Erectile dysfunction (impotence)

Is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance. Most men have sporadically experienced some difficulty with their penis becoming hard or staying firm. Yet erectile dysfunction (ED) is only considered a concern if satisfactory sexual performance has been impossible on a number of occasions for some time.

Types of ED

• Organic Erectile Dysfunction (Impotence)- involves abnormalities of the penile arteries, veins, or both and is the most common cause of ED, especially in older men. When the problem is arterial, it is usually caused by arteriosclerosis.
• Psychological- anxiety, depression stress

In the past, erectile dysfunction was commonly believed to be caused by psychological problems. Now it is known that, for most men, erectile dysfunction is caused by physical problems, typically related to the blood supply of the penis.

What are the risk factors for erectile dysfunction?

Some of the direct risk factors for erectile dysfunction are:

• Vascular diseases, atherosclerosis
• Peyronie’s disease (development of fibrous scar tissue inside the penis that causes curved, painful erections)
• Prostate problems
• Diabetes type 2
• Obesity and metabolic syndrome
• Hypertension
• Low levels of HDL and high levels of blood cholesterol
• Priapism ( prolonged and painful erection)
• Neurogenic disorders
• Peyronie's disease and priapism
• Alcohol use and smoking
• Depression, anxiety, stress at home or work
• Inadequate interpersonal relationships and poor sexual techniques
• Hormone-induced ED : high prolactin, steroid abuse by bodybuilders, too much or too little thyroid hormone, low testosterone

Another problem is premature ejaculation- ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration. There are effective modern methods of treatment for this disorder.

How to diagnose erectile dysfunction (impotence) ?

Seek help if the erection problems keep happening.

The doctor will ask about your medical history and your lifestyle and relationship. It is possible that you will have to fill a questionnaire that indirectly determines index of erectile dysfunction. Then they will carry out with basic health checks and examining your genitals to rule out physical cause. Sometimes it is necessary to do the so-called “Erection test” when the doctor injects a substance into the penis which causes the pharmacological erection and determines the degree of erectile dysfunction. The doctor can order laboratory tests ( blood count, lipid status, hormonal status, glycaemia, prostate markers, etc.). If your symptoms include having to pee more often the doctor will have to examine your prostate.

It is a great mistake if a person suffering from erectile dysfunction suppresses this problem, or, as often happens, resorts to self-medication, usually by purchasing medicines of untested origin, with possible serious unintended consequences.

Intraoperative video AMS 700 demo prosthesis (clik to play)

How do you treat erectile dysfunction (impotence)?

Your doctor is going to base your treatment on your age, medical history, extent of the disease and expectations for the course of the disease. Your opinion and preference is also important. Non-invasive treatments are often tried first.

• Lifestyle changes: lose weight, stop smoking, diet, exercise daily, try to reduce stress and anxiety
• Medical treatments: the so-called 5 phosphodiesterase inhibitors have revolutionized the therapy for erectile dysfunction. (Sildenafil, Vardenafil, Tadalafil -Viagra and the other drugs from this group). A person suffering from erectile dysfunction should not take these medications alone considering the side effects.
• Injection therapy: Alprostadil (Caverject) is a medication that is injected directly into the penis by injection. In some patients there is a satisfactory effect with this treatment.
• Hormone replacement therapy: Testosterone replacement therapy can heighten sexual interest in older men who may have deficient levels of testosterone. Testosterone supplementation is not recommended for men who have normal testosterone levels for their age group due to the risk of prostate enlargement and other side effects. Testosterone replacement therapy is available, but needs to be closely monitored, as a cream or gel, topical solution, skin patch, injectable form and pellet form placed under the skin.
• Vacuum devices- are a mechanical way of producing an erection for men who do not want or cannot use drug treatments.
• Penile implants

Two types of implants are used to treat ED:

• Inflatable Penile Prosthesis- A pump and two cylinders are placed within the erection chambers of the penis, which causes an erection by releasing a saline solution; it can also remove the solution to deflate the penis. The most common prosthesis models are the AMS LGX 700 (manufacturer: Boston Scientific) and Titan (Coloplast). Inflatable implants make a normal looking erection and are natural for you and your partner. With the implant, men can control firmness and the size of the erection sometimes. Implants allow couples to be spontaneously intimate. This type of implant has extremely good results and in the developed world is the “gold standard” in the surgical treatment of erectile dysfunction.

• The surgery will be done under general or spinal anesthesia and will take an 1.5 hours. There are two approaches to insert the prosthesis, one is infrapubic and the other one is through the penoscrotal side of the penis. After the surgery You will be in the hospital for one or two days.
• After surgery: During the first two days after surgery you will have to rest. You will get pain medication and antibiotics. Your sutures will dissolve over time and do not need to be removed. The pump will be activated after 2 weeks and You will be taught how to manipulate with it. No sexual activity for 6 weeks after surgery.
• Semi-rigid Penile Prosthesis-two easy-to-bend rods, often made of silicone, give the man's penis firmness needed for sexual penetration. The Genesis model (Manufacturer : Colopast) and the AMS Spectra model ( Manufacturer : Boston Scientific) have shown excellent clinical results. The implant can be bent downward for peeing or upward for sex.

• The surgery will be done under general or spinal anesthesia and it will take an hour. One day after surgery you are allowed to go home. You will get pain medication to help with discomfort and antibiotics to prevent infection. Before resuming with sexual activities you will have to wait for 4 weeks after surgery.

Surgical implantation of penile implants can be considered in patients who have failed drug therapy or in those seeking a permanent solution. Penile implants are not considered as the first line of treatment for patients but they have a very high patient satisfaction rate and are excellent treatment choice in the appropriate patient. It should be emphasized that after implantation, the implants are not visible, that is, it is impossible to determine with the naked eye that a person has a penile implant.

Everybody has the right to a quality life

It is vital to communicate openly with your partner. The loss of erectile function can have a profound effect on a man. The good news is that erectile dysfunction can usually be treated safely and effectively.

Being uncomfortable talking about sexual health problems may prevent many patients from looking for the medical help they need, which can postpone diagnosis and treatment of more serious underlying conditions. Finding the cause(s) of your erectile dysfunction will help treat the problem and help with your overall well-being.