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This is the final article on Erectile Dysfunction with 2 days to our Men’s Health Awareness Open Day which will be taking place on Saturday 24th June at the Outspan Medical College grounds. We invite all men to attend and get free checkup, treatment and learn more on major health conditions affecting men today. The event starts at 9.00 a.m., share widely.

How is erectile dysfunction diagnosed?
A diagnosis of erectile dysfunction is made in men who have a history of repeated inability to achieve and/or maintain an erection for satisfactory sexual performance for at least three months. Candid communication between the patient and the doctor is important in establishing the diagnosis of erectile dysfunction, assessing its severity, and determining the cause.
After a interview, the doctor will perform a physical examination check for clues for physical causes of erectile dysfunction.
To confirm the cause of the dysfunction, the doctor may request all or some of the following laboratory tests: -

  • Complete blood counts
  • Urinalysis: An abnormal urinalysis may be a sign of diabetes mellitus and kidney damage.
  • Lipid profile: High levels of LDL cholesterol (bad cholesterol) in the blood promotes atherosclerosis.
  • Blood glucose levels: Abnormally high blood glucose levels may be a sign of diabetes mellitus.
  • Blood hemoglobin A 1c: Abnormally high levels of blood hemoglobin A 1c in patients with diabetes mellitus establish that there is poor control of blood glucose levels.
  • Serum creatinine: An abnormal serum creatinine may be the result of kidney damage due to diabetes.
  • Liver enzymes and liver function tests: Advanced liver disease (cirrhosis) can result in hormonal imbalance and gonad dysfunction leading to low testosterone levels. Thus, evaluation for liver disease may be necessary in cases of erectile dysfunction.
  • Total testosterone levels: Blood samples for total testosterone levels should be obtained in the early morning (before 8 a.m.) because of wide fluctuations in the testosterone levels throughout the day. A low total testosterone level suggests hypogonadism. Measurement of bio-available testosterone may be a better measurement than total testosterone, especially in obese men and men with liver disease, but measurement of bio-available testosterone is not widely available.
  • Other hormone levels: Measurement of other hormones beside testosterone (luteinizing hormone (LH), prolactin level, and cortisol level) may provide clues to other underlying causes of testosterone deficiency and erectile problems, such as pituitary disease or adrenal gland abnormalities. Thyroid levels may be routinely checked as both hypothyroidism and hyperthyroidism can contribute to erectile dysfunction.
  • PSA levels: PSA (prostate specific antigen) blood levels and prostate examination to exclude prostate cancer is important before starting testosterone treatment since testosterone can aggravate prostate cancer.
  • Other blood tests: Evaluation for hemochromatosis, lupus, scleroderma, zinc deficiency, sickle cell anemia, cancers (leukemia, colon cancer) are some of the other potential tests that may be performed based on each individual's history and symptoms.

Imaging tests
In a setting of a previous pelvic trauma, X-rays may be performed to assess various bony abnormalities. Ultrasound of the penis and testicles is done occasionally to check for testicular size and structural abnormalities. Ultrasound with Doppler imaging can provide additional information about blood flow of the penis. Rarely, an angiogram may be performed in cases in which possible vascular surgery could be beneficial.

Psychosocial examination
A psychosocial examination using an interview and questionnaire may reveal psychological factors contributing to erectile dysfunction. The sexual partner also may be interviewed to determine expectations and perceptions encountered during sexual intercourse.

What are the treatments for erectile dysfunction?
The following are treatments for erectile dysfunction:

1. Since many common medications for treating hypertension, depression, and high blood lipids can contribute to erectile dysfunction, working with your doctor to select medications that do not impair erectile function in case you are on regular medication will improve the condition.

2. Life style modification aimed at eliminating modifiable predisposing factors. These include, quitting smoking, exercising regularly, losing excess weight, curtailing excessive alcohol consumption, controlling hypertension, and optimizing blood glucose levels in patients with diabetes Some studies suggest that men who have made appropriate lifestyle improvements experience improvement in their sexual performance.

3. Taking drugs to treat Erectile Dysfunction

4. Inserting medications into the urethra 

5. Injecting medications into the muscles of the penis

6. Vacuum constrictive devices for the penis

7. Penile prostheses

8. Psychotherapy techniques are used to decrease anxiety associated with intercourse. The patient's partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated. If these simple behavioral methods at home are ineffective, referral to a sex counselor may be advised.




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What is erectile dysfunction?

Erectile dysfunction (previously called impotence) is the inability to get or maintain an erection that is sufficient to sustain satisfactory sexual activity for both partners.

How common is erectile dysfunction and what age group is more susceptible? 

There are no current statistics available for Kenya, but in America about 10% of men are believed to be affected. While erectile dysfunction can occur at any age, it is more common among elderly men than in young men. By age 45, most men have experienced erectile dysfunction at least once. Incidence increases with age: about 5% of men at the age of 40 and between 15 and 25% of men at the age of 65 suffer from erectile dysfunction and the percentage grows to 70% as men reach 80 years of age. As men age, they typically report some loss of sexual desire as well, although neither loss of desire nor erectile dysfunction is an unavoidable feature of ageing.

What makes an erection problem occur? 
The brain is the main sex organ. An erection begins with sensory and mental stimulation. Impulses from the brain travelling down the spinal column and impulses from the nerves in the penis relax smooth muscles in two spongy cylinders that run the length of the penis, parallel to the urethra. When the impulses cause the muscles to relax, blood flows into spaces in the spongy tissue, and this pressure makes the penis swell out. A membrane surrounding the cylinders helps to trap the blood in the penis and maintain the erection. The penis returns to its flaccid state if the muscles contract, stopping the inflow of blood and opening outflow channels. An erection problem can occur if any of the events in this sequence are disrupted: the problem may involve mental processes, nerve impulses, or responses in muscles, fibrous tissue, veins and arteries in the penis.

What are some of the risk factors for erectile dysfunction? 

The common risk factors for erectile dysfunction include advanced age, cardiovascular disease, diabetes mellitus, high cholesterol, cigarette smoking, recreational drug use, anxiety, depression or other psychiatric diseases.

What are the causes of Erectile Dysfunction?

1. Physical causes of Erectile Dysfunction

Damage to blood vessels, smooth muscles and fivrous tissues of the penis are the commonest physical causes of Erectile Dysfunction. Blood vessels problems contribute 48% of erection problems while those of the nerves account for 14% and those of the structure of the penis or surrounding tissues account for 3%. Below is a list of underlying factors which lead to above problems: -

  • Diseases affecting the whole body account for 70% of physical causes. These may include diabetes, kidney disease, and multiple sclerosis. Arteriosclerosis or "hardening of the arteries" can prevent adequate blood from entering the penis.
  • Injury to the penis, spinal cord, prostate, bladder or pelvis: such injury can be the result of sports or car accidents, or even riding on hard bicycle seats. 
  • Complications of surgery or radiation (for example, for prostate cancer): these can interfere with nerve impulses or blood flow to the penis. When the nervous system cannot transmit arousal signals, or when the blood vessels in the penis cannot fill or stay filled with blood, you cannot have an erection. 
  • Side effects of common medication: these include drugs taken for high blood pressure, antidepressants, antihistamines, tranquillisers, appetite suppressants, and the ulcer drug cimetidine. • Substance abuse: chronic use of alcohol, marijuana or other drugs often causes impotence, which may be aggravated by decreased sexual drive. Excessive tobacco use can also block penile arteries. 
  • Hormonal factors, such as low testosterone levels. 
  • Zinc deficiency.

Erection problems in men over 50 are more likely to have physical causes.

2. Psychological causes

Psychological problems, such as anxiety, interfere with the erection process by distracting the man from things that would normally arouse him. These problems cause between 10 and 40% of erectile dysfunction. Even in cases where the underlying problem is physical, these factors can play an important secondary role, for example when a man who has had some erectile difficulty starts to anticipate and fear sexual failure. As a result, psychological factors play some causal role in at least 80% of cases of erectile dysfunction. These factors include:

    • Depression: erectile dysfunction is twice as likely among men suffering from depression as it is among those without depressive symptoms.
    • Relationship problems: a man who loses sexual interest in or desire for a particular partner may develop erection problems. 
    • Anxiety and stress, including that caused by major life changes. 
    • Grief and other reactions to major loss: recently widowed men may have erection problems. 
    • Low self-esteem

It is important to note that Erection problems in men under 50 are more likely to be due to psychological causes while they are physical in men over 50.

Our final post on Erectile Dysfunction will be covering Diagnosis and Treatment. We also wish to remind all that our Men’s Health Awareness Open Day will be taking place on Saturday 24th June 2017 (7 days to go) at the Outspan Medical College. Share widely with your friends, family and contacts.




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LeoTolstoy, a Russian writer of 19th Century once said, “Man survives earthquakes, experiences the horrors of illness, and all of the tortures of the soul.  But the most tormenting tragedy of all time is, and will be, the tragedy of the bedroom.”  This tragedy is the interference with male sexual performance leading to inability to sustain satisfactory sexual activity.  It affects both partners, kills the Man’s ego and self esteem and may finally lead to depression, suicidal attempts and death if no professional help is forthcoming. 

This article series is meant to create awareness of this fairly common problem and inform men who are affected by this condition as well as their partners that management of the problem is available. There are many conditions that are known to interfere with male sexual performance.  These include erectile dysfunction which is also known as impotence, decreased libido or lack of sexual desire and ejaculatory dysfunction which is associated with problems with ejaculation and orgasm.

This month being our Men's Health Awareness Month, we shall be covering some of the major health problems affecting men today. In our next post, we shall be focusing on Erectile Dysfunction, what it really is and the causes.

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