What are the physical causes of ED?
• Arterial diseases like, high blood pressure (BP), diabetes, atherosclerosis (calcification in the arteries leading to low blood flow) and heart diseases.
• Hormonal issues like low testosterone
• Obesity
• Nerve diseases like spinal cord injury and stroke, back or pelvic injuries, multiple sclerosis, Parkinson’s disease.

What lifestyle factors might be associated with the occurence of ED?
• Addiction to substances/drugs like marijuana, cocaine, or opioids/narcotics.
• Excessive alcohol consumption.
• Smoking.
• Sedentary habits and lack of physical activity or exercise.

Which medications have the potential to contribute to erectile dysfunction (ED)?
• Anti-depressants.
• Some anti-hypertensives/Blood pressure control medicines and diuretics.
• Anti-cancer medicines.
• Anti-histamines.
• Muscle relaxants.

How can ED be diagnosed?
A common method of diagnosing this condition is:
• Physical examination of penis to find curvature or any specific problems with the penis.
• Detailed history taking through questionnaire about the problem.
• Conducting blood tests like blood sugar levels for diabetes mellitus/ lipid profile for high cholesterol/ measuring serum testosterone hormone levels.
• In case history suggestive of heart diseases will require detailed cardiac evaluation.
• Any other relevant tests if history or examination is suggestive of any underlying health conditions.
• Penile ultrasound to check for scarring and blood flow to the penis.
• Sleep study at home to measure nighttime erections.

What are the treatments available for ED?
Treatment depends on treating underlying cause along with assistance with below therapies:
• Medicine:
• Oral medicine to enhance erection.
• Oral/injectable testosterone supplements as hormonal replacement therapy for low testosterone levels.
• MUSE (medicated urethral system for erections) therapy: Medications administered via a thin applicator tube. The tube is inserted into the urethral orifice, which is situated at the tip of the penis. A pellet (tiny pill particle) is inserted into the urethra. Pellet dissolves and improves erectile function.
• Vacuum pump therapy: A ring is attached to the pump device. By applying pressure to the penis via the pump to achieve erection and then delivering the ring will maintain/facilitate erection.
• Penile implant/prosthesis surgery: There are broadly two types of penile prosthesis/implant procedure are available and includes:
1. An inflatable three-piece implant/prosthesis: Two cylinders, a pump, and a reservoir comprise this. A fluid can be used to inflate the cylinders, which facilitates erection; they can be deflated after the completion of sex.
2. A semi-rigid malleable/two-piece implant/prosthesis: This is comprised of two rods of silicone. The rods contribute to the penis rigidity. Furthermore, they are flexible, allowing the penis to assume a straight position during sexual activity and curve downward after completion of sexual activity.
• Surgery to improve blood flow to the penis: A blood vessel from a nearby anatomical site is anastomosed with the blood vessel of penis to allow blood to flow which eventually bypass the damaged or blocked blood vessels.
• Lifestyle modifications: like exercising, quitting smoking and losing weight.

What factors contribute to PME?
There are several psychological/emotional and physiological/physical factors which can lead to premature ejaculation.
• It could happen if a man experiences excessive stimulation or excitement, or if his penis is exceptionally sensitive.
• It can also occur when a male is uneasy or nervous around a new partner.
Additional causes comprise the following:
• Men with low amount of a special chemical called serotonin in their brain may experience premature ejaculation.
• Performance anxiety
• Depression/stress/relationship problems/guilty feelings.

What are the treatment options for PME?
There are several possible methods for delaying orgasm:
• Behavioral methods: Over 95% of men who experience premature ejaculation find behavioral methods beneficial. Ejaculation control is practiced individually or with the partner during this form of treatment.
• Distraction method: Practicing mental/thought distractions. While being sexually stimulated, think about the names of players from favorite sports team.
• Start-and-stop method: you or your partner will stimulate your penis until you feel like you are about to have an orgasm. Then the stimulation stops for about 30 seconds. Once you regain control, stimulation begins again. This process is repeated few times (3-4) before allowing yourself to have an orgasm.
• Squeeze method: When you feel like you are about to ejaculate, you or partner will gently squeeze the head of your penis for about 30 seconds so that you begin to lose your erection. This process is repeated few times prior to allowing yourself to reach orgasm.
• Psychological treatments:
• Seeking help with psychologist, psychiatrist, or sex therapist to treat anxiety, depression, other emotional issues, and relationship problems.
• Medical treatments:
• Selective serotonin reuptake inhibitors (SSRIs): like dapoxetine and is available with your doctor's prescription. It may cause side effects such as dry mouth, drowsiness, or low sexual desire.
• Topical anesthetic sprays: to apply locally over penis to delay sensation. Typically applied 5-10 mins before intercourse over erect penis. Drying it is essential before penetration otherwise may also lead to vaginal numbness and loss of interest of female partner.
• Barrier method: A few men may find that using a condom can assist in delaying ejaculation by slightly reducing the sensitivity of the penis.