Shock waves, hormone therapy and cognitive reprogramming, innovative treatments for erectile dysfunction

It is difficult to define when a man is considered to be suffering from erectile dysfunction. Theoretically, it takes six months from the time the patient begins to notice the problem until a diagnosis can be established, but this is not entirely true. There are patients who, for example, after certain types of surgery know that they may have an erection problem. And, on the other hand, it is always important to remind patients that having a bad day does not mean having a problem, there is no need to go to the doctor right away or become obsessed. However, after a season of having bad erections and noticing that something is not working well, a specialist in Andrology should be consulted.

What factors can influence erectile dysfunction (health problems, lack of libido, partner problems, lack of communication…)?

Basically there are two main types of causes. Up to the age of 50 (although this is not always the case), the problems are usually mental or psychological, related to many factors: a new partner, a separation, performance anxiety, having had a bad season, having had less sex for a while, among others. All this makes the man feel more insecure and any of these situations ultimately leads to two problems: one is lack of desire and the other is performance anxiety. The latter is the fact of being afraid and the patient continually thinks that it is going to happen again and that he is going to look bad to his partner. This would be the first of the major causes of erection problems.

On the other hand, there are organic causes: prostate problems, diabetes, medications and other diseases. These can cause poor blood flow to the penis, nerves to malfunction or hormones to be low and therefore cause erection problems.

When is erectile dysfunction a “problem” and when to see a specialist?

It is something that depends on each man. There are men who, after having a problem only once, visit a specialist, and others who have had the problem for perhaps 20 years and have never seen a specialist before.

There is no red “line” that establishes the limit but neither the first day nor the first week that it happens means anything, we all have bad days and bad seasons when we are more worried about other things. But we must also think that if the patient has been suffering from this problem for a month or two and is not getting better, is worried and has tried other remedies without result, it means that it is necessary to look for a specialist who can help.

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What kind of treatments will be applied, depending on the origin of the problem? What innovative techniques are currently available?

There are currently many innovative treatments. For vascular problems shock waves are applied and for hormonal problems there are testosterone supplementation treatments. On the other hand, for psychogenic problems there is a therapy that works very well and very quickly called cognitive reprogramming therapy. It is a psychological treatment that is used in many aspects of mental health, not only in the sexual area, and it works very well in controlling anxiety, identifying the thought “it will happen to me again” and changing it for another one. The effectiveness of this therapy is about 95% in two months, so it works very well and very fast.

But the important thing is to find the cause. When the correct diagnosis is made the treatment generally works very well. And for an accurate diagnosis it is necessary to go to specialists with a lot of experience and to have the technological means to reach that diagnosis. In the area of sexuality the diagnosis is perhaps less technological than in other areas of health because it cannot be reflected in a blood test or in certain tests, but the blood test will be very useful in this case, especially to rule out hormonal and vascular causes. On the other hand, penile Doppler ultrasound will also help to rule out vascular causes and, to rule out psychological causes, there is the nocturnal penile tumescence test, something that allows to know if the patient has good erections at night and, in such cases, it is assumed that the problem will be more mental, since when the patient relaxes he has good erections.