Erectile Dysfunction: Causes and Treatment

Symptoms

Erectile dysfunction or so-called erectile dysfunction refers to the persistent or recurrent inability to achieve or maintain an erection, which is necessary for sexual activity. This makes sexual intercourse impossible and severely limits sexual life. For the affected man, erectile dysfunction can be a great psychological burden. It can trigger stress, negatively affect self-esteem and cause mental illness.

Causes

The development of an erection depends on physical and psychological factors. The central and peripheral nervous systems, smooth muscle, hormones, erotic, tactile, and emotional stimuli, and blood vessels are involved. Diseases and risk factors that disrupt this system can lead to erectile dysfunction. Underlying causes of erectile dysfunction may include anatomic, vascular, neurologic, psychological, hormonal, iatrogenic, and medication. For example, cardiovascular disease, atherosclerosis, metabolic syndrome, high blood pressure, hyperglycemia, smoking, obesity, and dyslipidemia affect blood vessel and endothelial function. Diabetic neuropathy, multiple sclerosis, Parkinson’s disease and spinal cord injuries interfere with nerve conduction. In addition, there is a close relationship to benign prostate enlargement. Especially in younger men, the psyche plays an important role. Medications such as 5α-reductase inhibitors (finasteride and dutasteride), antiandrogens (e.g., bicalutamide and spironolactone), antihypertensives (e.g., beta blockers, diuretics), antidepressants, and neuroleptics (e.g., benzodiazepines) can also trigger erectile dysfunction. Intoxicant use (e.g., alcohol, nicotine, drugs) is among the risk factors. Finally, an important factor is the age of the affected person. With increasing age, erectile dysfunction may also be considered normal and physiological. Other causes:

  • Alzheimer’s disease
  • Surgeries, radiotherapy
  • Hyperthyroidism or hypothyroidism
  • Psychiatric diseases

Diagnosis

Diagnosis is made in medical treatment based on the patient’s history, with targeted questions (IIEF-5), with a physical examination, laboratory analysis and imaging techniques, among others.

Nonpharmacologic methods

Treatment should address the causes as much as possible. It should be noted that many men with erectile dysfunction are at higher risk for cardiovascular disease and should be treated accordingly, including nonpharmacologic measures.

  • Influencing known risk factors.
  • Physical activity
  • Psychological care in the case of a psychogenic revenge, counseling.
  • To stop smoking
  • Reduce excess weight
  • Maintain a healthy lifestyle and eat healthy food
  • Reduce intoxicant consumption (alcohol, nicotine, drugs).
  • In consultation with the doctor causing drugs discontinue or change.
  • Medical devices such as vacuum pumps and prostheses.

Drug treatment

Phosphodiesterase-5 inhibitors:

  • The best-known and most commonly used agents for the treatment of erectile dysfunction are the phosphodiesterase-5 inhibitors, such as sildenafil (Viagra, generic), tadalafil (Cialis, generic), and vardenafil (Levitra, generic). Their effects are based on inhibition of the enzyme phosphodiesterase 5 (PDE 5), which leads to an increase in cGMP, which plays an important role in the formation of erection. Depending on the active ingredient, the tablets are taken at least half an hour to an hour before sexual intercourse. The most common adverse effects include headache, visual disturbances, low blood pressure, dizziness, flushing, nasal congestion, and indigestion. Phosphodiesterase-5 inhibitors should not be combined with nitrates and related agents because this can cause a severe decrease in blood pressure.

Prostaglandins:

  • Alprostadil relaxes smooth muscle and dilates cavernous arteries, was leads to erection. The effects are due to binding to PGE receptors on smooth muscle cells. Unlike phosphodiesterase-5 inhibitors, the effect is independent of sexual stimulation.Alprostadil is injected into the penis, inserted into the urethra or applied as a cream to the penile opening.

Dopamine agonists:

Androgens:

Melanocortin receptor agonists:

  • Bremelanotide has shown erection-promoting properties in clinical trials, but has so far only been approved for women.

Dietary supplements: