Synonyms
Potency disorder, impotence, medical: Erectile Dysfunction (ED)Drug therapy: The drug therapy of erectile dysfunction is administered (via the oral route) in tablet form. The substances used here are phosphodiesterase-5 inhibitors (PDE-5 inhibitors) with the active substance names Sildenafil (probably best known by the name Viagra) and its further developments Vardenafil (Levitra) and Tardalafil (Cialis). They have a specific penile vasodilator effect and thus enable an improvement in blood flow and thus erection in cases of vascular erectile dysfunction, provided that both the erectile tissue and the nerve tracts are functional and there is no isolated psychological cause.
The individually required dose can be determined empirically and can be adjusted again and again during the course of erectile dysfunction therapy. The positive effects can be seen both in the improvement of the quality and the duration of the erection, but a previously impossible erection cannot be reestablished. The tablets have to be taken on average half an hour before sexual intercourse, which naturally takes away some of the spontaneity.
Depending on the preparation, the duration of effect ranges from 4 hours (Viagra, Levitra) to 36 hours (Cialis). The latest therapeutic findings even show that long-term therapy with low-dose PDE-5 inhibitors, taken every day or every other day, can bring about a long-term improvement in vascular condition. Thus, in some cases, vascular impotence could be cured and patients were able to achieve an independent erection without medication after some time.
Possible side effects of the drugs may be: headache, indigestion, flushing, stuffy nose and dizziness. Regarding the undesirable side effects, there is a reduction in frequency compared to sildenafil and tardalafil or vardenafil. However, these drugs must not be used if nitrate or molsidomine-containing drugs such as nitroglycerin spray are taken at the same time, as there is a risk of a life-threatening drop in blood pressure.
PDE-5 inhibitors must also not be used in diseases that prohibit physical exertion, such as severe heart failure. If necessary, oral drug therapy can be combined with other options if there are other causes of impotence. Cavernous body autoinjection therapy (SKAT): The SKAT technique, which has been used to diagnose erectile dysfunction, can also be used to treat erectile dysfunction.
The man injects a substance that dilates the blood vessels into the erectile tissue, where it locally increases the diameter of the arteries and thus improves blood flow and erection. The substances used here are the same as in the SKAT test: first choice is prostaglandin (PGE1) called alprostadil; if there is no response, the opium alkaloid papaverine or the alpha-receptor blocker phentolamine can also be used. This form of therapy is attempted in men who do not respond adequately to the tablets or have contraindications to the active ingredients.
The success rate of the SKAT technique is 94% when used correctly. The disadvantages of this form of therapy are the possibly painful injection, which can be avoided by slow injection of the substance, and the risk of prolonged erection (priapism) (approx. 1%) or hematoma formation (approx.
8%). Hormone therapy: If the erectile dysfunction is due to a hormone deficiency, this can be remedied by substitution. If hypogonadism exists, testosterone is administered.
If the testosterone deficiency is due to an excessive prolactin level which suppresses testosterone production, this is treated by the dopamine agonist Cabergolin. Although the effects on erectile function per se are rather minor, the loss of libido associated with the disorder can be significantly reduced. Thus, there is an indirect improvement in potency, as sexual stimulability and the psychogenic component are improved, which in combination with pharmacological therapy leads to good results.
Surgical therapy: If there is a sole venous insufficiency in the penis, the additionally existing or excessively dilated vessels can be ligated (prevented) surgically. This ensures that the blood flowing into the erectile tissue can be better retained there, which increases the quality and duration of the erection.The success rate is initially 70%, but cannot be maintained well over the long term. Nevertheless, in suitable cases, this measure is definitely considered a therapeutic option.
Even a purely arterial erectile dysfunction can be treated surgically by re-dilating the narrowed feeding vessels. However, if the underlying disease, such as diabetes mellitus, is not treated, the success rate is very low. The long-term results are also rather moderate.
Technical aids: One possibility to provide technical assistance for a better erectile function is the use of a penile implant. This can be the last option to treat a severe erectile dysfunction that does not respond to medication or other therapies or that is caused by a damaged erectile tissue. This method may also be indicated in cases of nerve damage.
There are three variants of the implant: a one-piece rigid one (it consists of only one cylinder), a two-piece hydraulic one (it contains a pump in addition to two cylinders connected to each other) and a three-piece hydraulic one (it consists of an erectile tissue implant, a pump and a reservoir). The urologist inserts the cylinders into the cavernous bodies in a surgical procedure, which are then preserved. In the two-part version, the pump is implanted in one of the two scrotum sacs.
If the three-part variant is used, an additional fluid reservoir is attached behind the abdominal muscles in the lower abdomen. If the patient now actuates the pump in the scrotum by squeezing it several times, sterile saline is pumped from the lower end of the cylinders (two-part implant), or from the reservoir (three-part implant) into the cylinders, thus producing an erection that appears physiological from the outside. By pressing the pump for several seconds, the solution flows back into its reservoir and the penis relaxes.
In the rigid version, the cylinders always have the same strength and size, but can be bent flexibly. This means that the penis can be straightened up for sexual intercourse, but is still just as large and stiff in its normal state as it was at the time of the reproduced erection. The advantage of this variant is the comparatively small procedure and the lower costs.
Otherwise, the multi-part version, which is more flexible and more in tune with nature, is more suitable. The ability to orgasm and ejaculate should not be affected by this procedure, but may be temporarily impaired by it. The implants will last a lifetime, provided they are not infected or damaged.
Another technical aid, which is used externally, is the vacuum pump, also simply called a penis pump. The plastic cylinder is put over the flaccid penis and sealed at its base, then a vacuum is created inside it by pumping several times, which causes a passive influx of blood into the penis and thus an erection. This is maintained by means of a rubber ring that is put around the base of the penis shaft.
However, there is the risk of a painful erection or even ejaculation difficulties. In addition, compared to other therapy options, the application is rather unpleasant and somewhat difficult, which leads to a low acceptance by those affected. However, the effect of the vacuum pump can be improved by taking additional medication.
Sexual therapy/psychotherapy: Since a high percentage of erectile dysfunction is caused by psychological factors and organic causes due to emotional stress usually have a psychological component, psychotherapy or sex therapy is indicated in such cases. This can be done individually or together with the partner and aims to uncover and treat the mostly subconscious psychological causes of impotence. An advantage is the possibility to attack the cause of the problem, but this possibility is only taken up by a few affected persons, because erectile dysfunction is still a taboo subject nowadays and it is not easy for a man to open up to someone in this respect.