Erectile Dysfunction

Description

Erectile dysfunction (ED) is a sexual disorder in men. Increasing age increases the risk of ED, for which the causes are predominantly physical. But in some cases - especially in younger men - psychological factors can also provoke the disorder (e.g. depression, anxiety). Often erectile dysfunction is a result of atherosclerosis, and thus a serious alarm signal for stroke or heart attack in men over the age of 50. Following a diagnosis of erectile dysfunction, the patient should enlist the advice of an internist and a cardiologist.

Symptoms

From a medical perspective, erectile dysfunction is when a man cannot, in the majority of attempts over a period of more than 6 months, achieve or sustain sufficient erection of the penis for coitus. The penis is either not hard enough or relaxes too quickly.

Temporary, suddenly occurring or single episodes of sexual impotence are not usually considered a disorder that requires treatment.

Causes and Risks

In the majority of cases, erectile dysfunction is due to several causes, and with advancing age, physical factors are of greatest importance. Besides diseases such as diabetes (diabetes mellitus), multiple sclerosis, Parkinson's disease and high blood pressure (hypertension), other possible causes are injury to the spongy body of the penis and longtime alcohol or nicotine consumption. In addition, excess weight, calcification of the blood vessels, lack of exercise or an unbalanced diet can lead to erection problems. Also disorders of the musculoskeletal system (e.g. herniated disc, spinal cord injury, blockage in the lumbar spine area) and the influence of drugs (e.g. psychotropics, beta-blockers, anti-androgens) may adversely affect a man's potency.

Although the male sex hormone testosterone or the lack of it (hypogonadism) primarily plays a role in sexual desire (libido), in case of severe and persistent deficiencies erectile problems may also be caused.

Examination and Diagnosis

In order to clarify the causes of sexual problems, there should first be a medical history interview with the urologist, which must also include any special risks or medicines taken. After subsequent physical examination, possible injuries can be detected using sonography, and a blood sample can provide clues of hormonal disorders (e.g. lack of testosterone) or metabolic disorders (e.g. diabetes mellitus).

In special cases, intracavernous auto-injection therapy is performed with pharmacoduplex sonography. Here, a vasodilator drug is injected with a very fine needle directly into the erectile tissue, after which the blood flow in the penile arteries is measured with color ultrasound. Only in very rare cases is the performance of a selective penile artery angiography or an X-ray image of the erectile tissue (cavernosography) indicated.

Treatment

Drugs are used for treatment of erectile dysfunction in the majority of cases, if there are no contraindications. The most important substance group is the phosphodiesterase-5 inhibitors (PDE-5 inhibitors, e.g. sildenafil, tadalafil, vardenafil or avanafil). The different preparations vary in the speed and duration of their effects. These preparations inhibit the body's own enzyme PDE-5, which is responsible for the reduction of a neurotransmitter that is produced during sexual arousal and controls blood flow to the penis.

Another method is intracavernous auto-injection therapy, in which an erection-triggering and circulation-promoting drug is injected into the erectile tissue with a very fine needle. The MUSE method (Medical Urethral System for Erection) introduces the blood flow enhancing prostaglandin E in the urethra.

In vacuum therapy, a plastic cylinder attached to a suction pump is placed over the penis. By the generation of negative pressure, blood flows into the member, thereby producing an erection. A sensor mounted at the root of the penis prevents the backflow of blood - but this should be removed after 30 minutes to avoid circulatory problems.

For all forms of severe erectile dysfunction (e.g. after radical prostate surgery or injury) there is a surgical treatment method which has been very successful for more than 40 years. In this, a usually hydraulic penile implant is inserted through a small incision during surgery. It consists of two cylinders that are introduced into the erectile tissue. The pump to activate and deactivate it is located in the scrotum. A connection to a reservoir in the lower abdomen is made via a thin tube. Now, by squeezing the pump through the skin of the scrotum, the patient can pump a sterile infusion solution from the reservoir into the cylinder. This leads to a stiffening member, externally indistinguishable from a normal erection. The feeling of the penis is not affected, meaning the patient can as before have orgasms and ejaculate. Patient and partner satisfaction is more than 90 percent each.

Course and Prognosis

Thanks to the currently available treatment options for erectile dysfunction, almost every patient can be successfully helped. Important here is individual diagnosis and counseling that takes into account the wishes and expectations of the patient and his partner.

What can the patient do himself?

By avoiding harmful influences (e.g. smoking or excessive alcohol consumption), the patient can achieve an improvement in his ability to have erections. Of particular importance here is regular physical/sporting activity and reduction of visceral obesity (excess abdominal fat). Scientific studies show that a significant improvement in erectile function is thereby possible.