Erectile Dysfunction - Causes and Treatment of Erectile Dysfunction

Erectile dysfunction (ED) is a common health problem that affects men worldwide, impacting both their physical and emotional lives. It is estimated that 5 to 20% of men over the age of 40 are affected to varying degrees, although this figure may vary depending on region and lifestyle.

ED is characterized by difficulty achieving or maintaining an erection sufficient for sexual intercourse. Various factors can contribute to the development of ED, including chronic diseases such as diabetes and heart disease, as well as psychological factors such as stress and depression.

In the case of erectile dysfunction, lifestyle changes can have a significant impact on improving the condition of those suffering from ED. Weight loss, regular physical activity, a healthy diet, limiting alcohol consumption, and quitting smoking can significantly improve sexual functioning. Furthermore, treating underlying conditions and psychological support are also important in a comprehensive approach to ED treatment. All of these measures can contribute to improving the quality of sexual life and overall health of men. Learn more about ED.

 

Erectile Dysfunction and Impotence - Explaining the Terms

Erectile dysfunction and impotence are two terms, often used interchangeably, that mean almost the same thing. Erectile dysfunction refers to difficulty achieving or maintaining a proper erection that is firm enough to complete sexual intercourse. Impotence is a broader term that can encompass other sexual health issues, such as low libido, as well as problems with ejaculation (e.g., premature ejaculation) and orgasm.

According to the 1993 NIH definition, erectile dysfunction is the persistent inability to achieve and maintain an erection during intercourse. The truth is, any single incident can negatively impact a man's psyche. Therefore, it's not worth waiting to be diagnosed if you repeatedly experience problems with satisfactory sexual intercourse.

 

What is an Erection? How Does an Erection Occur?

During sexual arousal, the brain signals nerves to release chemicals that increase blood flow to the penis. Blood flows into two erectile chambers composed of spongy muscle tissue (the corpora cavernosa). The chambers of the corpora cavernosa are not empty. During an erection, the spongy tissue relaxes and retains the blood. Blood pressure in the chambers causes the penis to harden, resulting in an erection. When a man reaches orgasm, a second set of nerve signals reaches the penis and causes the muscle tissue there to contract. Blood is released back into the male's circulation, and the erection subsides.

When you are not sexually aroused, the penis is soft and flaccid. Men may notice that the size of the penis changes depending on heat, cold, or anxiety. This is normal and reflects the balance of blood flowing in and out of the penis.

  

Erectile Dysfunction and Erectile Dysfunction - A Definition of Terms

Erectile dysfunction and erectile dysfunction (potency problems) are two terms that are often used interchangeably, but they can have slightly different meanings in a medical context:

Lack of Erection (Anerection):

• Refers to the complete inability to achieve an erection.
• It can be the result of very serious health problems, both physical (e.g., significant damage to blood vessels or nerves) and psychological.
• It requires a thorough medical diagnosis, as it can indicate a serious disorder.
  

Erectile Dysfunction (ED):

• Refers to difficulty achieving and maintaining a full erection or ejaculation.
• This is a more general term that covers a wide range of erectile problems, from mild to severe.
• It can include situations where a man is able to achieve some degree of erection, but it is not firm or lasting enough for full sexual intercourse. 
• It can have various causes, including psychological, hormonal, vascular, neurological, and lifestyle factors.

In practice, "erectile dysfunction" is a more encompassing term that can encompass varying degrees of erectile dysfunction, including complete erectile failure. Diagnosing and treating these problems requires consultation with a qualified medical professional who can determine the cause and recommend appropriate treatment options.

 

Causes of Erectile Dysfunction

The causes of erectile dysfunction (ED) can be divided into several main categories, each of which encompasses various factors that can affect the ability to achieve or maintain an erection, i.e., have satisfactory intercourse. Below is a list of these factors, broken down by category.

Vascular causes, i.e., factors that influence poor blood flow to the penis (circulation problems):

• Cardiovascular diseases such as atherosclerosis (narrowing and hardening of the arteries are associated with a high risk of erectile dysfunction)
• Hypertension, which can damage blood vessels
• Heart disease and other circulatory system diseases
• Smoking
• Physical inactivity
• Obesity
• Diabetes
• Vascular damage resulting from surgery or radiotherapy in the pelvic area (radical prostatectomy)
• Hyperlipidemia

Neurogenic causes, i.e., neurological diseases that affect the ability to conduct nerve signals to the penis:

• Multiple sclerosis
• Parkinson's disease
• Stroke
• Spinal cord or nerve damage

Anatomical causes, congenital or related to surgery:

• Congenital or acquired penis abnormalities, such as Peyronie's disease (curvature of the penis)
• Pelvic surgery, which can affect nerve structures and Vascular
• Penile cancer and other external genital cancers

Hormonal causes:

• Testosterone levels decrease with age, most often after the age of 40 (andropause)
• Hormonal disorders, such as pituitary or thyroid dysfunction

Pharmacologically induced causes: Taking certain medications may be one of the causes of erectile dysfunction:

• Antidepressants, antihypertensives, antipsychotics, and others can affect sexual function.
• Substance abuse, such as alcohol and drug abuse
  

Psychological causes:

• Stress, anxiety, relationship problems, depression, fear of sexual failure
• Emotional and psychological problems
• Lack of arousal, intimacy problems, personality disorders

Traumatic causes:

• Pelvic or genital injuries
• Injuries resulting from surgery, such as prostatectomy (removal of the prostate)

Understanding the causes of ED is crucial for proper treatment. Each of these causes may require a different therapeutic approach, so diagnosis and treatment should be tailored to the individual patient.

   

Diagnosis of a patient with symptoms of erectile dysfunction

• Detailed medical history – general medical history (illnesses, medications, previous surgeries) and information about stimulants and occupation
• Sexual history – duration and symptoms of ED, e.g., frequency of problems maintaining an erection, estimation of the severity of erectile dysfunction
• Laboratory tests, e.g., lipid profile, fasting glucose
• Physical examination to rule out congenital defects, phimosis, or Peyronie's disease
  
• Cardiology consultation if further testing is indicated after the general medical history
• Additional tests: e.g., Doppler ultrasound of the penis, nocturnal penile stiffness test

 

Who should I consult with sexual problems?

Here are the main doctors and specialists you can consult for ED:

• Urologists: They specialize in the treatment of diseases of the genitourinary system in men, including erectile dysfunction. Urologists are often the first point of contact for men with ED.
• Andrologists: These are doctors who specialize in male reproductive and sexual health issues. Andrology is a subspecialty of urology that focuses on men's sexual health.
• Sexologists: Sexologists can help when ED is caused by psychological factors, such as stress, anxiety, or relationship problems.
• Endocrinologists: These doctors address hormonal imbalances that can affect sexual function, including erectile dysfunction.
• Psychotherapists and psychologists: If ED is psychological in origin, the assistance of a psychotherapist or psychologist can be crucial to effective psychotherapy.
• Family doctors: Although they are not specialists in ED, they can assess the overall health and make an initial diagnosis, then refer the patient to the appropriate specialist.
• Furthermore, it is worth considering clinics and centers specializing in the treatment of sexual problems, which offer a multidisciplinary approach to ED treatment, combining the knowledge and experience of various specialists.

It is important to consult with a specialist before starting treatment to ensure the cause of the problem is properly diagnosed and effective treatment is provided.

  

Erection Problems Treatment

Achieving and maintaining an erection depends on many physiological and psychological factors, which determine the treatment approach. Below, we present a range of treatment methods:

Lifestyle Changes

• Quitting smoking, stimulants, and legal highs – the most common cause of problems is related to vascularization and maintaining an organic erection
• Avoiding excessive alcohol consumption
• Minimizing stress
• Daily physical activity
• Healthy diet
• Adequate sleep

Patient Education (self-help/psychotherapy/visiting a sex therapist)

Patient education plays a key role in the treatment of erectile dysfunction (ED), especially when stress or other psychological factors are the cause. It is important for the patient to understand that ED is a common disorder and can be the result of both physical and psychological factors. Psychotherapeutic treatment, including cognitive behavioral therapy, can help address emotional and psychological issues that contribute to ED. Patients are also encouraged to communicate openly with their partner, which can help reduce tension and stress related to sex.

In some cases, it may be necessary to consult a sexual health professional who can help develop a personalized treatment plan that addresses both the physical and psychological aspects of ED. Regular exercise and relaxation techniques, such as meditation or yoga, can also help reduce overall stress levels, which can have a positive impact on the ability to achieve and maintain an erection.

Pharmacological Treatment

Phosphodiesterase type 5 inhibitors (PDE5i) are the most commonly used pharmacological agents for the treatment of ED. The following substances are available on the Polish market:

• sildenafil (known under the trade name "Viagra")
• tadalafil (known under the trade name "Cialis")
• vardenafil (known under the trade name "Levitra")
• avanafil (known under the trade name "Stendra")

All of these substances differ in their pharmacokinetic properties, allowing patients to find the most suitable medication. The substances differ in their speed of action, duration of action, and route of administration. Patients should be aware that several visits to a reputable andrologist may be necessary before finding the right solution. Patients should also make their partners aware that finding the right medication takes time. Sexual stimulation is required for PDE5i medications to work properly (the medications alone do not ensure achieving or maintaining an erection). Once you find the right medication, you can ask your doctor for a prescription for a larger pack that will last longer.

Vacuum Erection Pumps

A vacuum erection pump, also known as a vacuum therapy device, is a non-pharmacological tool used to treat erectile dysfunction. It works by placing the penis in a cylinder, which then removes air, creating a vacuum and causing blood to flow into the penis, leading to an erection. Once an erection is achieved, a constriction ring is placed around the base of the penis, which maintains the erection by restricting blood flow. An erection pump is an effective tool for many men, regardless of the cause of ED, and can be especially helpful for those who cannot use oral medications.

It is a safe method, but it can cause some side effects, such as a bluish discoloration of the penis or decreased ejaculation force. The pump can also be used in conjunction with other ED treatments, such as medications or therapy. This is a popular option due to its one-time purchase cost, lack of serious side effects, and suitability for a wide range of ED conditions. The key is finding the right penis ring that won't cause pain and/or discomfort.

There are some contraindications to its use. Here are a few:

• Blood clotting disorders: Patients with blood clotting problems or those on anticoagulant therapy may be at increased risk of bleeding or bruising from using a vacuum pump.
• Priapism: People prone to priapism, or painful and prolonged erections, should avoid using a vacuum pump, as it may worsen their condition.
• Severe cardiovascular disease: In patients with serious cardiovascular problems, using a vacuum pump may be risky, especially when sexual activity is contraindicated.
• Penile Anatomical Deformities: In cases of existing anatomical deformities of the penis, such as Peyronie's disease, using a vacuum pump may be unsafe or ineffective. However, pumps specifically designed for these patients do exist.

Shockwave

Low-energy shockwave therapy is a relatively new treatment for erectile dysfunction (ED). Shockwave therapy involves the use of short pulses of low-energy acoustic waves directed at various areas of the penis. These waves are designed to stimulate new blood vessel growth (angiogenesis) and improve blood flow in the penis. It is a non-invasive method, meaning it does not require surgery or injections, which is beneficial for patients who are afraid of invasive procedures.

Preliminary studies have shown that shockwave therapy can be effective in treating ED, especially when it is caused by vascular factors. It is particularly promising for men for whom traditional treatments, such as oral medications, have not been effective. Shockwave therapy has the potential to provide long-term benefits in the treatment of ED because it can treat the underlying cause of the problem, which is insufficient blood flow.

Alprostadil - Cream, Intraurethral Pellet, Injectable Injection

Alprostadil is a medication used to treat erectile dysfunction (ED), working by dilating blood vessels and increasing blood flow to the penis. It is available as an injectable injection, which is administered directly into the corpus cavernosum of the penis, and as a preparation for use in the urethra. Alprostadil injections work quickly, usually within minutes, and the effect can last from one to several hours. Possible side effects include pain at the injection site, bleeding, prolonged erection (priapism), and scarring or fibrosis. Before starting alprostadil, it is important that the patient receives thorough instructions from a physician on how to properly administer the injection.

Alprostadil is also available as a cream or an intraurethral pellet. The alprostadil intraurethral pellet is a medication used to treat erectile dysfunction, which is inserted directly into the urethra using a special applicator. Designed for patients who prefer to avoid painful injections with this medication.

Penile Implants

When other treatment methods are ineffective, implantation is the last resort. This method also yields over 90% satisfaction among patients who have undergone surgery and their partners, according to research presented by Peter Baijc and Joseph Muhan in "Etiology of Erectile Dysfunction and Duration of Symptoms in Patients Undergoing Penile Prosthesis: A Systematic Review." Implants require only a mechanical system to achieve a full erection, independent of arousal. At the same time, the patient retains all the sensations associated with intercourse. The following types of implants are distinguished:

• Fluid-Filled (Hydraulic) Implants:

Three-Piece Fluid-Filled Implants: These consist of two cylinders placed in the penis, a fluid reservoir placed in the abdominal cavity, and a pump and valve placed in the scrotum. Erection is achieved by manually pumping fluid from the reservoir into the cylinders.
Two-piece fluid-filled implants: Similar to three-piece implants, but the reservoir and pump are combined into a single unit placed in the scrotum. They are less complex than three-piece implants, but they provide a less natural erectile sensation.

• Semi-rigid (bendable) implants:

They consist of two flexible rods placed in the corpora cavernosa of the penis. These implants allow for permanent, yet controlled, stiffening of the penis. The user can manually bend the penis into the sexual intercourse position or downward when an erection is not desired.
For phalloplasty, intended for transgender individuals (MC) and men who have lost their penis, e.g., due to cancer, implants with a similar design are used. In these cases, the corpora cavernosa lack a natural stop for the pumped fluid, and this stop must be additionally secured.

 

Erection Problems - Summary

The occurrence of erectile dysfunction (lack of erection, short duration of erection) is a common problem. Erectile dysfunction (ED) is a common problem that can stem from a variety of causes, both physical and psychological. Treatment: The symptoms and treatment of ED are closely intertwined, including lifestyle changes, medical therapies, and psychological support. It's important to openly discuss the problem with your doctor, who can recommend appropriate diagnostic tests and treatments. Psychological support and psychotherapy, especially when ED is caused by emotional factors or stress, play a key role in the effective treatment of this condition.