Erectile dysfunction is defined as the persistent inability to initiate or maintain an erection of sufficient quality to permit satisfactory sexual intercourse. Thus, we speak of erectile dysfunction when either or both of the two conditions are present:
- Lack of penile rigidity adequate for penetration.
- Inability to maintain an erection long enough to allow satisfactory sexual intercourse.
Erectile dysfunction has a multifactorial origin. There are organic causes that are responsible for this lack of adequate penile rigidity in almost 80% of cases:
- Age: Erectile dysfunction is an age-dependent disease, i.e. its incidence and prevalence increases as the male gets older, but it should not be confused, as is often the case, as something normal with age. Erectile dysfunction is always pathological regardless of the patient’s age.
- Cardiovascular diseases: Almost 70% of patients with angina pectoris or coronary artery disease present erectile problems 2 or 3 years earlier. Cardiovascular risk may have been reduced in these patients before the first symptoms of coronary heart disease appeared, and erectile dysfunction may therefore be a useful indicator of hidden cardiovascular disease.
- Diabetes: appears at younger ages and is more frequent in diabetic patients, as well as being more difficult to treat.
- Dyslipidemia: hypercholesterolemia and hypertriglyceridemia.
- Arterial hypertension: Erectile dysfunction is associated with both hypertension and the use of antihypertensive drugs.
- Toxic habits: Tobacco and excessive alcohol consumption.
- Adverse effects of drugs.
- Neurological diseases.
- Hormonal alterations with testosterone deficiency.
- Trauma or pelvic surgery.
Apart from these factors that we could call organic, there are also psychological factors that can cause difficulties for the male to achieve an erection sufficient to penetrate or maintain it throughout sexual intercourse:
- Anxiety, relationship conflicts.
- Social or work problems.
- Affective disorders.
- Depression – Sexual inhibition.
- Result of sexual preferences.
- Fear of pregnancy.
- Sexually transmitted diseases, Psychiatric diseases.
Who is usually affected by erectile dysfunction?
Erectile dysfunction in Spain affects almost 20% of men between 20 and 75 years of age, according to epidemiological research carried out in our country, but it can also affect younger men.
The frequency of this pathology increases progressively with age, reaching almost 50% of men over 60 years of age.
According to data published by the Spanish Association of Andrology, Sexual and Reproductive Medicine in 2013, only a third of these patients are diagnosed, and of this third only half are treated, so it is a very underdiagnosed and undertreated disease.
This is important because it has a very negative impact on the quality of life of both the patient and his partner. Erectile dysfunction causes embarrassment and anxiety and proper treatment improves the self-esteem of these patients, as well as relationships in general and logically the sexual relationship.
Treatment has evolved dramatically in recent times. At present, we can affirm that more than 95% of the cases, with some of the available treatment modalities, can recover an active and satisfactory sexual life.
Treatment is carried out in a stepwise manner: first the risk factors present in the patient (tobacco and alcohol consumption, dyslipidemia, overweight, diabetes, etc.) must be corrected. Then, counseling and sexual education are carried out, taking into account the expectations and preferences of the patient and his partner when planning the treatment. When the cause is treatable we can cure the patient:
- Hormonal treatment.
- Surgical treatment.
This will allow the patient to recover erectile function without the need for chronic treatment. When this is not possible we have different stages of treatment:
- Oral drugs: These are drugs with an efficacy level of more than 80% that enhance the body’s normal physiological erectile response. Despite “the fear that they continue to arouse in patients”, they have a high level of safety.
They are only contraindicated in patients taking Nitrates, therefore, I include most of the cardiac patients, they can take them. There are different molecules on the market with different pharmacokinetic profiles, so we must take into account what diseases the patient has and what their preferences and expectations are in order to prescribe one or the other, but I insist on their high level of efficacy and safety.
Another modality that can be considered as a first step in some patients are vacuum devices that, by attracting blood to the penis, allow its erection, although in Spain they are little used due to the rejection of most men.
In those patients who do not respond to this medication or have contraindications for its use, we go to the second level:
- Injections of vasoactive substances: (Generally alprostadil) intracavernosal, it is the only medically authorized. It is performed through a local injection in the corpus cavernosum and the patient himself must be trained to self-inject.
Intraurethral Alprostadil: has the advantage of not requiring self-injection but is less effective than when administered intracavernosally.
- Penile Prosthesis: Only in cases where previous treatments fail. This measure has a high level of satisfaction of both the patient and his partner.
Preventive measures for erectile dysfunction
To prevent erectile dysfunction as effectively as possible, it is necessary to adopt lifestyle and psychological habits that improve cardiovascular and general metabolic health. Sex education is also necessary, since having adequate information on sexual function prevents false expectations.
In the case of taking medications, it may be necessary to change the dosage or drugs that affect erectile function, always under medical supervision.