Erectile dysfunction disorder

What is an erection disorder – known as erectile dysfunction disorder?

Erectile dysfunction disorder is a male sexual problem in which no erection can be achieved or maintained, over a period of at least six months.

Erectile dysfunction disorder can occur at any age, but its frequency increases with age. Only about 20 per cent of men aged between 40 and 49 are affected, whereas the figure rises to as much as about 50 per cent in men aged over 70.

Erectile dysfunction disorder is a serious disease that usually has physical causes. If it is caused by a circulatory disorder, erectile dysfunction disorder may even be a warning signal for the possibility of an impending heart attack. If nocturnal spontaneous erections occur at the same time, it is possible that the disorder has been triggered by psychological factors, such as stress.

Detailed diagnostics for patients with problems of erectile function are therefore extremely important and it is essential that they are carried out.

What are the causes and risks for the development of erectile dysfunction disorder?

There is a wide variety of potential causes of erectile dysfunction disorder: underlying physical diseases will be present in many cases; underlying mental illness, causes rooted in the nervous system or even anatomical abnormalities are also among the possible causes.

Diabetes and coronary artery disease are among the most common underlying physical diseases. In cases of diabetes, damage occurs to the blood vessels and nerves of the erectile tissue, while circulatory problems will usually be present with coronary heart disease. Erectile dysfunction persisting over any length of time may even be a warning signal for heart disease, because erectile dysfunction may develop about two years before a heart attack.

Between 20 and 80 per cent of men are affected by erectile dysfunction disorder after surgical removal of the prostate gland. Patients with disorders of the nervous system, such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, hormone disorders or nervous system disorders caused by alcohol abuse are similarly affected.

Another common cause is taking medicines, such as antihypertensives, antiandrogens, sedatives, neuroleptics or antiepileptics. All these medicines may cause erectile dysfunction disorder as a side effect.

In younger patients, erectile dysfunction disorder is psychological in origin in up to 30 per cent of cases: the result of depression, anxiety disorder or psychosis, for example.

What role does lifestyle play in erectile dysfunction disorder?

Lifestyle plays an important role. Individuals with a particularly healthy lifestyle are at a lower risk of developing erectile dysfunction disorder. Doctors recommend a healthy lifestyle that is generally considered to help prevent a large number of diseases.

A balanced diet is particularly important in this context. It should not contain too much fat or too much meat. Eating fruits and vegetables is particularly recommended. Fibre is also good. A diet on this basis will prevent the development of Type 2 diabetes which, in turn, reduces the risk of erectile dysfunction disorder.

The same applies to being overweight. Here, again, a balanced diet is helpful, as is exercise. Physical activity also strengthens the cardiovascular system. Alcohol and tobacco are definite risk factors for erectile dysfunction disorder and responsible use is recommended.

As erectile dysfunction disorder may also have mental causes, psychological pressures should also be avoided.  Reducing stress is regarded as a preventive measure: stress can encourage erectile dysfunction. This applies in particular to pressure related to sexual performance.

How is erectile dysfunction disorder diagnosed?

The doctor discusses with the patient the exact nature of the sexual problems and how long they do exist.

A clinical examination of reproductive function and disorders follows by laboratory tests in order to investigate the patient’s hormonal status and blood glucose levels.

Clinical diagnostics covers an ultrasound scan as well as measurements and records of nocturnal erections. In case of potency disorder this procedure allows to diagnose if the erectile dysfunction has a pychological or physical cause.

How is erectile dysfunction disorder treated?

If the findings are not serious and if there are no contraindications, the patient can be helped with a commonly used active substance. It increases the blood flow into the penis by expanding the blood vessels and this improves the capacity for erection. The abbreviated name of this active substance is a PDE5 inhibitor, which stands for phosphodiesteras-5 inhibitor.

If the PDE5 inhibitor is contraindicated or the therapy is not successful, the doctor will prescribe a topical treatment. Vasoactive substances may be administered via the urethra or a syringe and will have a positive effect on vascular tone.

If these treatment options do not work either or if they are contraindicated, a vacuum erection device may be used in combination with a constriction ring. The reduced pressure created by the vacuum results in increased blood flow into the erectile tissue and hence an erection. Once the penis is sufficiently erect a rubber ring is slipped over the base of the penis to prevent blood from draining out and the cylinder is then removed. After intercourse, the rubber ring is removed and the penis relaxes.

The final therapeutic option available is the surgical insertion of penile implants.