What is erectile dysfunction and how to treat it?

Erectile dysfunction (ED) or previously impotence, it is an erection dysfunction in which in arousal, the volume of a man’s penis and its hardness are insufficient for complete sexual intercourse.

The term “impotence” means the inability of a man to insert the penis in any form of penetrative sex and finish the coitus due to lack or disappearance of the sufficient tension on the penis. However, the term is no longer used because it is considered outdated, inaccurate and unreasonably condemning. Instead, the trouble with obtaining and maintaining an erection throughout intercourse is called erectile dysfunction or violation of erection.

Erectile dysfunction isn’t directly related to the ability of a man for ejaculation. There are multiple reasons for erectile dysfunction, for instance, diabetes. Some of the causes are reversible and some are not.

Starting from the middle ages, medical practitioners and pharmacists tried to develop means for erectile dysfunction treatment. However, the breakthrough happened only in the mid-1990s with the discovery of new features of drugs used for other health conditions. For instance, the substance called Sildenafil was initially tested for the treatment of angina and ischemic heart disease but it occurred that its effect is minimal on the blood circulation in the heart but is significant on the blood inflow of the pelvic area (including penis). Currently, this substance is manufactured and sold by multiple companies around the world with the most known name being Viagra. Besides, the discovery of such features of Sildenafil inspired researchers to start paying attention to other substances with possibly the same properties. Eventually, several substances have been discovered and approved. One of the most successful alternatives to Sildenafil that can be even used in lower dosages and provide a longer-lasting effect is Tadalafil, known in the U.S. mostly as Cialis.

What can cause erectile dysfunction?

Usually, sexual dysfunctions develop as a result of underlying conditions. Erectile dysfunction can occur as a result of endocrine disorders, for instance, diabetes (it causes neuropathy, damage to one or more peripheral nerves), hypogonadism (low testosterone due to dysfunction of the pituitary gland or testicular function), due to an injury of the spine, urological diseases, damage of the cerebral cortex, and in other conditions. Problems with erection caused by these conditions are identified as organic.

An often reason for the development of ED is when intercourse is painful for one of the partners as it can result in fear of intimacy and subsequent problems with erection.

However, in the majority of cases, especially in younger men, erectile dysfunction related to neuropsychiatric disorders (neurosis, bipolar disorder, depression, generalized anxiety, etc.). This is the so-called psychogenic erectile dysfunction.

Erectile dysfunction can also develop as a result of the use of various medications, for instance, drugs for hypertension, psychotropic drugs that suppress the central nervous system, some estrogens, anti-cancer drugs, and others. Organic and psychogenic impotence manifest themselves in different ways.

How is erectile dysfunction treated?

For effective treatment, it is first of all important to find the underlying reason for ED. You can refer to the table provided above to check your symptoms and even before going to a doctor understand with what kind of ED you are dealing with. However, we would still advise you to undergo a general checkup even if you think that most likely you have psychogenic ED.

In pronouncedly manifested mental disorders, it is advised to go for psychotherapy which can be used as a monotherapy or in combination with other methods, for instance, popular ED drugs such as Cialis.

In young men (younger than 40 years) with a long-lasting primary ED, a psychiatrist examination may be effective even before conducting any research for the presence of organic disorders.

The treatment options for ED include:

- Psychotherapy. It is especially relevant for young men.

- Use of erectile dysfunction drugs such as Cialis (Tadalafil), Viagra (Sildenafil), Levitra (Vardenafil), and their generic versions. Keep in mind that these drugs are not a cure. They help most men achieve and maintain an erection for a set period of time so they are used before anticipated intercourse only and not on a daily basis.

- Lifestyle changes, for instance quitting smoking and consuming alcohol, eat healthily, and do physical exercises. This helps with the potential causes of ED in the long run. - Injections into the cavernous body of the penis (papaverine, alprostadil, etc.);

- Vacuum devices for pumping blood into the penis before intercourse.

- Surgery on the vessels of the penis aimed to lower the venous blood outflow or increase the inflow of the arterial blood in the penis. This procedure is invasive but has an effect for only 1-2 years. Besides, it is not suitable for everyone.

If none of the listed techniques are effective, penile prostheses can be used. This method is advised for men with organic causes of ED when the treatment of the underlying condition doesn’t provide sufficient results and the use of erection-promoting medicines is also ineffective or unsuitable for some reason. It is an invasive procedure that causes certain discomfort but the restoration of sexual function occurs in 95% of men.