What is Erectile Dysfunction?
With erectile dysfunction (erectile dysfunction), a man cannot achieve an erection sufficient for sexual intercourse. The penis does not harden or relax after a short time. However, if these problems persist for at least six months and occur in more than two-thirds of erection attempts, it is a disorder that requires treatment. If you only have occasional erection problems, this is completely normal.
The older a man is, the greater the risk of developing erectile dysfunction. There are many physical and psychological causes. In most cases, erectile dysfunction can be successfully treated with medication, mechanical assistance or psychotherapy.
Colloquially, erectile dysfunction is also called impotence. However, this is only one form of impotence. However, the term impotence also refers to infertility (impotentia generandi).
Causes of Erectile Dysfunction
Physical and psychological triggers can cause erectile dysfunction. If men suffer from physical strength problems, this can easily cause additional psychological problems.
Purely psychological causes are found mainly in young men. In addition to conflicts in relationships, stress, problems or anxiety disorders, depression is often associated with erectile dysfunction.
In men over 50, there are primarily physical causes that trigger erectile dysfunction.
Circulatory disorders
The blood flow to the penis is often disturbed and/or the penile muscle itself, whose vascular wall is very similar to the musculature, becomes diseased. The arteries that supply the penis "calcify" (arteriosclerosis). Due to calcification, there is not enough blood supply to the penis. Or the blood drains too fast from the veins. Or both. In any case, the amount of blood in the cavernous bodies of the penis is no longer sufficient for a satisfactory erection.
Various diseases that promote circulatory disorders also increase the risk of erectile dysfunction:
- Diabetes mellitus (diabetes)
- High blood pressure
- Dyslipidemia
Lifestyle also has a decisive influence: smoking, obesity, lack of exercise and an unbalanced and unhealthy diet put pressure on blood vessels and increase the likelihood of potency problems.
Testosterone deficiency
A sufficiently high level of the male sex hormone testosterone is an important prerequisite for a satisfactory erection. With age, the level of testosterone in the blood usually falls in men. Testosterone deficiency (hypogonadism) is not necessarily present in the disease, but can lead to erection problems. Therefore, low testosterone levels should be considered as a possible cause.
Side effect of medication
Medications, including beta-blockers for high blood pressure, dehydration medications, lipid-lowering medications or medications for depression, can cause erectile dysfunction as a side effect. If there is a relevant note in the instructions for use and it is suspected that the drug may trigger erectile dysfunction, patients should consult their doctor. A different medicine may be prescribed. Caution: Do not stop or change the medicine on your own!
Other causes
For an erection to occur, not only the blood flow to the penis needs to be right. All the nerve pathways involved - from the penis to the spinal cord to the brain - must also be intact.
Herniated discs, injuries, radiation or operations in the pelvic area or spinal cord can cause erectile dysfunction. Likewise, diseases that can damage peripheral nerves (neuropathy) - such as diabetes mellitus (diabetes) or chronic alcohol abuse.
Other possible causes of erectile dysfunction are diseases affecting the central nervous system: for example multiple sclerosis, Parkinson's disease, Alzheimer's dementia or stroke.
Obstructive sleep apnea may also be associated with erectile dysfunction. Serious illnesses - such as cancer, severe kidney or liver disease - can also impair sexual potency.
Symptoms of Erectile Dysfunction
With erectile dysfunction, a man is unable to achieve or maintain an erection sufficient for sexual intercourse. If the penis does not harden sufficiently and/or softens rapidly, the disease may be present. Problems last at least six months and occur in more than two thirds of cases.
Signs indicating physical causes:
- Erectile dysfunction develops gradually.
- It occurs both in intercourse with a partner and in masturbation.
- There are no normal erections during sleep that occur in every healthy man.
Signs indicating psychological causes:
- Erectile dysfunction occurs suddenly, possibly after stressful life events.
- Erectile dysfunction usually only occurs in certain situations
- The patient is less than 50 years old.
Treatment Methods for Erectile Dysfunction
If possible, the doctor will eliminate the specific cause of erectile dysfunction - for example, prescribing a different medication if the erectile dysfunction is caused by a medication side effect. (Attention: Never leave or change medicines on your own!)
In most cases, only the symptoms of erectile dysfunction can be treated. There are different options here. What helps best in individual cases is an individual decision, which should be made after detailed medical advice about possible side effects and risks.
Compensating for testosterone deficiency
With increasing age, the level of testosterone in the blood drops somewhat in almost all men. This is not unusual and is not a reason for therapy. However, if a man suffers from erection problems, testosterone deficiency (hypogonadism) can play a decisive role. In this case, your doctor may advise you to correct the hormone deficiency. This can already improve potency problems. Drugs against erectile dysfunction (PDE-5 inhibitors) are generally very effective in treating the disease.
When it makes sense to administer hormones should be decided individually in consultation with a doctor. Testosterone is injected into the skin as a gel or, at longer intervals, into the muscle.
Initially, research seemed to indicate that testosterone therapy could potentially increase the risk of prostate cancer or heart attack. However, recent research has shown that medically indicated and monitored testosterone replacement therapy does not increase the risk of prostate cancer or promote heart attack. However, those affected should inform themselves in detail about the possible advantages and disadvantages of the treatment in the medical consultation.
Medicines Phosphodiesterase-5 Inhibitors (PDE-5 Inhibitors)
In Turkey, several phosphodiesterase-5 inhibitors (PDE-5 inhibitors) are approved for the treatment of erectile dysfunction. The first was Sildenafil, which entered the market in 1998. Tadalafil, Vardenafil and Avanafil followed. It all requires a prescription. The effect and side effects are roughly comparable. The tablets help around 70 to 80 percent of those affected and differ mainly in dosage and duration of action. Sildenafil, vardenafil and avanafil take about 15 to 60 minutes to start working (sildenafil and vardenafil may take longer to work after high-fat meals). The effect lasts for about four hours. Tadalafil works after about 30 minutes for about 24 to 36 hours. This medicine can also be prescribed as a maintenance medicine with one tablet a day.
PDE5 inhibitors only work when the man is sexually aroused. So they don't increase desire. The erection - without medication - ends with orgasm or ejaculation. However, further erections are possible within the duration of action.
Possible side effects include headache, facial flushing, heartburn, nasal congestion, temporary changes in color vision with sildenafil and vardenafil, and muscle and back pain with tadalafil. Detailed information can be found in the package leaflet.
