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Erectile Dysfunction: Causes, Symptoms, Treatment Options and Approaches

Reading Time: 5 minutes Understanding Erectile Dysfunction: Causes, Symptoms, Treatment Options and Approaches Erectile dysfunction (ED) refers to the incapability to achieve or sustain an erection sufficient for sexual intercourse. Did you know that as per research, 1 in 10 men will experience erectile dysfunction at some point in their lifetime? In the year 1995, more than 152 million men worldwide were estimated to have experienced ED. It’s predicted that by 2025, the global prevalence of ED will reach around 322 million. What is Erection? Erection is a physiological response represented by the enlargement and engorgement of the penis. This complex process involves the harmonious functioning of various systems such as endocrine, neurological, circulatory, and musculoskeletal processes. The autonomic nervous system, comprising the parasympathetic and sympathetic nervous systems, primarily regulates this response. The sensory signals from the genital area are transmitted to the brain after a man experiences sexual stimulation or sexual arousal. In response, the brain sends signals back to the genital area through the parasympathetic nervous system. These signals stimulate the release of nitric oxide, which relaxes the smooth muscles of the blood vessels in the penis. When these blood vessels relax and dilate, they allow an increased flow of blood into the spongy corpora cavernosa of the penis. This heightened blood flow causes the corpora cavernosa to become engorged, resulting in an enlarged and erect penis. Simultaneously, the veins responsible for draining blood from the penis are compressed, aiding in the maintenance of the erection. What is Erectile Dysfunction? Erectile Dysfunction (ED) can be referred to as a persistent incapability to attain or maintain an erection required for satisfactory sexual intercourse. ED is believed to be a prevalent medical condition that can impact the quality of an individual’s life. Did you know that research indicates ED is more widespread among older males, but it also affects a significant number of younger males? What are the Symptoms of Erectile Dysfunction? Symptoms of erectile dysfunction comprise: Difficulty in getting an erection Complete inability to get an erection Inability to maintain an erection Only occasionally being able to get an erection. Low self-esteem Distress and depression Additional sexual disorders linked to ED may encompass Premature ejaculation, Delayed ejaculation and Anorgasmia, which is the inability to attain orgasm even after sufficient stimulation What causes erectile dysfunction? Erectile dysfunction (ED) can result from various factors, and it often involves a combination of physiological, psychological, and relational components. The common ED causes include the following: Diabetes Age over 50 Radiation therapy or other injuries from treatments for prostate cancer or surgery Cardiovascular diseases Smoking Kidney diseases Obesity A sedentary lifestyle and lack of movement High cholesterol Drug and alcohol abuse Emotional issues such as depression, conflicts in relationships, stress Organic etiologies such as neurogenic, drug interactions, Peyronie’s disease (PD), and endourologic causes may be responsible. Men with diseases such as multiple sclerosis, trauma, or epilepsy are believed to be at greater risk of developing erectile dysfunction. Medications such as NSAIDs, antiepileptics, antidepressants, and neuroleptics can also cause erectile dysfunction. Possible etiologies of hormonal abnormalities such as acquired hypogonadotropic hypogonadism, congenital hypogonadotropic hypogonadism, and Klinefelter’s syndrome may result in ED. Alterations in the components of erectile response, whether relational, psychological, or organic, can be factors in erectile dysfunction. Available Treatment Options for Erectile Dysfunction: Oral Drugs: Mostly PDE type-5 inhibitors are used as they help increase penile blood flow. Oral drugs are advised to be taken 45- 60 minutes before sexual activity. The drugs provide normal functioning and erectile responses. However, PDE5 inhibitors should be avoided in the case of individuals with heart disease. Common drugs include: Tadalafil (Cialis) sildenafil citrate (Viagra) Avanafil (Stendra) vardenafil HCl (Levitra) Testosterone therapy: The combination of PDE5 inhibitors and testosterone therapy may help fix the rare cases of low sex drive and low testosterone levels resulting in relief from ED symptoms. Self-injection therapy: A dose of alprostadil is administered to the side of the penis, with the dosage adjusted based on the condition’s severity. On occasion, a combination of two other drugs alongside ICI (Intracavernosal Injection) alprostadil may be used. Intraurethral Therapy: A medicated drug pellet of Alprostadil is inserted in the urethra. Surgical treatment: A penile implant is inserted as the primary surgical treatment for ED. Patients who have failed oral pills, self-injections, or other therapies opt for surgical treatments. It’s important to note that the choice of treatment depends on the specific underlying causes of ED, the individual’s overall health, and their preferences. MED3000 (Eroxon) In June 2023, the FDA approved the first-ever over-the-counter gel for erectile dysfunction,  known as MED3000. This gel is applied directly to the penis just before intercourse and is available in single-use tubes. It contains various volatile compounds that stimulate penile nerve endings, leading to increased blood flow, a crucial factor for achieving an erection. Some reports suggest that the gel can lead to an erection within just 10 minutes, while commonly prescribed ED drugs like Viagra typically take around 30-40 minutes to take effect. MED3000 is now approved in multiple countries, including those in Africa, the Middle East, and Europe. It is available in the UK and can be purchased online. Eroxon introduced it for online sales in the Benelux region and made it available in retail pharmacies throughout Belgium in March 2023, with plans for additional online and retail releases in the coming months. Conclusion: Erectile dysfunction (ED) is a prevalent condition affecting approximately 30 million men. It can be attributed to underlying health issues or the natural aging process. Fortunately, numerous treatment options, therapies, and medications are available. However, it’s crucial to assess the severity of the condition and consult with a healthcare professional before selecting a treatment. Adopting a healthy lifestyle is also vital for managing ED effectively, which includes maintaining a balanced diet, regular exercise, smoking cessation, and limiting alcohol consumption. Making these positive changes can help alleviate ED symptoms in the long term. References Ludwig W, Phillips M. Organic causes of erectile dysfunction in men under 40. Urologia internationalis. 2014

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The Gut-Diabetes Link: Exploring The Influence Of Gut Microbiota On Diabetes​

Reading Time: 7 minutes the Gut-Diabetes Link: Exploring the Influence of Gut Microbiota on Diabetes What is Diabetes? The World Health Organization (WHO) defines diabetes as a chronic metabolic condition marked by elevated blood sugar levels, which can after that result in significant consequences. [1] As of 2019, more than 460 million adults worldwide have been diagnosed with diabetes, which is projected to reach 700 million by 2045. The primary hormone at play is insulin, which controls how much blood glucose is absorbed by organs. In diabetes, insulin is either shown to be nonfunctional, destroyed, or produced insufficiently. The malfunction of insulin regulation results in inadequate glucose uptake by cells, leading to high blood sugar levels. What is Gut Microbiota? A group of microbes called the gut microbiota live in the gastrointestinal tract (GIT), including bacteria, fungi, and viruses. Our diet majorly influences the composition and diversity of gut bacteria. Beginning at birth, the gut microbiota continues to evolve until a child is three years old. The types and abundance of microbes in the gut can change over time in response to various factors, including diet, environment, and age. The composition of gut bacteria can vary throughout the gastrointestinal tract, with the colon being the region where they are most prevalent.  Humans and gut microbiota work in a symbiotic relationship. The gut microbiota helps with tasks like breaking down complex carbohydrates and producing certain vitamins, while humans provide a stable environment and nutrients for the microorganisms.   The collaborative MetaHit project (Metagenomics of the Human Intestinal Tract) has given us a better insight into the types of microbiota species residing in our gut. According to the findings, a particular type of bacteria called “Firmicutes” made up the majority of the composition, with another phylum called Bacteroidetes. [2]   The diverse gut microbiota is generally considered a sign of good gut health. It’s not just the presence of specific bacterial groups but also the overall diversity of the microbiota that plays a role in maintaining health and preventing certain diseases. The findings from such research projects have had a substantial impact on our understanding of the gut microbiota’s role in health and disease. They have shed light on how variations in the gut microbiota may be associated with various health conditions, including obesity, metabolic disorders, and gastrointestinal diseases. What fuels the gut microbiota? The answer would be fibres. While human enzymes cannot break down fibres, they benefit the microbiota. The fibres reach the large intestine (colon) undigested, where they become a source of nutrition for the gut microbiota. Microbiota ferment fibres, and as a result, they can create short-chain fatty acids (SCFA) including acetate, propionate, and butyrate. These SCFAs have several important functions in the body which may include: Improve glucose metabolism: It helps improve insulin sensitivity, thus regulating blood sugar levels. Reduce the buildup of fat in adipose tissue which may help in better weight management. Preserve the intestinal epithelial barrier’s integrity: SCFAs, particularly butyrate, play a role in preserving the integrity of the intestinal epithelial barrier. Promote the metabolism of liver glycogen: It assists in maintaining stable blood sugar levels. [3] How can Gut Microbiota dysbiosis cause Diabetes? The gut microbiota interacts closely with the intestinal epithelial barrier, which includes components like mucus, enterocytes (intestinal cells), and tight junction proteins (e.g., zonula occludens, cingulin, occludin, and claudin 2). These components collectively help maintain the integrity of the gut barrier. Dysbiosis refers to an imbalance in the composition of the gut microbiota which can lead to changes in the gut barrier. Factors such as diet, environment, medications, and lifestyle can contribute to dysbiosis. This dysbiosis can compromise the integrity of tight junctions, making the intestinal epithelium more permeable. This condition is often referred to as “leaky gut” or increased intestinal permeability. Consequently, it allows microbial components from bacteria to enter the bloodstream. This process is termed Endotoxemia. Studies have revealed that these bacteria’s lipopolysaccharides (LPS) are thought to trigger an inflammatory response in the bloodstream and are linked to an array of autoimmune and metabolic diseases including Diabetes. [3, 4] It has also been shown that blood samples from patients with chronic diseases contain bacterial DNA, which causes systemic inflammation. Studies have shown that different types of bacterial compositions are associated with various diabetic complications. This suggests a close link between the gut microbiota and both the development of diabetes and its related complications. [5] How does the gut microbiome affect Type 1 Diabetes? Type 1 diabetes (T1D) is an autoimmune disorder in which the Langerhans beta cells of the pancreas are destroyed, resulting in decreased or absent insulin production and leading to hyperglycemia. Data from bioinformatics indicates that few microorganisms can produce an insulin-like peptide that can activate the immune system and lead to a cross-reactive immune response, where the immune system mistakenly attacks both the microbial molecules and the body’s own insulin-producing cells (Autoimmunity). Studies have found differences in the gut microbial composition of individuals with T1D and those without the condition. [6] Children with autoantibody positivity (a sign of increased risk for T1D) have been observed to have different microbial profiles. They may have higher levels of certain bacteria, such as Bacteroides, and lower levels of microbes that produce short-chain fatty acids (SCFAs). Before the onset of T1D, some children had larger concentrations of Bifidobacterium species and lower concentrations of Streptococcus thermophilus and Lactococcus lactis. The differences in microbial composition suggest a potential link between gut bacteria and the development of T1D.     How does the gut microbiome affect Type 2 Diabetes? Type 2 diabetes is mainly characterized by insulin resistance and metabolic disturbances. Researchers have identified 43 distinct bacterial taxa (types of bacteria) that may be associated with T2D. This suggests that the composition of the gut microbiota differs in individuals with T2D compared to those without the condition. Specific bacterial taxa, such as Acidaminococcales, Bacteroides plebius, and Phascolarctobacterium sp CAG207 have been suggested as potential biomarkers for detecting T2D. Studies have found correlations between certain bacterial species and markers of

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