Erectile dysfunction

| erectile dysfunction is defined as the inability to achieve sufficient penile rigidity both in quality (degree of hardness) and in quantity (time) to maintain sexual intercourse.

erectile dysfunction must be differentiated from others pathologies associated with sexual intercourse with anorgasmia, loss of libido, etc.

As seen in the previous section, erection depends on multiple factors. Any alteration in one of these factors can lead to erectile dysfunction. There are basically two types:

• erectile dysfunction of psychogenic origin.
• erectile dysfunction of organic origin.

In the psychogenic origin there is no alteration in the functions of the erection but the nervous system blocks some of the steps due to anxiety, stress, depression, bad relationship with the partner, etc.

In organic origin if there is any alteration at the hormonal, neurogenic or vascular level and secondarily there may be an associated psychogenic disorder due to not being able to get erections. The main cause is alteration of the vascular system, preventing the correct arrival or retention of. heart disease, hypertension, and diabetes are clearly associated with organic erectile dysfunction.

Mention aside are the causes of surgical origin. Prostate, bladder or rectal operated patients may have damaged nerves involved in erection and have erectile dysfunction as a result.

Diagnosis

The diagnosis is initially based on a correct medical history and physical examination, emphasizing the medical and surgical pathological history as well as mental health questions and relationships. Subsequently, blood tests and penile functionalism tests can be performed by injecting vasodilator substances directly into the penis to achieve an erection. This test may be accompanied by a penile ultrasound during injection.

When there are diagnostic doubts about the origin, a study can be performed that records erections during the night. If there are good quality erections at night, there are hardly any organic problems.

Treatment

The treatment of erectile dysfunction has changed a lot in recent years due to the arrival of drugs that are administered orally with very good efficacy. Its main action is based on an enzymatic inhibition that produces a powerful vasodilation allowing a better arrival of blood to the penis. The first to be marketed was viagra® and later levitra® and cialis®, which have improved the time of action of the drug. Patients with a history of nitrate treatment cannot take these drugs.

The therapeutic alternative is more aggressive because it is based on direct injection to the penis of vasodilator substances (prostaglandins, papaverine, phentolamine), with good efficacy. It requires prior learning for its injection in the correct place.

There are vacuum devices (vaccum) that allow an erection to be achieved not of such good quality, placing a constricting ring at the base of the penis that retains blood, preventing venous return and perpetuating the erection.

The surgical alternative It is reserved for selected cases, through the placement of a penile prosthesis. The prostheses are placed inside the corpora cavernosa. This prosthesis can be rigid (which keeps the penis constantly erect) or with a pump mechanism that makes it rigid when activated.

Some patients with very particular vascular deficits can benefit from vascular reconstruction surgeries.