Erectile dysfunction is the inability to achieve or maintain an erection necessary for intercourse. Most cases of erectile dysfunction are associated with vascular, neurological, psychological, or hormonal disorders; it may also be caused by taking certain medications. The examination usually includes screening for potential causes and measuring testosterone levels. Treatment options include therapy with oral phosphodiesterase inhibitors, intraurethral or intracavernous prostaglandins, use of vacuum erectile devices, and surgical implantation of prostheses.
All men need to remember that there are predisposing risk factors for the development of erectile dysfunction! These include:
- increased weight;
- smoking and alcohol abuse;
- the use of any drugs;
- frequent depressive conditions;
- lifestyle with physical inactivity;
- metabolic syndrome and lipid metabolism disorders;
- pronounced vitamin deficiencies;
- a variety of adverse environmental factors (radiation, various types of radiation, etc.).
Three main types of causes of impotence
- Psychogenic – when erectile disorders are associated with anxiety, some specific situations, mental disorders, etc.
- Organic – when violations of sexual function develop due to some structural changes in the genital organ as such.
- vascular causes (due to increased blood pressure, atherosclerosis, diabetes mellitus, venous insufficiency, surgical interventions, etc.);
- neurological reasons (due to strokes, multiple sclerosis, various neuropathies, tumors, injuries, etc.);
- endocrine causes (due to low testosterone levels, high prolactin levels, thyroid dysfunction, etc.);
- structural reasons (due to trauma to the penis, congenital malformations, Peyronie’s disease, curvature, priapism, etc.).
- Medicinal – when erectile function develops while taking some drugs (psychotropic, antidepressant, antihypertensive, etc.).
Erectile dysfunction is usually distinguished by the degree of severity: the lung is distinguished; medium; moderate to severe erectile function.
The classification is also generally accepted and important due to the development of the disease:
- psychogenic – about 40% of cases;
- organic – 30% of cases;
- mixed – 25% of cases;
- without an established reason – 5% of cases.
Alarming symptoms of erectile dysfunction are:
- difficulty in the onset of sexual arousal and its continuation;
- weak erection;
- partial or complete absence of morning erection.
Other types of sexual dysfunctions in men
There are also disorders of sexual function in men, which are not directly erectile dysfunction, but cause an equally decrease in the quality of life.
There are various ejaculation disorders. The greatest discomfort not only for a man, but also for a woman is delivered by accelerated ejaculation. The inability to conduct high-quality sexual contact leads to psycho-emotional stress and even an unwillingness to have sex at all. Painful and difficult ejaculation is less common, but also dramatically reduces the quality of life. With various neurological diseases, anejaculatory syndrome can develop – a complete inability to independently achieve orgasm and ejaculation. After surgery on the prostate gland and taking certain medications, persistent retrograde ejaculation may develop – the sperm is thrown into the bladder during orgasm.
One of the most common sexual disorders is a lack of sexual desire, desire (libido). Decreased libido can be caused by both neuro-emotional overstrain, physical fatigue, and concomitant diseases in the body, a violation of hormonal metabolism.
Most of all these abnormalities are quite successfully and safely treated. Their timely correction is important in order to prevent the formation of secondary psychological deviations.
When diagnosing erectile dysfunction, it is very important to determine the degree of their severity. It is also necessary to find out the cause of these disorders, to establish the disease that caused the development of a decrease in erection. It is necessary to determine the presence or absence of other types of sexual disorders (decreased sex drive, ejaculation and orgasm disorders).
Psychogenic dysfunction usually occurs suddenly. At the same time, normal morning erections are preserved. In psychogenic disorders, there are often problems in the relationship with a partner. Erectile dysfunction in this case occurs only under certain circumstances, and under other conditions – sexual function is normal.
With organic erectile dysfunction, the opposite is true. Problems arise gradually, morning erections are reduced or completely absent. At the same time, as a rule, a good sex drive remains. The quality of sexual intercourse almost always suffers, with any partner and in various situations. When the first alarming symptoms occur – a lack of sexual desire and a weak erection – it is necessary to consult an andrologist.
Before starting treatment, all patients are advised to exclude as much as possible risk factors for erectile abnormalities. Normalization of lifestyle and sexual activity is important. An important step is to decide on the possibility of canceling or replacing the drugs taken that can negatively affect an erection.
Neurological and cardiac problems are eliminated with the help of narrow specialists, in particular a psychotherapist. Doctors recommend that such patients come to a consultation with a sexologist and psychologist together with a partner – this will help to understand each other, relax and trust.
Depending on the cause of the disease, treatment methods are also distinguished. If a curable cause of erectile dysfunction is identified, it is necessary to eliminate it.
Erectile dysfunction drugs
First-line drugs for treating ED are usually oral phosphodiesterase inhibitors. Other drugs include prostaglandin E1 for intracavernous or intraurethral administration. However, since almost all patients prefer oral drug therapy, these drugs are used if they are not contraindicated and are well tolerated.
- Oral phosphodiesterase inhibitors selectively inhibit cyclic guanosine monophosphate (cGMP) -specific phosphodiesterase type 5 (PDE-5), the main isomer of phosphodiesterase in the penis. These drugs include sildenafil, vardenafil, avanafil, and tadalafil. By preventing hydrolysis of cGMP, they promote cGMP-dependent smooth muscle relaxation, which is essential for normal erection. Although vardenafil and tadalafil act more selectively on the vessels of the penis than sildenafil, the clinical efficacy and side effects of these drugs are similar. In comparative clinical trials, these drugs demonstrate comparable efficacy (60% versus 75%).
- Alprostadil (prostaglandin E1), self-administered intraurethrally or in the form of intracavernous injections, can induce an erection with an average duration of 30-60 minutes. Alprostadil intracavernous administration can be combined with papaverine and phentolamine to increase efficacy when needed. Overdosing can lead to priapism and pain in the genital or pelvic area. Training and monitoring by a physician helps to achieve optimal and safe use, including a minimum risk of long-term erections. Intraurethral therapy is less effective in obtaining a satisfactory erection (in 60% of men) than intracavernous injections (in 90%). Combination therapy with a PDE5 inhibitor and intraurethral alprostadil may be beneficial for some patients who do not respond to oral PDE5 inhibitor monotherapy.
Mechanical devices for the treatment of erectile dysfunction
For men who may have, but cannot be maintained, an erection, it is possible to use a constricting ring to maintain an erection; An elastic ring is placed around the base of an erect penis to prevent early loss of erection.
Men who cannot achieve an erection can first use a vacuum device, which increases blood flow to the penis by suction, after which an elastic ring is placed at the base of the penis to maintain an erection. The appearance of bruises on the penis, coldness in the head area and the lack of spontaneity of erection are the disadvantages of this technique.
If necessary, the use of these devices can be combined with drug therapy.