Erectile dysfunction
Summary/Definition
Erectile dysfunction is a persistent inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse, and it is not only a functional problem; subjective satisfaction is also an important factor. Types of erectile dysfunction are classified according to their causes, which are a combination of psychological and physical problems. After the age of 50, physical problems become of particular importance.
The types of erectile dysfunction include psychogenic, vascular, neurogenic, endocrine and other causes. Psychogenic erectile dysfunction is caused by mental or relationship-related causes, such as anxiety and anxiety about sexual activity and sexual function. Vascular erectile dysfunction is caused by a decrease in the function of blood vessels and can be divided into arterial erectile dysfunction, in which there is insufficient arterial blood flow, and cavernous erectile dysfunction, in which blood cannot be retained. This is due to aging, smoking, ischemic sclerosis, Peyronie’s disease, etc. Neurogenic erectile dysfunction is caused by problems with the nervous system controlling erection, as well as stroke or spinal disease. Endocrine erectile dysfunction is caused by a decrease in male hormones or a violation of the endocrine system of the body, as well as a violation of the function of the thyroid gland or pituitary adenoma. Other causes of erectile dysfunction include pelvic organ surgery, trauma, side effects of medications, etc. Dysfunction can be caused by medications for high blood pressure, antidepressants, tranquilizers, drugs for hair loss and drugs for prostatic hyperplasia.
Symptoms
The inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse persists.
Diagnostics
Erectile dysfunction can be diagnosed by conducting, if necessary, special tests based on anamnesis collection, physical examination and blood tests. Thanks to the anamnesis, we will find out the cause, the severity of erectile dysfunction, the frequency of sexual activity, the history of diseases, the regimen of medications, concomitant diseases. Thanks to the anamnesis, it is possible to determine the presence of a psychological component. During a physical examination, you can check the development of secondary sexual characteristics, small penis, urethral malformations, foreskin abnormalities, testicular tumor development and gynecomastia. Diabetes, hyperlipidemia and hormonal disorders can be checked with a blood test. For this purpose, the level of glycated hemoglobin, cholesterol, serum lipids, testosterone, prolactin and gonadotropin is measured. Among the studies conducted with ultrasound, dopplerography of the vessels of the penis is the safest study for the detection of vascular and structural abnormalities of the penis. You can also make an injection that causes an erection, ultrasound to study the structure of the protein shell of the cavernous body, as well as determine the speed of blood flow in the penis and whether it reacts to the injection. A vasoactive test during a night’s sleep using Rigiscan allows you to identify psychological causes, and an electromyography of the penis and a test for the speed of the pulse along the dorsal nerve (measurement of the somatosensory evoked potential from the dorsal nerve) are carried out to check the psychological causes. Venous anomalies are also detected using manometry of the cavernous bodies of the penis (dynamic cavernosometry) or cavernosography of the penis (cavernosography).
Treatment and course of the disease
Psychogenic erectile dysfunction has a very variable course, accompanied by a weak or absent erection, while organic erectile dysfunction may not manifest immediately, but worsen over time and is never cured. The goal of erectile dysfunction treatment is to restore an erection sufficiently so that the patient and the sexual partner can lead a satisfactory sexual life. To this end, it is very important to correct and eliminate factors that can cause erectile dysfunction, for example, to change the lifestyle, treat concomitant diseases and take medications. It is advisable to first try to eliminate the cause through physical exercise, lifestyle changes and training, and then try medication for erectile dysfunction. If the first two attempts are not effective enough, surgical intervention should be considered.
| 1st stage | 2nd stage | 3rd stage |
| • Elimination of modifiable risk factors • Eliminate mental factors • Discontinuation or modification of concomitant medications. • Hormone replacement therapy | • The use of oral erection stimulants • Intracavernous injection • Penile inhalers | • Penile implants • Reconstruction of arteries |
Medical treatment includes oral medications for the treatment of erectile dysfunction, injectable medications for the treatment of erectile dysfunction and supplements to increase testosterone. Oral treatment of erectile dysfunction dilates peripheral blood vessels due to the inhibitory effect of phosphodiesterase type 5 (PDE5), causing an erection, and the effect manifests itself 1-2 hours after taking it. Injectable drugs for erectile dysfunction cause an erection by injecting a vasodilator into the penis, specialists should know how to inject the drug and what dosage to use. If the level of testosterone, a male hormone, in the blood is below normal, it is necessary to take supplements in parallel to increase testosterone.
Non-pharmaceutical treatments include vacuum compressors and surgery. A vacuum compressor is a device that maintains erection by increasing blood flow into the penis using a medical vacuum compressor and then tightening the penis roots with a compression band. It is not preferred by Korean patients because of the decreased sensation of the penis and the feeling of coldness, so the sale of the equipment has stopped. The effect is very effective and is used a lot by Western patients. If the previous treatments do not work, surgical treatments such as insertion surgery of the penis prosthesis can be performed.
