Erectile dysfunction (ED) means the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.
Erectile Dysfunction could anticipate a heart disease or could be an early manifestation of it. Therefore, it should not be considered only as a quality of life issue but also as a potential warning sign of severe underlying heart morbidity.
The treatment depends on the causes of erectile dysfunction that can be organic or psychogenic. Lifestyle modifications, correction of underlying risk factors and specific medications may enhance the erectile response to sexual stimulation. Sexology counselling helps to treat psychogenic ED. In severe and unresponsive cases, a penile prosthesis may be the last resort.
Some health conditions increase the chances of developing Erectile Dysfunction:
Urological conditions related to ED:
Procedures that may cause ED:
While the ED diagnosis is self-made, some test may help us staging the disease and understanding possible underlying causes. The patient’s evaluation starts in the urologist’s office with a detailed medical history and physical examination. The International Index of Erectile Function questionnaire (IIEF) is a valuable and simple diagnostic tool to stage the severity of symptoms and their impact on the patient’s quality of life. Lab tests (hormones and blood work) usually complete the baseline diagnostic workup.
The urologist or andrologist may order other tests to complete the diagnostic journey (advanced workup) like:
Several studies have shown that lifestyle modification, including physical activity, weight loss and pharmacotherapy for cardiovascular disease risk factors, may improve sexual function in men with ED. There is also a positive effect of lipid-lowering therapy with statins on erectile function.
In most cases, we cannot radically cure and solve the ED. When the cause is psychogenic, post-traumatic arteriogenic (in young patients) or hormonal, then the ED is potentially reversible after treatment and leads to a stable recovery. However, we can improve most ED with a tailored, integrated and comprehensive strategy (controlling risk factors, pharmacologic erectile enhancement, psychodynamic/psychiatric treatment and sexology training).
We recommend oral medication to enhance natural erection. Since these medications are not initiators of erection, sexual stimulation is required to facilitate an erection. If the patient takes this medication will never have any erectile response without sexual stimulation.
These medications are considered safe without increasing the risk of myocardial infarction. However, the prescription is restricted and controlled in patients with cardiovascular disease and high cardiovascular risk.
Nitrate derived medications are an absolute contraindication to oral medication. We must use caution when the patient is under antihypertensive agents for a possible additive drop in blood pressure.
The patient must tell the urologist all his medical history to have a safe oral medication prescription.
Topical therapies are medications applied externally on the surface of a part of the body (skin or mucosa). We treat selected patients with topical treatment through a specific formulation of alprostadil inserted into the urethra at the tip of the penis. Alternatively, in the same area, we can apply a cream formulation.
Extracorporeal Shockwave Therapy (ESWT) employs focused shock waves directed at the penis to improve erectile function. Standard treatment consists of 6 sessions, and we can repeat it if necessary.
We can consider this non-standard treatment option when patients do not want to take oral or topical treatment.
We offer this treatment in selected patients who did not respond to lifestyle changes and other conservative treatments (oral, topical, ESWT).
We usually train the patient to self-inject the medication into the spongy tissue in the penis to induce an erection.
Although self-injection scares many men, after feeling the benefits, they soon overcome the fear of it.
The vacuum erection device (VED) is a cylinder-shaped device with a rubber constrictive ring that tightens around the penis. The vacuum effect makes it possible to get and maintain an erection.
We consider VED as an alternative treatment when others do fail.
A penile prosthesis (penile implant) is a device implanted internally into the penis and allows the patient to have an artificially maintained erection. In severe ED or contraindications to all suitable treatments, we can consider this surgery a last resort.