Erectile dysfunction (ED) is defined as the inability to achieve or maintain sufficient penile rigidity to allow continued satisfactory sexual intercourse.
Erectile dysfunction should be differentiated from the typical trigger, in which the erection problem is occasional and situational.
It is a health problem with a high prevalence among men over 40 years of age, and it has a significant impact on the quality of life of the affected person (stress and anxiety, depression, low self-esteem, etc.) and that of his partner, as well as on the relationship itself.
In addition, erectile dysfunction can be a warning sign of a hidden cardiovascular problem.
According to the EDEM study carried out in Spain, globally, 12.1% of men between 25 and 70 years of age have erectile dysfunction. However, only 16.5% of those affected consult a doctor due to cultural, religious or moral factors.
What are the causes of erectile dysfunction?
Erectile dysfunction can be a consequence of an alteration of several physical and psychological factors. The causes of erectile dysfunction can be classified into three groups.
- Psychogenic cause. It occurs especially in men under 50 years of age. Some factors such as stress, anxiety, depression, low self-esteem, negative sexual experiences, lack of education in the sexual sphere or couple conflicts may be the cause of erection problems.
- Organic causes. Age is an inevitable factor in the development of erectile dysfunction, affecting more than eight out of ten men over 80 years of age. However, cardiovascular risk factors are the factors most related to erectile dysfunction, such as smoking, obesity, hypertension or diabetes (this being the most common endocrine reason, multiplying the risk by 3 with respect to the general population), dyslipidemia and arterial vascular disorders.
Some neurological diseases (such as Parkinson’s, cerebral vascular accidents, or multiple sclerosis) as well as hormonal problems (thyroid, testosterone deficiency, elevated Prolactin, etc.) can also be the cause of erection problems. - Pharmacological cause. Substances such as antihypertensive drugs, prostate drugs and some psychotropic drugs together with drug use (alcohol, heroin, cocaine and cannabis abuse) increase the risk of erection problems. However, in most cases of erectile dysfunction there is usually a combination of factors from the different groups, especially in the case of organic causes.
Signs and symptoms of erectile dysfunction: how to identify it?
The first symptoms that may signal an incipient dysfunction may be:
- Erection is less rigid than normal.
- Erection (in certain positions) is more easily lost.
- More stimulation is needed to maintain the erection.
- Erection is shorter in duration
Depending on its severity, erectile dysfunction is graded. To identify it, there are several questionnaires that establish this severity. The most commonly used is the IIEF questionnaire, either in its extended version (15 questions) or its reduced version (5 questions).
Types of erectile dysfunction
Depending on the predominant cause (it should be remembered that most of them share several causes), they can be differentiated into two large groups.
- Psychological: stress and anxiety, depression and other pathologies.
- Organic or physical: vascular causes, neurological causes, hormonal, drug and substance abuse, surgeries.
It can be classified as mild, moderate and severe.
Treatments for erectile dysfunction
Today there are several lines of treatment. Their differences lie in whether they are more or less invasive, as well as in the patient’s preferences.
The first-line treatments are oral drugs (i.e. tablets, bucodispersible tablets, and spray solutions), called Phosphodiesterase 5 Inhibitors (PDEI5). This group includes the famous Viagra and its derivatives.
A second line of treatment is intracavernous drugs, in the form of injections or intraurethral gels, whose active ingredient is Alprostadil.
Both drugs work by dilating the blood vessels that go to the penis and are responsible for producing the erection.
The third line of treatment would be penile prosthesis surgery. Currently there are different types (hydraulic, either two- or three-component or malleable), and they are indicated when other lines of treatment have failed.
Today there is a new line of treatment, which, although still in the process of data collection, promises hope for those patients who have failed the first and second line of treatment.
In this case, we are talking about Growth Factors, Platelet Rich Plasma, Shock Waves and Stem Cells, which are obtained from ultra-filtered abdominal fat.
The objective of these treatments is to stimulate the formation of new blood vessels inside the corpora cavernosa of the penis. In this case, we are talking about “regenerative” and autologous treatments (obtained from the patient himself), so there are no known adverse reactions or rejections, nor systemic side effects, since they are painless and ambulatory procedures.
The effect of this form of treatment is not immediate, but is more of a medium-term benefit, as it allows in many cases to achieve satisfactory erections in patients without the use of drugs, in patients who with drugs could barely maintain an erection to penetrate or in those in whom penile prosthesis was presented as the only possible solution. Moreover, these can be combined with each other or with other treatments, thus obtaining a cumulative effect.
We are therefore facing a future new step prior to the placement of a penile prosthesis or as an alternative to other lower line treatments.
For more information, consult a specialist in Urology.