Signs and symptoms of erectile dysfunction
Erectile dysfunction is defined as the inability of a man to achieve or maintain sufficient erection to achieve a satisfactory sexual relationship. It is considered that a man suffers from erectile dysfunction when they spend at least six months without erections or being unable to maintain them.
Erectile dysfunction affects 50% of men over 40 at least temporarily or sporadically for some circumstances such as alcohol abuse, fatigue, stress, affective problems and so on.
The chances of getting erectile dysfunction increase with age. Thus, it is estimated that at age 60, 17% of men are unable to have or maintain an erection. At age 70, half of men have erectile dysfunction. Although this pathology is associated with aging, men under 40 years of age may also be affected by it.
There are two chambers called cavernous bodies in the penis. These corpora cavernosa are formed by muscles, fibers, veins and arteries, in what is called spongy tissue.
When the man feels excited, either mentally or physically, the brain sends signals to those cavernous bodies so that the muscles relax.Then, it is mobilized by the bloodstream, filling all the spaces and growing the penis, thanks to the pressure it causes. Thus an erection occurs.
If the muscles of the cavernous bodies do not relax, they do not let the veins and arteries fill with blood, so erection is impossible and we would be facing erectile dysfunction.
Erection problems (popularly called impotence) can significantly limit the quality of life and well-being of patients, as well as that of their partner. However, we must know that they are treatable problems from different fronts and at any age.
The causes of erectile dysfunction are very numerous. There are psychological factors (eg stress or fear of sexual failure) as well as certain diseases, hormonal disorders, neurological injuries or side effects of certain medications that can trigger this dysfunction. The physical factors of risk, as well as the causes of erectile dysfunction (erection problems) can be among others at the following:
- Cardiovascular diseases
- Mellitus diabetes
- Alcohol consumption
- Nicotine consumption
In the face of erectile dysfunction, the treatment is usually a drug treatment with pills. If this does not improve the erection problems, it can also be treated by an injection into the penis, a urethral bar or by mechanical methods (such as the vacuum pump). Treatment with medication should always be done under medical supervision. If the cause is psychological factors, psychiatric or psychological treatment may be helpful. A diagnosis and early treatment are indispensable to solve the erectile dysfunction. The specialist consulted must be a urologist.
What is erectile dysfunction?
What is erectile dysfunction? How is erectile dysfunction defined? Erectile dysfunction (ED) is the persistent inability to achieve and maintain a sufficient erection to allow a satisfactory sexual intercourse. It is a benign problem related to the physical and psychological aspects of health that has a significant impact on the quality of life of the people affected and their partners.
Erectile dysfunction occurs in one in two men over the age of 40 at least temporarily. The percentage increases with age. If the dysfunction has always been present, it is spoken of primary erectile dysfunction. This would be when the man has never been able to maintain a complete sexual relationship due to lack of erection. When erection problems occur after a period of normal erections or after a systemic or general illness, we talk about secondary erectile dysfunction.
Erectile dysfunction is one of the most common sexual problems in men. It is estimated that in the Western world there are between 25 and 30 new cases per thousand inhabitants per year.
Erectile dysfunction is closely related to other health problems, especially with cardiovascular disorders. Thus, cardiovascular disease and diabetes are risk factors. Also other health problems like metabolic syndrome or urinary tract infections can cause erectile dysfunction.
In general, erectile dysfunction is a poorly diagnosed problem, since men do not usually see their doctor because they perceive it as an inevitable age-related disorder. For this reason, it is difficult to know the actual incidence figures. Thus, it is estimated that more than half of men with erectile dysfunction have never consulted a specialist about it. This is especially striking among males aged 60-70 years.
In addition to erectile dysfunction, there are other sexual dysfunctions in which orgasm occurs uncontrollably, either early or delayed. The most frequent of these dysfunctions is premature ejaculation.
What Causes To Erectile Dysfunction?
The causes of erectile dysfunction are very numerous and often combine. In young people, it is often about psychological causes. In older men, physical reasons are the main factor of erectile dysfunction. However, erectile dysfunction occurs due to physical causes in 70 to 80% of cases.
Physical causes of erectile dysfunction
Among the possible physical causes of erectile dysfunction are the following:
- Circulatory Disorders
- Mellitus diabetes
- Hormonal disorders
- Chronic renal failure
- Chronic liver disease
- Vascular surgery in the abdomen
- Bladder and bowel operations
- Radiation in the pelvis
- Neurological diseases (such as multiple sclerosis, polyneuropathy)
Also certain drugs can produce impotence:
- Gastrointestinal drugs (such as cimetidine, ranitidine)
- Drugs for the heart (such as digital, propafenone, verapamil)
- Anti-inflammatory drugs (such as cortisone)
- Drugs for dehydration (eg, thiazides, spironolactone)
- Antihypertensive drugs (such as clonidine, hydralazine)
- Drugs for hair growth (finasteride)
- Anxiety drugs, known as tranquillizers (such as phenothiazines, butyrophenones, thioxanthenes)
- Beta-blocking drugs (propranolol, atenolol)
- Antiandrogenic drugs (drugs that inhibit the action of male hormones)
Possible psychic causes of erectile dysfunction include:
- Unresolved conflicts
- Lack of sexual interest
The following points may indicate that erectile dysfunction is caused by psychic causes:
- Erectile dysfunction begins abruptly
- Physical causes do not appear to exist
- There are stressful situations in the life of the patient when erectile dysfunction begins
- Erection problems come and go
- Spontaneous erections occur at night or in the morning
- Patients do not suffer from physical risk factors (such as diabetes mellitus, erectile suppression drugs, alcohol or drug abuse)
- The patient is less than 50 years old
What are the symptoms of erectile dysfunction?
The characteristic symptom of erectile dysfunction is the fact that the penis does not remain sufficiently erect or does not do so long enough to achieve satisfactory sexual intercourse. Sometimes, other disorders of sexual function such as premature ejaculation or delayed ejaculation occur simultaneously.
Erectile dysfunction can have a great impact on the patient’s self-esteem. Erection problems affect the quality of life in such a way that can cause much suffering, both in the affected man and his partner.
When erectile dysfunction occurs sporadically, in many cases an emotional or psychological cause lies behind it. if the inability to generate or maintain the erection is prolonged for more than three months, it is advisable to consult the problem with a doctor.
How is Erectile Dysfunction Diagnosed?
It is important to conduct a full clinical interview that includes clinical, psychological and sexual history data to establish a correct diagnosis of sexual dysfunction.
In a relaxed environment, we will discuss the degree of harmony in the couple’s relationships, the emotional situation, the way of appearance and the duration of the problem, as well as possible consultations and treatments previously performed.
It is necessary to know the quality of the erections, both those related to sexual activity and the morning erections, in terms of rigidity and duration. This information and other data from the medical history allows us to orient erectile dysfunction towards its organic or psychological cause.
Physical examination includes data from vascular systems (blood pressure, peripheral pulses, inguinal murmurs), neurological (anal, cremasteric and bulbocavernosus reflexes), nervous system (erectile dysfunction may be caused by a penile nerve disorder).
To verify this, there are different neurological examinations such as electroneurography or electromyography (endocrine gynecomastia) which helps to explore the genital apparatus to rule out the presence of problems in the penis, such as Peyronie’s disease or altering the size of the testicles.
Laboratory tests are aimed at clinical suspicion, it is advisable to measure glycemia, glycosylated hemoglobin (HbA1c), cholesterol, renal function and TSH. There is a recommendation for testosterone and prolactin determinations although there is no agreement on the need to do so on a routine basis.
The required level of testosterone is not known to maintain erection as it is in relation to other factors such as LH levels. It is reasonable to request morning testosterone levels in patients with altered secondary sexual characteristics or in a male over 50 years which presents erectile dysfunction and loss of libido. if testosterone is decreased, we will think of late-onset hypogonadism and assess the need to request prolactin determination.
There are a number of complementary tests that are not part of the basic assessment, which will be asked to complete the study in selected cases such as nighttime recording of penis tumescence, intracavernous injection of alprostadil, echo-doppler and caversonography.
Intracavernous Injection Test
In the intracavernosal injection test, the physician injects the patient with a male sex hormone from the prostaglandins group into the erectile tissue of the penis. In this way the erection usually occurs in a short time. If sustained erection is enough, the causes of erectile dysfunction are probably due to non-vascular conditions.
Doppler color ultrasound
With Doppler ultrasound, a type of ultrasound, the doctor can evaluate the blood flow to the penis and thus determine if erectile dysfunction is caused by vascular causes.
To determine if the blood flow has problems passing through the penile vein and erection is not possible (for example, due to a venous leak), a cavernosography is performed.
The doctor supplies a contrast medium in the erectile tissue and with an x-ray taken at regular intervals (every few seconds) can observe the blood flow in the erectile tissue.
What is the treatment for erectile dysfunction?
The treatment of erectile dysfunction addresses the specific causes of each case. When erectile dysfunction is due to physical causes, it is possible to apply a treatment with drugs or with different means.
If erectile dysfunction occurs due to underlying diseases (such as diabetes mellitus), these should be treated first. In very few cases a surgical intervention is necessary to resolve erectile dysfunction. In cases where erectile dysfunction is related to psychic causes, a psychiatric treatment or psychological treatment is advisable.
Erectile dysfunction can be treated with the use of different drugs. Usually, thanks to these you can get an erection without problems and hold it for long enough. Phosphodiesterase inhibitors cause better blood flow to the penis. Drugs such as sildenafil, tadalafil and vardenafil are the best known drugs in this group. Taking of these drugs must be done before sexual intercourse and no more than once every 24 hours. Because there may be interactions and side effects, these drugs are only available on prescription. Possible side effects are:
- Redness of the skin with burning sensation
- Disorders of vision
- Clogged nose
Intracavernous injection therapy
Intracavernosal injection is painless. It is done with a very fine needle. The use of pre-filled syringes facilitates their delivery.
Complications of Intracavernous injection therapy
Cavernous autoimmune treatment can cause side effects such as bruising, pain in the penis and erection or erectile tissue infection.
Treatment for erectile dysfunction with intracavernosal autoinjection is not indicated in patients with cardiovascular, hepatic, renal, sexually transmitted diseases, anemia or heart attack in the last year.
In very few cases, treatment with intracavernous autoinjection can lead to priapism, which consists of a painful erection that lasts for more than two hours and must be treated medically. If priapism is not treated, it can result in fibrosis (tissue tightening) and permanent erectile dysfunction.
Transurethral therapy is one of the options for treating erectile dysfunction. This therapy is used when the desired results are not obtained with the tablets.
In transurethral therapy the patient uses a plastic applicator in the form of a rod. The applicator is 1.4 mm thick and 3 cm long and contains the substance alprostadil. After urination, the applicator is inserted into the urethra. At the push of a button, a small “suppository” containing the substance is released.
After removing the applicator, the penis should be grasped with the palms of the hands and massaged to dissolve the active agent in the urethra, distribute it and that can be absorbed through the urethral wall. Alprostadil relaxes the muscles of the penis, increases blood flow and causes a few minutes later an erection lasting between 70 and 80 minutes.
Complications of transurethral therapy
Side effects such as pain, headache, urethral injury, dizziness, low blood pressure or brief loss of consciousness can occur with transurethral treatment. If painful and durable erections (priapism), blood clotting disorders or urethral infections have been previously reported, this method should not be used. Transurethral therapy is also not recommended if the sexual partner is pregnant, since alprostadil may pose a risk to the fetus.
Vacuum pumps are used for all forms of erectile dysfunction. The vacuum pumps are made of a clear plastic cylinder that is connected through a tube with a hand pump. At the end of the cylinder there is a ring that slides. The cylinder is placed on the penis. The pump creates a vacuum in the cylinder, the penis is filled with blood and an erection occurs.
Next, the ring will be placed at the base of the penis. This keeps the blood from flowing and keeps the erection going. When the ring is removed after intercourse, the erection disappears.
Complications of vacuum pumps
This method can cause blood flow disorders in the penis. Therefore, vacuum pumps should not be used if there have been cases of priapism, blood flow disorders or other types of cardiovascular disease.
Operations (Penis Implant)
Patients in whom drugs or mechanical methods do not work as a treatment for erectile dysfunction, there remains the option of penile implant. In this operation, a prosthesis is implanted in the erectile tissue of the penis. However, the long-term results of this method are contradictory, so this method is only used in sporadic cases.
In rare cases a bypass operation may be necessary (such as when vascular lesions or occlusions occur in the penis).
In the bypass operation a new connection is created for the damaged vessels. However, this operation is performed on very few occasions.
Psychiatric / psychological therapy
Psychiatric treatment or psychological treatment is performed, especially when the causes of erectile dysfunction are psychic.
Drugs (such as antidepressants) are sometimes used.
The type of therapy chosen (eg, cognitive, individual or couple therapy) should be based on a personal decision.
How does erectile dysfunction evolve?
The evolution of erectile dysfunction addresses the specific causes of each case. In most cases, erection problems can be resolved through the use of drugs (such as phosphodiesterase inhibitors). Although drug treatment should always be prescribed by a physician; Self-medication in these cases can be very dangerous when treating only the symptom and not the causes that cause it.
Unlike erectile dysfunction due to physical causes, erectile dysfunction due to psychic causes is usually a temporary problem that responds to a specific circumstance, such as work or partner problems, excessive stress, insecurity, having experienced traumatic experiences, depression and so on.
The sooner you start treatment, your chances of curing erectile dysfunction will be more. So whenever it is a recurring problem it is advisable to go to the doctor to determine the cause and seek the best treatment.
When erectile dysfunction is not solved, both the man and his partner may suffer from self-esteem and relationship problems that end up implying problems added to the medical cause that has led to impotence. Sometimes the problem has to be addressed by several professionals, such as a psychologist, a sexologist and a urologist or other specialist.
Can erectile dysfunction be prevented?
Erectile dysfunction can have several causes. That is why this can only be prevented in part.
It is important to eat a balanced diet and exercise. Also, it is recommended to avoid being overweight, nicotine and excessive consumption of alcohol. Stress in sexual intercourse whether caused by yourself or your sexual partner should be minimal.
In any case, it is necessary to try to talk with the couple of what happens and if it is something sporadic, to look for what can have caused it and to correct the precipitating cause.
Before the symptoms of erectile dysfunction, it is not necessary to doubt and it is advisable to consult a doctor. First, the probability of success of treatment will be greater as soon as possible. In addition, other diseases such as diabetes mellitus or cardiovascular disease can be hidden behind erectile dysfunction which require treatment. In this case, erectile dysfunction would be the symptom for which another series of diseases would be discovered, so it is important that if it is produced in a habitual way and doctor is consulted so that the male is subjected to medical tests that can determine the origin.
However, currently half of men with problems of erectile dysfunction do not consult with the doctor because they believe there is no solution or for other reasons such as shame.