ERECTILE DYSFUNCTION

• Erectile dysfunction or impotentia coeundi is the inability to achieve or sustain an erection sufficient in rigidity or duration for sexual intercourse which is present for a minimum of 6 months 
• Affects 40 % of men older than 50 years exerting substantial effects on quality of life

Organic (most common)

• Vascular: hypertension, diabetes mellitus, cardiovascular disease, hyperlipidemia, smoking
• Neurogenic: stroke, brain or spinal cord injury, dementia, Parkinson disease, multiple sclerosis
• Endocrine: hypogonadism, hyperprolactinemia, thyroid disorders
• Medications: Antihypertensives (beta-blockers, thiazide diuretics), Antidepressants (SSRIs), Dopamine antagonists (e.g. antipsychotics)
• Iatrogenic: surgery or radiotherapy (radical prostatectomy, pelvic radiation)
• Trauma: pelvic fracture and urethral injury
• Alcohol abuse
• Peyronie disease

Psychogenic

• Depression, anxiety (performance-related), relationship issues, trauma from prior experiences, stress

Mixed organic and psychogenic

• Difficulty developing an erection
• Difficulty maintaining an erection
• Reduced rigidity of the erection
• Symptoms last for a minimum of 6 months
• Causes clinically significant distress in the individual
• Not due to another mental disorder, severe relationship distress, substance abuse, or an organic disorder
• Lack of nocturnal erections suggests an organic etiology (neurogenic or vascular)

• According to DSM V criteria usually, a clinical diagnosis is made
• Lab Tests: ↓ testosterone, ↓ LH, ↓ FSH, ↑ SHBG, ↑ prolactin, ↑ TSH, ↑ fasting glucose or hemoglobin A1C, abnormal lipid profile
• Nocturnal penile tumescence measurement (phallography): measurement of spontaneous nightly erections in erectile dysfunction (primarily performed in a sleep laboratory) to differentiate between organic from psychogenic erectile dysfunction
• Duplex Doppler ultrasound or arteriography- to identify suspected arterial inflow or venous leaks after injection of a vasodilatory agent

• Identify the underlying etiology
• Psychotherapy
• Counselling
• Sensate focus exercises for performance anxiety

Medical therapy:

• Phosphodiesterase-5 inhibitors are considered the only first-line therapy; Contraindicated in patients taking nitrates due to profound hypotension
• Testosterone replacement if patient's serum testosterone is low (e.g. in hypogonadism)
• Intracavernous injection therapy or prostaglandin E1 (alprostadil) are second-line therapies
• Mechanical: Vacuum pump (hollow cylinder that is placed onto the penis) with penis ring (outflow obstruction of the existing erection) is also considered a second-line therapy

Ayurvedic Treatment

• Treat according to the cause

Internal Medicines 

• Kalyanaka kashaya
• Saptasara kashaya
• Manasamitra vataka
• Bringarajaasava
• Vidaryadi gritha
• Gokshura choorna
• Aswagandha choorna
• Vasanta kusumakara rasa
• Aswagandha rasayana
• Shilajith
• Poorna chandrodaya rasa

Procedure 

• Snehapana – Kalyanaka Gritha
• Virechana – Kalyana guda
• Mustadi Rajayapana vasti
• Ext Application - Bala Aswagandhadi taila