Erectile dysfunction

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.

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.

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

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.

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:

1. 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.
2. 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.
3. 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.
4. 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%.
5. To remedy psychological causes, sexual psychological counseling sessions and also psychotherapy can help.

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.