8 March 2019 Author: Bruno Graça Erectile dysfunction is a male sexual dysfunction characterised by a persistent inability to achieve or maintain a penile erection allowing satisfactory sexual performance. Who can suffer from erectile dysfunction? It is more common in older men, but can occur at any age. A study in Portugal has shown that 50% of men aged between 40 and 70 have experienced some degree of erectile dysfunction. This percentage can reach 85% over the age of 75. Erectile dysfunction has been recognised as substantially reducing quality of life, both for the patient and his partner. What are the causes of erectile dysfunction? A penile erection is the result of a neurovascular phenomenon that occurs under the right hormonal and psychological circumstances. All the systems involved must therefore be in full anatomical working order. Developing and maintaining a normal erection require activation of neurological pathways that: Relax the trabecular smooth muscle; Increase the blood flow in the corpus cavernosum (through the cavernous arteries); Reduce venous return by collapsing veins and thus allowing erection. These neurological pathways are activated by the brain via different tactile and visual stimuli, among others. They are also modified by psychological stimuli such as sexual desire and the hormonal environment, such as testosterone . Changes in any of the factors leading to an erection can result in erectile dysfunction. The main causes of erectile are: Psychogenic – e.g. anxiety or depression; Vascular – e.g. obstruction of the cavernous arteries; Neurological – e.g. surgical section of the cavernous nerves; Anatomical – e.g. severe curvature of the penis; Hormonal – e.g. a low testosterone level; Drug-induced – e.g. drugs for high blood pressure and for depression; Mix - e.g. both vacular and psychogenic. What are the risk factors for erectile dysfunction? The following are risk factors for erectile dysfunction: Aging; Obesity; Diabetes mellitus; Dyslipidaemia; High blood pressure; Smoking; Sedentary lifestyle; Cardiovascular disease; Some medicines. How is erectile dysfunction diagnosed? Diagnostic assessment begins with a complete psychosexual history . This includes: A description of sexual habits; Onset and duration of dysfunction; Previous treatments; Results achieved. Self-report questionnaires may be used, e.g. international index of erectile function (IIEF). It is necessary to distinguish between circumstantial (e.g. with only a certain type of stimulation) or general (in all situations) erectile dysfunction. Diagnostic procedures include assessing the patient’s exercise tolerance for a possible subsequent cardiac evaluation and correction of risk factors. The most common lab tests are: Determination of total testosterone; Determination of blood sugar; Determination of lipids profile. Other possible diagnostic exams are: Injection of a vasodilator into the penis; A eco-doppler ultrasound exam of the cavernous arteries. How is erectile dysfunction treated? In most cases, erectile dysfunction can be treated effectively , though without a permanent cure. The patient will be asked to make lifestyle changes , including regular physical exercise and giving up smoking. Existing conditions that may affect the nerves and blood vessels in the penis (e.g. dyslipidaemia and diabetes mellitus) must also be controlled . The patient’s partner should preferably be involved in the treatment in order to increase the couple’s compliance, satisfaction and involvement. Possible treatments for erectile dysfunction: The front-line pharmacological treatment consists of oral drugs , which have a high success rate. Second-line treatments consist of more invasive, less convenient methods , such as: A vacuum constriction device; Injection of a vasodilator into the penis; A urethral suppository or cream. Last line treatment consists of a penile prosthesis , which results in an artificial erection strong enough for penetration and control of the duration of intercourse. In some cases, experimental treatment with low intensity shock waves can also be effective. In summary The fact that sexual dysfunction is regarded as taboo for the patient, within the relationship and for the family physician means the problem is under-diagnosed and left untreated. However, these days there are a number of effective treatments available. There is also increasingly substantial evidence that erectile dysfunction may be a marker for coronary disease and peripheral vascular disease. This may be an a sign of non diagnosed cardiovascular disease. More about the urology service medical team at Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
