Erectile dysfunction

Erectile dysfunction

What is erectile dysfunction?

By the term erectile dysfunction we mean the inability to achieve or maintain an erection, in order to have a successful sexual intercourse, while there is a desire. It can be transient, recurring or permanent.

What are the causes of erectile dysfunction?

An erection is achieved when the blood flow increases and the penis fills with blood. This process can be hindered by various factors that we divide into two categories: organic and psychological. Sometimes, erectile dysfunction is the result of wrong surgical manipulations in pelvic procedures or medication that a patient may be taking.

 

The most common organic causes are:

  • Heart diseases
  • Vessels obstruction
  • High cholesterol and triglycerides values
  • High blood pressure
  • Diabetes
  • Obesity
  • Neurological diseases (spinal cord injuries, Parkinson's disease, Multiple Sclerosis, etc.)
  • Hormonal disorders (e.g. low testosterone)
  • Peyronie's disease
  • Smoking / Drug use / Alcoholism
 

The most common psychogenic causes are:

  • Anxiety about performance, responsiveness or body image
  • Low self-esteem
  • Family or relationship problems
  • Anxiety disorders
  • Poor sexual communication with the sexual partner
  • Embarrassment in front of a new partner
  • Guilt from a secret (infidelity)

Diagnosis

For most patients, taking a good history (medical and sexual) is sufficient to establish a diagnosis. Based on this, we usually have an estimate of whether the problem is psychological or organic. The doctor should therefore know any health problems, the medication you follow, operations you have undergone, as well as if there is a history of drugs, alcohol or smoking. He should also know the description of the problem, if other sexual problems coexist, if it is periodic or permanent, if an erection is achieved through masturbation, and if aggravating factors have been observed. 

If the doctor deems it appropriate, you will undergo more specific tests, such as: blood tests (sugar, cholesterol, testosterone), vascular-penile triplex or recording of nocturnal erections.

Treatment

The treatment will be determined by the type of erectile dysfunction. If the cause is psychological or there are problems in the relationship, a specialized sexologist will be able to help you overcome the problem. Often, when the problem is mixed, a combination of psychotherapy and medication is used.

For erectile dysfunction, which is due to organic causes, the options available are:

  • Oral medications (avanafil, vardenafil, sildenafil and tadalafil).
  • Hormone therapy. It is applied to patients with testosterone deficiency.
  • Penile injections: when you want to have an erection. It is important to determine the correct dose of medication to prevent priapism.
  • Shock wave therapy (targets the generative cause of vascular erectile dysfunction).
  • Vacuum pump device. It is a method in which, with a device placed inside the penis, an air vacuum is created, and this causes blood to enter and the penis to swell. A ring is then placed at the base of the penis to maintain an erection.
  • Penile prosthesis. It is applied when all previous forms of treatment have failed and is surgically placed.