Erectile dysfunction (ED) is the persistent inability to achieve and/or maintain an erection sufficient to maintain satisfactory sexual activity. This has to happen for at least 3 months.
What are the causes that can lead to it?
- Chronic diseases such as hypertension, diabetes, hepatic or renal insufficiency, neurological diseases.
- Psychopathological alterations.
- Pelvic trauma and pelvic surgery.
- Radiotherapy
- Use of drugs such as antihypertensives, antidepressants, neuroleptics, antiarrhythmics, androgens and steroids.
- Smoking, alcohol and recreational drug use.
From what age can erectile dysfunction occur?
ED can occur at any age. In young people it is usually of psychogenic cause. It usually occurs in people who have had a negative experience in their sexual relationship and have a lack of confidence to satisfy their partner or demand too much of themselves. This type of ED is usually easily cured.
It occurs more frequently in adults over 60 years of age, due to hormonal changes such as a decrease in testosterone and the appearance of chronic diseases mentioned above.
ED can predict ischemic heart disease in adults. It can appear 2-3 years before angina pectoris and 3-5 years before myocardial infarction.
What treatments are available?
- Oral treatments: The administration of phosphodiesterase type 5 inhibitors that cause smooth muscle relaxation of the corpus cavernosum of the penis and erection whenever there is sexual stimulation.
There are four active ingredients: sildenafil, vardenafil, tadalafil and avanafil.
It is the treatment of choice because they are effective, well tolerated and have few side effects.
It is recommended that the patient receives four doses of the drug to know if it is effective, always complying with the indications for use recommended by the urologist.
- Intracavernous injection of drugs: It consists of injecting Alprostadil (prostagladin E1) into the lateral part of the penis in the corpora cavernosa with a very fine needle. It is very effective but of moderate tolerability. Erection occurs 5-10 minutes after injection.
- Shock wave treatment: Consists in the application of low intensity shock waves to the penis by means of a transducer.
This technique produces a neovascularization, so it would only be indicated in vascular ED. However, it is not effective in all cases.
- Penile prosthesis implant surgery: It would be indicated for patients with severe ED who have not responded to the usual treatments.
For this type of surgery an evaluation by a psychology service is indicated to confirm if he is a good candidate.
There are several types of prostheses. The semi-rigid or malleable ones are made of silicone, which are two solid cylinders that are implanted inside the corpus cavernosum and produce rigidity in the penis.
Hydraulic prostheses are composed of two cylinders that are connected to a pump that is implanted in the scrotal sac and that is inflated with the fingers when an erection is desired and deflated in the same way.