Erectile dysfunction (ED), the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse, is a prevalent issue that affects many men.
In Kenya, about 15 to 20 per cent of men suffer from erectile dysfunction and premature ejaculation. Ten to 15 per cent of adults below 40 years have ED. It goes up to 76 per cent between the ages of 50 and 70. However, 25 per cent of adults in all age groups have the problem.
According to Dr Vic Albert, a consultant urologist at the German Medical Centre and Turkana County Referral Hospital, the intricate vascular mechanisms governing vascular problems are the leading cause of erectile dysfunction, making it crucial to understand how the process of erection works and explore ways to improve it.
"When you get aroused, the nerves release nitric oxide, which is the ignition of erections," he explains.
Nitric oxide triggers a cascade of events that facilitate blood flow into the penis.
"This causes the muscles to relax and arteries to widen, allowing for higher blood flow into the penis," Dr. Albert explains.
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As the penis fills with blood, the tunica albuginea, the envelope-like structure surrounding the corpora cavernosa (the spongy erectile tissue), expands, compressing the surrounding veins.
This veno-occlusive mechanism is vital for sustaining an erection. "When the veins are flattened, this prevents the blood from leaving the penis, leading to the rigid erection phase," Dr Albert adds.
The trapped blood within the corpora cavernosa enables the penis to achieve and maintain its rigid state.
However, medical conditions that affect the arteries, such as heart disease or high blood pressure, can impair the ability to achieve and sustain an erection. Dr Albert warns, "This can affect your penis before it affects anywhere else in your body like your heart because the arteries of the penis are significantly smaller than the arteries to the heart."
Increased arterial pressure can make it more difficult for blood to enter the penis, hindering erection.
"This can lead to chronic hypoxia over time, which can, in turn, lead to fibrosis or scar tissue, exacerbating the erectile dysfunction," Dr Albert explains.
Venous leak, a condition where blood flow enters the penis but fails to be trapped due to ineffective vein compression, is another complication that can contribute to erectile problems.
"Venous leak is essentially when blood flow enters the penis, the veins don't get compressed well, or they are unable to compress well, so the blood essentially leaks right out," says Dr Albert.
This can result in erections that are short-lived or fail to reach full rigidity.
To combat ED, Dr Albert recommends a holistic approach, emphasizing lifestyle changes such as improved nutrition and regular exercise, which can benefit overall health, including penile tissue health. Medications like PDE5 inhibitors, penile injections, constriction bands, vacuum erection devices, and surgical options like penile implants are also available.
However, Dr Albert notes that many men with ED do not seek medical treatment, often due to embarrassment or reluctance to discuss the issue.