Erectile Dysfunction
Erectile Dysfunction or Male Sexual Impotence is defined as the persistent inability (over three months or more) to obtain and maintain an erection that allows satisfactory sexual intercourse. It is a problem that affects males and can occur at any age, although it is more common in older age groups. Erectile dysfunction affects
Despite being a benign disease, sexual impotence has a major impact on a man’s sex life as well as on a psychological level. Given its influence on self-esteem, many men don’t seek help, which tends to make the problem worse. However, the majority of cases are treatable, around 90%.
Symptoms
The warning signs are a decrease in sexual desire, changes in the quality of the erection and consequent difficulty in penetration, as well as changes in ejaculation. These signs can manifest themselves progressively or sometimes suddenly, the latter usually being the result of previous illness, trauma or surgery. Their characteristics, the times at which they occur and their duration are all aspects that help to determine whether the cause is psychological, physical or both.
Causes
Sexual impotence can have multiple causes: psychological, physical or hormonal. It can be a symptom of other diseases such as
Diagnosis
The diagnosis of erectile dysfunction should include as detailed a psychosexual history as possible, a physical examination and a laboratory and hormonal study.
It may also be necessary to carry out other diagnostic tests, such as Doppler ultrasound of the cavernous arteries and penile injection of a vasodilator.
Treatments
Although there are many options for treating erectile dysfunction today, therapy should not be started without a doctor’s prescription. It is the clinician who defines the treatment, personalizing it according to the causes and degree of severity of the erectile dysfunction. Treatment can be divided into three categories – non-pharmacological (psychological or psychiatric support), pharmacological (with the prescription of drugs that promote blood supply to the penis) and other approaches, including surgery.
Latest available treatments
An oral suspension (oral spray) that promotes erection. This oral spray
There are currently four oral drugs in the class of phosphodiesterase type 5 (PDE5) inhibitors. These drugs promote erection by relaxing the blood vessels in the penis, allowing blood to flow to it when sexually stimulated.
For men with moderate erectile dysfunction who are contraindicated or have not responded to treatment with oral medication, self-administered injections of prostaglandins can be offered, which are applied to the penis before sexual intercourse. There are other options, such as topical prostaglandins, which are applied locally to the male urethra and have a vasodilatory effect.
There is also the possibility of having a penile prosthesis fitted, which is a third-line treatment for erectile dysfunction. This intervention is reserved for men who have not responded to previous treatments or who are looking for a longer-lasting solution. Vascular surgery – another possible treatment for erectile dysfunction – aims to increase arterial flow and decrease venous return.
This strategy, which includes the support of a psychotherapist or psychiatrist, will be recommended in cases where erectile dysfunction is associated with stress, anxiety or depression. The non-pharmacological approach can complement other forms of treatment for Erectile Dysfunction. Before instituting a drug strategy, a change in lifestyle should be tried, involving, for example, quitting smoking and drinking alcohol, as well as promoting physical exercise and a healthy diet.
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