What is erectile dysfunction? | vascularte.ro

What is erectile dysfunction?

What is erectile dysfunction?

Any man can occasionally experience erectile dysfunction. When this is a repeated situation for several months, it can be erectile dysfunction. In this case, a visit to the urologist is a must-do.

Erectile dysfunction is found in 7% of men for the age group 18-29 years, 9% for the age group 30-39 years, 11% for the age group 40-49 years and 18% for the age group 50 -59 years (according to the National Health and Social Life Survey).

The prevalence of erectile dysfunction worldwide is steadily increasing. Taking into account the increase in the life expectancy of the population, as well as the estimated data on the prevalence of erectile dysfunction on the globe, in 2025 a doubling of the prevalence of erectile dysfunction is predicted (Ayac et al., 1999)

Content

What is erectile dysfunction?

Erectile dysfunction is the constant inability to obtain or maintain a necessary erection to allow satisfactory sexual intercourse.

Although it is considered a benign pathology, it has a significant negative impact on patients, their socio-professional performance and their couple life.

Erectile dysfunction is no longer a solitary phenomenon, but a mass phenomenon, which manifests itself first in the couple and then becomes a medical and psycho-relational problem.

The mechanism of erection is not only the desire but especially the sexual stimuli and the general health of the man, more precisely the functioning of the nervous and circulatory system (ensures vascularization in the penis).

How do you know you have erectile dysfunction?

It is recommended to go to the doctor if:

  • You have problems getting or maintaining an erection during sexual intercourse or if you have other problems such as premature or delayed ejaculation
  • Suffer from diabetes, heart or blood vessel disease or any other disease that may be associated with erectile dysfunction
  • You have other symptoms that accompany sexual dysfunction
  • You experience decreased sexual desire (libido)

Male sexual arousal is a complex process that involves hormones, the brain, emotions, nerves, muscles and blood vessels. Any problem with them can be related to the appearance of sexual dysfunctions.

Why does erectile dysfunction occur?

At the origin of sexual dysfunctions, there may be physiological and psychological problems or it may be a combination of both.

Factors that can influence sexual function are part of  several categories:

  • Psychological - depression, anxiety, social stress
  • Neurological - spinal cord injuries, multiple sclerosis, herniated disc
  • Endocrine - hypogonadism, hyperprolactinemia, hypothyroidism/hyperthyroidism
  • Chronic conditions - diabetes, heart disease, high blood pressure, dyslipidemia, kidney failure, liver disease, vascular disease

Sexual dysfunction can also be linked to various penile conditions (Peyronie's disease, priapism, anatomical abnormalities), pelvic trauma, pelvic surgery, pelvic radiation therapy, age, medication or lifestyle (smoking, chronic alcohol abuse).

Men with erectile dysfunction have an unsatisfactory sex life, and this can lead to stress, anxiety, low self-esteem or problems in the couple.

Diagnosis of erectile dysfunction

In most cases, a physical examination and a medical history are sufficient to diagnose erectile dysfunction. If the patient has a chronic illness or if the doctor suspects that there is another health problem underlying the erectile dysfunction, certain medical tests are also recommended.

  • To diagnose erectile dysfunction, you need:
  • Physical control - includes an examination of the penis and testicles
  • Blood tests - are needed, among others, to detect diseases (diabetes, heart disease) - microscopic examination of post-ejaculatory urine, total and free serum testosterone levels, thyroid hormone levels, prolactin, PSA levels, bacteriological examination
  • Urine tests
  • Doppler ultrasound to assess blood flow to the penis
  • Psychological examination

Several questionnaires related to erectile dysfunction, premature ejaculation or quality of life may also be used.

How can erectile dysfunction be treated?

If the patient has a chronic illness, treating the condition is the first step in the treatment of erectile dysfunction.

Depending on the cause and severity of erectile dysfunction, there are various treatment options.

Oral drug treatment - Is an option with good results for most men, with multiple options from dietary supplements to 5-phosphodiesterase inhibitors (Viagra, Cialis, etc.)

Intracavernous injections - Another option for treating erectile dysfunction is penile alprostadil injections. Their purpose is to obtain erections that last less than an hour.

Urethral Suppositories - By administering a urethral suppository with alprostadil through the orifice at the top of the penis (urethral orifice), an erection lasting up to one hour can be obtained.

Testosterone replacement therapy - in patients with low testosterone levels, possibly in combination with other treatments

Vacuum device - consists of placing a cylinder over the penis and using a pump to create negative pressure in the tube. Through this therapy, blood is drained into the penis. The erection obtained is maintained with the help of a ring placed at the base of the penis.

A penile implant - is a recommended option especially after the failure of other methods.

Psychological counselling - beneficial in all types of erectile dysfunction, especially if it is caused by stress, anxiety or depression, psychological therapy is recommended.

The article was written by Dr. Alexandru Grasu, Primary Care Urologist