Erectile dysfunction: causes, treatment and prevention

Erectile dysfunction is defined as the persistent inability to initiate or maintain an erection of sufficient quality to allow a satisfactory sexual relationship. Therefore, we talk about erectile dysfunction when either or both of the two conditions occur:

1. Lack of rigidity in the penis adequate to penetrate. 
2. Inability to maintain an erection long enough to end the sexual relationship satisfactorily.

Causes

Erectile dysfunction has a multifactorial origin. There are organic causes that are responsible for this lack of adequate penile rigidity in almost 80% of cases:

• Age: Erectile dysfunction is an age-dependent disease, that is, its incidence and prevalence is greater as the man reaches his birthday, but it should not be confused , as it often happens, as something normal of age.. Erectile dysfunction is always pathological regardless of the age of the patient. 
• Cardiovascular diseases: Nearly 70% of patients with angina or coronary disease have 2 or 3 years before erection problems. The cardiovascular risk could have been reduced in these patients before the first symptoms of coronary disease appeared, and therefore, erectile dysfunction can be a useful indicator of occult cardiovascular disease . 
• Diabetes: appears at younger ages and is more frequent in diabetic patients, besides being more difficult to treat. 
• Dyslipidemia: Hypercholesterolemia and hypertriglyceridemia. 
• Hypertension: Erectile dysfunction is associated with both hypertension and the use of antihypertensive drugs. 
• Toxic habits: Tobacco and excessive consumption of alcohol. 
• Adverse effects of drugs. 
• Neurological diseases. 
• Hormonal alterations with testosterone deficit. 
• Injuries or pelvic surgery.

Apart from these factors that we could call organic, there are also psychological factors that can cause difficulties for the male to reach an erection sufficient to penetrate or maintain it during the entire sexual relationship:

• Anxiety, relationship conflicts. 
• Social or labor problems. 
• Affective disorders. 
• Depression - Sexual inhibition. 
• Result of sexual preferences. 
• Fear of pregnancy. 
• Sexually transmitted diseases, Psychiatric diseases.

Who does erectile dysfunction usually affect?

Erectile dysfunction in Spain affects almost 20% of men between 20 and 75 years old , according to epidemiological investigations carried out in our country, but it can also affect younger men.

The frequency of this pathology increases progressively with age, reaching almost 50% of males over 60 years of age .

According to data published by the Spanish Association of Andrology, Sexual and Reproductive Medicine in 2013, of these patients only one third is diagnosed , and of this third only half is treated , therefore it is a very underdiagnosed and undertreated disease.

This is important since it has a very negative impact on the quality of life of both the patient and his partner. Erectile dysfunction causes embarrassment and anxiety and proper treatment improves the self-esteem of these patients, as well as the relationships in general and logically the sexual relationship.

Treatments

The treatment has evolved in recent times spectacular form. Currently, we can affirm that more than 95% of the cases , with any of the treatment modalities available, can recover an active and satisfactory sexual life .

In treatment it is carried out in a staggered way: first the risk factors present in the patient must be corrected (tobacco and alcohol consumption, dyslipidemia, overweight, diabetes, etc.). Then sexual counseling and education is carried out, taking into account the expectations and preferences of the patient and his partner when planning the treatment. When the cause is treatable we can cure the patient:

• Psycho / Sexotherapy. 
• Hormone treatment 
• Surgical treatment

This will allow the patient to recover erectile function without the need for chronic treatment. When this is not possible we have different stages of treatment:

• Oral Drugs : These are drugs with a level of efficacy greater than 80% that enhance the body's normal physiological erectile response. Despite "the fear that keeps waking up in patients", they have a high level of security.

They are only contraindicated in patients taking Nitrates, therefore, I include most patients with heart disease, can take them. There are different molecules in the market with different pharmacokinetic profile, so we must take into account what diseases the patient has and what their preferences and expectations are to prescribe one or the other, but I insist on their high level of efficacy and safety.

Another modality that can be considered as the first step in some patients are the vacuum devices that, drawing blood to the penis, allow its erection, although in Spain they are little used because of the rejection of most men.

In those patients who do not respond to this medication or have a contraindication to its use, we move to the second level:

• Injections of vasoactive substances : (Generally alprostadil) intracavernosum, is the only medically authorized. It is done through a local injection into the corpus cavernosum and the patient must be trained to self-inject.

Intraurethral Alprostadil: has the advantage of not needing autoinjection but has less efficacy than when intracavernosal is administered. 

1. Penile prosthesis : Only in cases where previous treatments fail. This measure has a high level of satisfaction for both the patient and his partner.

Preventive measures for erectile dysfunction

To prevent erectile dysfunction as effectively as possible, it is necessary to adopt the life and psychological habits that improve cardiovascular and general metabolic health. Sex education is also necessary, since having adequate sexual function information prevents false expectations.

In the case of taking medications, it may be necessary to change the dose or drugs that affect erectile function, always under medical supervision.