Erectile dysfunction

What is erectile dysfunction?

It is a repeated inability to achieve an adequate erection, or to maintain a sufficient penile rigidity to last in a sexual act of penetration or during masturbation.

This disorder does not present any health risk. However, it can have a significant impact on the quality of life of the patient and his or her partner.

It is important to note that erectile dysfunction is to be distinguished from the absence of libido which is rather called aphanisis, as well as from anorgasmia which designates the impossibility to reach orgasm. It can however coexist with these disorders.

The different types of erectile dysfunction

There are generally two types of erectile dysfunction:

• Organic or primary erectile dysfunction due to aging or disease;
• Psychogenic or secondary erectile dysfunction due to psychological, emotional, relational or situational problems.

What causes erectile dysfunction?

Organic causes

There are many causes of erectile dysfunction but the main one is simply ageing. It is a problem that affects less than 10% of people under 50, and more than 30% of people over 60.

Circulatory problems are another very common cause, including:

• Diabetes
• High blood pressure
• Kidney failure
• Hyperlipidaemia
• Neurological diseases (stroke, multiple sclerosis, Alzheimer's disease, but also trauma to the nervous system, etc.) or hormonal imbalances (male hormone deficiency due to hypogonadism, thyroid disease, etc.) also cause erectile dysfunction.

Finally, prostate surgery can also be a cause. Vasectomy does not affect erectile function.

Psychological causes

In many men, erectile function can be temporarily, episodically or permanently disturbed by psychogenic causes (stress, fatigue, emotional reaction or psychological and/or psychiatric disorders).

How is an erectile dysfunction diagnosed?

It is advisable to consult a urologist when erectile dysfunction has lasted for more than 3 months or is causing physical and/or psychological suffering.

During the consultation, the doctor will ask the patient about the characteristics of the dysfunction: sudden or gradual onset, permanent or intermittent erectile difficulties, situations that favour the disorder, etc.

Then, various examinations may be prescribed to refine the diagnosis:

• An examination of the genitals including a rectal examination to check the prostate.
• A recording of nocturnal erections on waking and/or during REM sleep.
• A blood test to check for diabetes, kidney disease or high cholesterol, as well as a testosterone level, which may suggest an endocrine cause.
• Doppler-duplex ultrasonography or selective angiography of the penile arteries to detect possible vascular pathologies of the penis.
• A cardiovascular examination to look for possible high blood pressure or a cardiac disorder that may explain the disorder.
• A neurological examination to rule out certain pathologies such as Parkinson's disease, for example.

Treatment of erectile dysfunction at Turó Park Medical Clinic

Several treatments can be offered depending on each patient's cause of the problem.

Non-drug treatments

The treatment of psychogenic dysfunctions may involve individual or couple psychotherapy, as well as gentle disciplines such as sophrology or yoga to regulate or alleviate minor stress disorders.

Oral treatments

There are several erection-inducing drugs such as Viagra®, Cialis® or Levitra®. These treatments are generally prescribed for occasional use because they have significant side effects.

Local treatments

Local treatments are intended to induce an erection. There are three of them:

• Prostaglandin injections
• Intraurethral application of PGE1 (MUSE®)
• Application of an alprostadil-based cream to the meatus

For all three treatments, a learning phase with a health professional is necessary to reduce the risk of injury, pain or misadministration.

The vacuum pump

Also known as a vacuum or vacuum erector, the vacuum pump is a mechanical medical device that allows an erection to be achieved without the need for medication or surgery.

The pump works as follows: blood is first drawn to the penis through a vacuum in a tube and then, in order to maintain the erection, the subject slides a constriction ring (a kind of tourniquet) at the base of the penis in order to maintain his erection and have sexual intercourse.

Surgery

As a last resort, a semi-rigid or inflatable penile prosthesis may be proposed.