Erectile dysfunction is the inability to maintain a rigid erection for satisfactory sexual intercourse. All men are candidates for erection problems and in Spain it affects 19% of men between 25 and 70 years of age.
Moreover, the frequency of erectile dysfunction increases with age and affects 14% of men aged 40-49, 25% of men aged 50-59 and 49% of men aged 60-69.
Causes of erectile dysfunction
Erectile dysfunction occurs when blood does not enter properly or leaks out of the sinusoids. This is when erection problems occur, as penile enlargement and rigidity do not occur.
Erectile dysfunction can be of physical or psychological origin. However, in most patients with erectile dysfunction of physical origin they also develop psychological problems that aggravate the situation.
Types of erectile dysfunction:
- Vascular. It occurs when too little blood reaches the penis or is not adequately retained. Among the most frequent causes are: diabetes, hypertension, increased cholesterol, smoking, and cardiovascular diseases.
- Neurological. It occurs when there are problems through the erector nerves when there are problems in the transmission of orders that the brain and spinal cord send to the penis. Diseases such as diabetes and diseases of the spinal cord accentuate erectile dysfunction of this type.
- Hormonal. It occurs when the body does not produce enough testosterone. It is known as hypogonadism. In patients with hormonal erectile dysfunction, there is a testosterone deficit and they respond very well to testosterone replacement therapy.
- Medications. A number of medications used for the treatment of hypertension or depression can affect erection.
- Psychological. Erection is affected by psychological problems that may respond to performance anxiety. In patients with erectile dysfunction of psychological origin, psychological counseling is essential to discuss erectile dysfunction with the patient and his partner to help them overcome the problem.
On the other hand, there are risk factors such as diabetes, smoking or increased cholesterol that can accelerate erectile dysfunction problems. If these risk factors are not corrected, vascular disease can progress and in many cases is a warning sign that the arteries are closing.
For the diagnosis of erectile dysfunction, the patient’s medical history is reviewed and a blood test is authorized. In some cases it is also advisable to perform an ultrasound and doopler that allows a detailed vascular study of the penis.
This technique makes it possible to assess the volume of blood that enters and/or escapes and also to distinguish between a psychogenic and organic cause. In very few patients, especially in young people, it is necessary to resort to specific tests.
What treatments are available?
There are different therapeutic options, but each patient should always be examined to adjust it to his or her needs. When the causes are known, it is easier to act.
When the problem has its origin in a physical cause, the main treatments are:
- Hormones (testosterone)
- Oral drugs (Sildenafil, Tadalafil and Vardenafil).
- Injection of a medication into the penis
- Penile prosthesis
Oral drugs and injections can also be used. The drugs are administered in pill form and the most common are: Sildenafil (Viagra®), Tadalafil (Cialis®) and Vardenafil (Levitra®). They act by blocking the enzyme phosphodiesterase 5 and offer good results in more than 70% of patients.
As for injection, it is another of the most effective treatments with results above 90%. Patients treated with shock waves also improve their erectile and endothelial function.
A disease without a cure
The treatments mentioned so far help to maintain a correct erection during sexual intercourse, but do not cure the disease.