Characterize by the inability to develop or maintain an erection of the penis during sexual activity in human. Which can be found up to 40 percent in males aged 40 – 70 years old, but with just a minimal number of patient who dare to consult with a physician.

Risk Factors and Causes of Disease

• Age (the older the individual gets, it affects the level of hormone in the body Testosterone).
• Fewer times or lack of morning erection.

Underlying Disease

More than 50 percent of men having Chronic disease suffers Erectile  Dysfunction ; ED

• Diabetes Mellitus, Diabetic Neuropathies.
• Hypertension , Heart disease can cause decrease blood circulation.
• Prostate cancer and BPH
• CKD (Chronic kidney disease)

Behavior and life styles habit

• Alcoholism
• Less exercise
• Not enough rest
• History of Operation e.g. Prostate operation
• Psychiatric Medication
• Stress anxiety during intercourse can contribute 10-20 percent to the cause of E.D.

How to diagnose

• Access for past medical and family history
• Physical examination
• Lab chemistry test including testosterone and PSA level

Treatment

1. reduce risk factors, life style modification, disease control and prevention, maintain good exercise and enough rest.
2. reduce stress and increase confidence and seek further counseling as necessary.
3. Treatment by Medication
   – PDE5 inhibitor, Viagra ( Sildennafil ), Levitra ( Vardenafil ), Cialis ( Tadalafil )
   – Take medication 1 hour before sexual intercourse.
   – The medication causes smooth muscle relaxation and increased blood flow into the penis causing penile erection.
   – The medication is contra indicated with patient taking nitrate and on hormone therapy (Testosterone).
   – Injection direct to the penis (papavarine, alprostadil)
4. Vacuum device
5. shock wave has angiogenic properties and stimulates neovascularization there for can improve penile blood flow and endothelial function.
6. Operation considered as the last treatment option by prosthesis insertion. Two types 1. Malleable penile prosthesis 2. Inflatable penile prosthesis