cavernosa. Often times the breakdown or damage in the sequence affects the arteries, muscles, and surrounding tissues of the penis, and this breakdown is most commonly the result of a disease.

Diseases that commonly cause ED include:

  • Diabetes : Diabetes can cause nerve and artery damage that can make achieving an erection difficult. Between 35% and 50% of men with diabetes experience ED
  • Neurological (nerve and brain) diseases: The nervous system (the body's system of nerves) plays a vital part in achieving and maintaining an erection and it is common for men with diseases such as stroke, multiple sclerosis (MS), Alzheimer's disease, Parkinson's disease and spinal cord injuries to experience ED. This is due to an interruption in the transmission of nerve impulses between the brain and the penis.
  • Vascular disease: Vascular diseases are those that affect the blood vessels. These diseases include atherosclerosis (hardening of the arteries), hypertension, and high cholesterol. These diseases, which account for 70% of physically-related causes of ED, all restrict blood flow to the heart, the brain and, in the case of ED, the penis.
  • Prostate cancer : Prostate cancer doesn't cause ED on its own, but treatment (radiation, hormonal manipulation, or surgery to remove the cancer) can lead to erectile problems.
  • Kidney disease: Kidney disease can cause chemical changes to occur in your body that affect hormones, circulation, nerve function, and energy level. Often times these changes will lower a person's libido (sex drive) or sexual ability. Drugs used to treat kidney disease may also cause ED.

The physical causes of ED are not only disease-related. There are many other potential causes, including:

  • Surgery: Surgery performed to treat diseases such as prostate cancer and bladder cancer often require the removal of nerves and tissues around the affected area which can lead to ED. Some of these surgeries result in only temporary problems (lasting 6-18 months) while others result in permanent damage to the nerves and tissue around the penis and require treatment in order for an erection to be achieved.
  • Injury: Injuries to the pelvis, bladder, spinal cord, and penis that require surgery also commonly cause ED.
  • Hormonal imbalances: Imbalances of hormones, such as thyroid hormones, prolactin, and testosterone, can affect a man's response to sexual stimulation. These imbalances can be the result of a tumor of the pituitary gland, kidney disease, liver disease, or hormonal treatment of prostate cancer.
  • Venous leak: If the veins in the penis cannot prevent blood from leaving the penis during an erection, an erection cannot be maintained. This is known as a venous leak, and can be a result of injury or disease.
  • Tobacco, alcohol or drug use: All three of these substances can damage a person's blood vessels and/or restrict blood flow to the penis, causing ED. Smoking in particular plays a large role in causing ED in people with arteriosclerosis.
  • Prescription drugs : There are over 200 types of prescription drugs that may cause ED.
  • Prostate enlargement: Bladder neck obstruction due to prostate enlargement has recently been implicated in being associated with varying degrees of ED.

Psychological causes

Psychological factors are responsible for about 10%-20% of all cases of ED. It is often a secondary reaction to an underlying physical cause. In some cases, the psychological effects of ED may stem from childhood abuse or sexual trauma. However, the most common psychological causes of ED include:

  • Stress: Stress can be job-related, money-related, or the result of marital problems, among other factors.
  • Anxiety: Once a man experiences ED, he may become overly worried that the problem will happen again. This can lead to "performance anxiety," or a fear of sexual failure, and consistently cause ED.
  • Guilt: A man may feel guilty that he is not satisfying his partner.
  • Depression: A common cause of ED, depression affects a person physically and psychologically. Depression can cause ED even when a man is completely comfortable in sexual situations. Drugs used to treat depression may also cause ED.
  • Low self-esteem: This can be due to prior episodes of ED (thus a feeling of inadequacy) or can be the result of other issues unrelated to sexual performance.
  • Indifference: This may come as a result of age and a subsequent loss of interest in sex, be the result of medications or stem from problems in a couple's relationship.

All men at one time or another will experience ED. Only if the problem becomes persistent -- occurs more than 50% of the time, or becomes a source of distress for you or your partner should you be concerned and consider seeking medical advice and treatment. For men whose erectile dysfunction is caused by psychological problems, therapy may be needed.

What should a man do if he develops erectile dysfunction?

A visit to the doctor is often the most difficult step to take. He will need to have a clear understanding of your problem . It is important to remember that over the last few years there have been major advances in the treatment of erectile dysfunction and the majority of sufferers can now be treated effectively.

What Happens at Hattat Clinic?

We aim to find out the exact cause of the problem (psychical or psychological ) with concultancy of a team of andrologists, sexual physicians, endocrinologists and psychologists. Because there are a variety of causes for ED, there are several different tests your doctor may use to diagnose the condition and determine its cause. Only after the cause of ED is determined can it be effectively treated. If you have any questions, do not hesitate to ask your doctor. With the results of the tests the real cause can be determined and the exact treatment protocol can be given in a 2 days time. Before ordering any tests, your doctor will review your medical history and perform a thorough physical examination. The doctor will also "interview" you about your personal and sexual history. Some of these questions will be very personal and may feel intrusive. However, it is important that you answer these questions honestly. The questions asked may include:

  • What medications or drugs are you currently using? This includes prescription drugs, over-the-counter drugs, herbal supplements, dietary supplements, and illegal drugs or alcohol.
  • Have you had any psychological problems such as stress, anxiety and depression?
  • When did you first notice symptoms of ED?
  • What are the frequency, quality, and duration of any erections you have had?
  • What are the specifics of the circumstances under which ED first occurred?
  • Do/did you experience erections at night or during the morning?
  • What sexual techniques do you use?
  • Are there problems in your current relationship?
  • Do you have more than one sexual partner?
  • If you have more than one partner, do you experience ED with one or both?

The doctor may also wish to interview your sexual partner since your partner may be able to offer in sight about the underlying causes.

After your physical examination and interview, your doctor may then order any one of the following tests:

  • Complete blood count (CBC): This is a set of blood tests that, among other things, can detect the presence of anemia. Anemia is caused by a low red blood cell count and can cause fatigue, which in turn can cause ED.
  • Liver and kidney function tests: These blood tests may indicate whether ED may be due to your kidneys or liver functioning improperly.
  • Lipid profile: This blood test measures the level of lipids (fats), like cholesterol. High levels may indicate atherosclerosis (hardening of the arteries), which can affect blood circulation in the penis.
  • Thyroid function test: One of the thyroid hormones' functions is to regulate the production of sex hormones, and a deficiency in these hormones may contribute to or cause ED.
  • Blood hormone studies: Testosterone and/or prolactin levels in the blood may be measured to see if abnormalities in either of these sex hormones are present.
  • Urinalysis: Analysis of urine can provide a wealth of information, including information on protein, sugar, and testosterone levels. Abnormal measurements of these substances can indicate diabetes, kidney disease, or a testosterone deficiency, all of which can cause ED.
  • Duplex ultrasound: This is perhaps the best test for evaluating ED. An ultrasound uses high-frequency sound waves to take "pictures" of the body's tissues. For people with ED, an ultrasound may be used to evaluate blood flow and check for signs of a venous leak, artherosclerosis or tissue scarring. This test is performed both while the penis is erect (usually induced by an injection of a drug that stimulates erection) and also while it is soft.
  • Nocturnal penile tumescence (NPT): This test measures a man's erectile function while he is sleeping. Normally, a man will have five or six erections while asleep. A lack of these erections may indicate there is a problem with nerve function or circulation to the penis. The test uses two methods, the snap gauge method and the strain gauge method. The snap gauge method is performed by wrapping three plastic bands of varying strength around the penis. Erectile function is then measured based on which of the three bands breaks. The strain gauge method works by placing elastic bands around the tip and base of the penis. If the penis becomes erect during the night, the bands stretch, measuring the changes in penile circumference.
  • Vasoactive injection: During this test, an erection is produced by injecting special solutions that cause the blood vessels to dilate (enlarge), allowing blood to enter the penis.
  • Dynamic infusion cavernosometry: This test is used for men with ED who have a venous leak. During this test, fluid is pumped into the penis at a predetermined rate. By measuring the rate at which fluid must be pumped to attain a rigid erection, doctors can determine the severity of the venous leak.
  • Cavernosography: Used in conjunction with the dynamic infusion cavernosometry, this test involves injecting a dye into the penis. The penis is then X-rayed so that the venous leak can be seen.
  • Bulbocavernosus reflex: This test evaluates nerve sensation in the penis. During the test, your doctor will squeeze the head of your penis, which should immediately cause your rectum to contract. If nerve function is abnormal, there will be a delay in response time or absence of rectal contraction.
  • PSA: This test may be abnormal due to prostate enlargement or infection, which may complicate ED. Before you are given any of these tests, your doctor will explain what is involved.

What treatments are available for erectile dysfunction?

  • Sex and/or couple's therapy
  • Intracavernosal injection therapy
  • Transurethral therapy
  • Vacuum constriction devices
  • Oral Treatments
  • Hormone treatment
  • Surgical treatments
  • Penile prosthesis
  • ESWT (Extra-corporeal Shock Wave Treatment)

ESWT (Extra-corporeal Shock Wave Treatment)

ESWT has gained some popularity in recent years. Extracorporeal shockwaves are high-pressure, low-frequency sound waves, generated by a device outside the body and applied to the penis of patients with vasculogenic ED. Results from studies have shown that LI-ESWT induces neovascularization, thus enhancing penile perfusion and substantially improving erectile function. A number of studies have been published on improving efficacy of PDE5i in men who do not respond or respond poorly to PDE5i therapy, suggesting potential ways other than intracavernosal injections or penile implants to increase the efficacy of PDE5i therapy.