Erectile dysfunction

International Classification (ICD)	F52.-
Symptoms	unsatisfactory sexuality, Stress and anxiety during sexual intercourse, Shame, Relationship problems, Inability to conceive, low self-esteem, reduced erectile function
Possible causes	Sexuality disorders
Possible risk factors	Cardiovascular diseases, Hypertension, Vascular calcification (arteriosclerosis), Hypercholesterolemia, diabetes mellitus, Testosterone deficiency, Multiple sclerosis, Parkinson's, Obesity, Smoking, Alcohol abuse, drug and medication abuse, surgical interventions
Possible therapies	Medication, Vacuum pumps, surgical procedure, Hormone therapy, Lifestyle Modification, Psychotherapy
disease.indicated_substances	Sildenafil , Tadalafil , Vardenafil

Basics

Erectile dysfunction (impotence) refers to the inability to get an erection or even maintain an erection for satisfactory sexual intercourse. The medical term Erectile Dysfunction comes from Latin and is composed of the words "erigere" (to erect), "dys" (to lack) and "functio" (function).

However, sporadic erectile dysfunction occurs more often and is usually not a cause for concern - it can occur due to relationship problems or even during stressful periods in life. However, erectile dysfunction that lasts longer should always be clarified medically, since physical causes such as diabetes mellitus or neurological diseases can also be hidden behind the symptoms.

Frequency

Erectile dysfunction (ED) is common. The frequency in 20 to 30-year-old men is given as about 2%. In the 60- to 70-year-old age group, on the other hand, about 50% of men are affected by the problem. Since many of those affected refuse help or do not see a doctor because they feel ashamed, only a small proportion of erectile dysfunctions are actually treated. The severity of impotence varies greatly from individual to individual. It ranges from problems that occur only now and then to complete and permanent loss of erectile function.

Causes

Achieving an erection is based on highly complex processes in the brain and body. Nerves, hormones, muscles and blood vessels are involved. Problems can occur at any of these levels that can make it difficult or impossible to achieve or maintain an erection. Physical as well as psychological stress can also have a negative impact on erectile function.

Physical causes	Risk factors
Internal diseases	Cardiovascular diseases, high blood pressure (arterial hypertension), vascular calcification (arteriosclerosis), hypercholesterolemia, diabetes mellitus
Urological diseases	Various surgical interventions (e.g. after prostate surgery)
Hormonal diseases	Testosterone deficiency
Neurological diseases	Multiple sclerosis, Parkinson's disease
Lifestyle factors	Smoking, obesity, drug and alcohol abuse, injury sequelae

Der männliche Urogenitaltrakt (iStock / peakSTOCK)

Nowadays, a physical cause is suspected in about 70% of those affected with erectile dysfunction. However, psychological and interpersonal factors always play a central role in sexual dysfunction. About a quarter of those affected suffer from erectile dysfunction that has purely psychological causes. Psychologists see inhibitions or fears, as well as pressure to perform and stress as the reason for erectile dysfunction in most cases. Many men also regard erectile dysfunction as a weakness of their masculinity.

Symptoms

Symptoms that can occur with Erectile Dysfunction are:

diminished or non-existent erectile function
an unsatisfactory sex life
Stress and anxiety during sexual intercourse
Feeling of shame and low self-esteem
Relationship problems
inability to procreate

Diagnosis

The diagnosis of erectile dysfunction is divided into:

Anamnesis
clinical examination
laboratory examinations
special diagnostic measures in case of suspected vascular genesis

The comprehensive medical history taken by the urologist should cover medical risk factors and also psychosexual aspects of erectile dysfunction. In addition, the use of medications is important, since certain active substances can also trigger impotence.

Blutuntersuchung (iStock / kukhunthod)

In addition, a thorough urological examination is also important. This includes an assessment and palpation of the external genitalia (e.g. penis size, penile changes, testicle size, foreskin constrictions, various inflammations) as well as an examination of the entire body with a special look for signs of testosterone deficiency (e.g. gynecomastia, reduced body hair). In addition, height, weight and also BMI should be recorded. If the last vascular examination was more than 6 months ago, the treating urologist should also examine the peripheral pulses (feet, wrists) as well as blood pressure and heart rate to rule out a vascular cause of erectile dysfunction.

According to the current EAU guidelines (European Association of Urologists), the following laboratory tests are recommended for patients with erectile dysfunction:

Determination of fasting blood glucose levels (if necessary, also HbA1c as a long-term glucose value).
Determination of blood lipid levels
Measurement of testosterone levels (e.g. to exclude hypogonadism)

Special diagnostic measures for a suspected vascular genesis of impotence include:

Ultrasound examination with duplex sonography of the penis.
Cavernous body injection testing (SKIT)

Therapy

Depending on the trigger for the potency disorder, there are different therapeutic approaches. These range from drug treatments, vacuum pump systems, hormone therapies to surgical interventions. Likewise, the implantation of a corpus cavernosum replacement (penile prosthesis) offers a permanent solution for those affected for whom drug therapy is not sufficient. In addition to these treatment options, lifestyle modifications often have a positive effect on erectile function. These include, for example, optimal blood sugar control in diabetics, physical exercise, nicotine abstinence or weight reduction in the case of overweight.

The following treatment options are available for erectile dysfunction:

The selective phosphodiesterase-5 inhibitors (PDE-5 inhibitors) are generally the first-line treatment option. The four approved phosphodiesterase-5 inhibitors (avanafil, sildenafil, tadalafil, and vardenafil) have comparable effects, but differ in pharmacokinetics and side effects. Inhibition of the PDE-5 enzyme results in an improved and longer-lasting erection.
If PDE-5 inhibitors do not achieve success, a vacuum pump that pumps blood into the penis can be used. This also reduces the outflow of blood from the penis. Possible undesirable side effects include pain, numbness, bleeding, and difficulty ejaculating.
Other treatment options include medications injected into the erectile tissue of the penis before intercourse (SKAT therapy) or suppositories containing prostaglandin E1 inserted into the urethra before sex (MUSE therapy). The success rate of SKAT therapy is about 70%. However, 41-68 % of those affected discontinue the therapy - usually even within the first 3 months.
If the above mentioned therapy options do not help, there is the possibility of a surgical intervention. Here, for example, a penile prosthesis can be inserted. However, this method is usually used as a last option, as it is permanent. The satisfaction rate for men with a penile implant is about 90%.
To remedy psychological causes, sexual psychological counseling sessions and also psychotherapy can help.

Forecast

The earlier erectile dysfunction is detected and the sooner adequate therapy is initiated, the better the chances of recovery. However, since the feeling of shame often prevails among those affected, many men avoid going to the doctor. On average, it takes about one and a half years for men with persistent erectile dysfunction to see a specialist.

(iStock / Evgeniia Medvedeva)

Erectile dysfunction is usually caused by physical triggers and increases with age. Since erectile dysfunction can also be caused by serious diseases, cardiovascular diseases, diabetes and neurological diseases should be ruled out by specialized doctors before a possible therapy.