Impotence

 

What is erectile dysfunction?

Erectile dysfunction is when a sufficient erection of the penis for sexual intercourse cannot be achieved or maintained and if this condition persists for a period of at least 6 months. The probability to suffer from erectile dysfunction increases sharply with age.

 

How does an erection occur?

An erection is caused by the interplay of muscles, blood circulation and nerve impulses. The shaft of the penis is composed of three erectile tissues (corpus cavernosum / corpus spongiosum), which consist of muscle fibers and blood vessels. In flaccid state the muscle fibers are contracted pressing the blood arteries together and thus preventing the flow of too much blood into the corpora cavernosa. During sexual arousal, the brain sends stimulating neurotransmitters through the spinal cord to the muscle fibers to the penis. When the muscles relax, the arteries dilate and the corpora cavernosa fills up with blood, causing the penis to stiffen. Simultaneously the corpora cavernosa presses against the veins impeding the blood to flow out of the penis.

When sexual arousal decreases, the brain signalizes the muscle to tense again. The blood supply into the erectile tissue reduces, the remaining blood flows slowly out making the penis to relax. When nerve- and/or bloodstreams are damaged, caused e.g. by alcohol, nicotine or diabetes, this natural flow and the interplay of the mentioned factors are disturbed, an erectile dysfunction can evolve over time.

 

Causes of erectile dysfunction

The causes for an erectile dysfunction may not only be a physical but also a psychological reason. The most common causes for an erectile dysfunction are organic, only 20-40% are psychological. Nevertheless, both causes could presuppose each other. The most important organic causes are:

  • Circulatory disorders in the penile area – often associated with diabetes
  • High blood pressure and/or elevated cholesterol
  • Nerve damage
  • Hormonal problems and
  • Problems after surgery or genital injuries.

Psychological causes of erectile dysfunction are especially linked to stress, anxiety, depression and/or relationship problems. Various drugs such as medication for hypertension, antidepressants, etc., can cause an erectile dysfunction as well.

Diabetes und erectile dysfunction

35-75% of all diabetics suffer from erectile dysfunction. Diabetes harms blood and nerves, both important prerequisites for an erection.

Attention

Given that erectile dysfunctions can advert to unrecognized cardiovascular diseases (myocardial infarction, stroke, etc.) associated with circulatory disorders, this corresponding symptoms should be clarified by a specialist.

 

Conventional treatments

Medication-based treatments for erectile dysfunction

PDE-5 inhibitors

PDE-5 inhibitors are pharmaceutical agents that cause an enhanced and more effective dilation of blood vessels, which supply the corpora cavernosa with blood and thereby facilitating the formation of an erection. PDE-5 inhibitors are currently the first treatment option for erectile dysfunction and provoke, in about 70% of users, an erection. The inhibitors are not suitable for patients who suffer from severe cardiovascular disease or are taking medication for high blood pressure. Like all medicines, also PDE5 inhibitors have side effects; the most common include headache, indigestion, skin rash with flushing, muscle and back pain, dizziness and visual disturbances.

Cavernous body auto-injection therapy

Another way to restore the erectile function, even for patients who do not respond to therapy with PDE-5 inhibitors, is the cavernous body auto-injection therapy. The patient injects itself with a very thin needle a vasoactive substance directly into the corpora cavernosa and experiences within 5-10 minutes the stiffening of its penis.

 

Non-medication based treatments for erectile Dysfunction

Vacuum penile pump

A penis or vacuum pump is a plastic cylinder that is placed over the penis. By pumping, the air is drawn out of the container and a vacuum is created and thus has a negative pressure as result, which induces the blood to flow through the feeding vessels into the corpora cavernosa and generating an erection. After reaching the required reinforcement of the erection, the pump is removed and a constriction ring applied on the base of the penis, which prevents the blood to flow out from the corpora cavernosa and thus the decrease of the erection.

Penile implant / penile prosthesis

When all treatment options listed so far failed, a surgical implant of a penile prosthesis can influence the erectile function positively. There are malleable and hydraulically functioning models. The implantation of a penile prosthesis is irreversible. The penile tissues could have been severely damaged in such an engagement that, other future non-operative therapy methods will no longer be applicable.