What is it?
Erectile dysfunction, also known as male sexual impotence, is the persistent inability to achieve or maintain an erection that allows for satisfactory sexual intercourse.
It must be differentiated from other sexual problems, such as lack of desire, ejaculation disturbances (premature ejaculation, delayed ejaculation and absence of ejaculation) or disorders of orgasm.
Erectile dysfunction is not a disease, but a symptom. Manuel Girona de Francisco, from the Urology Service of the La Paz University Hospital, Madrid, points out that, in the absence of a psychogenic cause, it is “a symptom of an involvement of vessels and nerves responsible for the erection, whether due to smoking, diabetes, hypertension due to aging with age, sedentary lifestyle, overweight and obesity, etc. ” In fact, he stresses, ” cardiovascular disease is a major cause of erectile dysfunction.”
It is a frequent problem that, if left untreated, can affect relationships with partners, family, and the work and social environment.
Impotence or erectile dysfunction can originate from:
In these cases, the penis does not present any physical alteration, however, diseases such as anxiety (often caused by fear of not getting an erection or defrauding the woman), depression, problems with a partner and even stress they can affect the sexual act.
Also excessive concern about work, social or family problems means that the necessary attention is not devoted to the sexual act. Fatigue, loss of appetite, lack of exercise, insomnia, or job failure also imbalances sexual reflexes.
This type is very common. The penis cannot accumulate the blood necessary for an erection to occur, generally because it does not arrive in sufficient quantity. Smoking, high blood pressure, diabetes, some heart conditions and increased levels of cholesterol in the blood can cause vascular disorders that make erection difficult.
In these cases there is an interruption in the transfer of messages from the brain to the penis because there is an injury to the nerves involved. This occurs with spinal cord injuries, multiple sclerosis or after some surgical interventions on the pelvis.
They are rare. They are generally due to a lack of male sex hormones.
There are several medications that have the side effect of reducing the ability to have an erection. Among them are some drugs to treat hypertension, heart disease, and psychiatric disorders.
The main symptom of erectile dysfunction is a change in the quality of the erection, both in terms of stiffness and the ability to maintain an erection.
If impotence is caused by physical causes, one of the main indicators of the inability to have or maintain an erection when waking up in the morning.
On the other hand, if it is caused by psychological causes, impotence usually occurs during a specific period of time (while the stress situation lasts, for example). If it persists for more than three months, the patient should seek an urologist specialized in andrology.
The main measure that men should take into account to avoid the appearance of erectile dysfunction is the modification of the lifestyle to avoid any habit that negatively affects the arteries and veins, such as smoking, the consumption of alcohol and saturated fats, sedentary life and stress.
Currently, some experts establish the following classification to distinguish the different types of erectile dysfunction:
In order to make a correct diagnosis, the patient must undergo medical reviews to establish a good clinical history.
An interview with the affected person may reveal psychological factors involved in the erection disorder. It is essential to rule out depression, which is not always apparent. The Beck Depression Scale and the Savage Geriatric Depression Scale in the elderly are simple and easy to perform.
Personal relationships should also be analyzed to determine if there are conflicts or communication difficulties with the partner. An interview with the affected person’s sexual partner can reveal extremely important data.
On the other hand, there are currently several tests that help establish the diagnosis of erectile dysfunction. The specialists usually use mainly two: the IIEF (International Index of Erectile Function) or SHIM (Index of Sexual Health for Men), a reduced variant of the IIEF that consists of 5 questions and has high sensitivity and specificity. A score less than or equal to 21 demonstrates signs of erectile dysfunction.
The general medical evaluation should include a history of drug intake, alcohol, smoking, diabetes, hypertension and atherosclerosis, an examination of the external genitalia to rule out the presence of fibrous bands, and an evaluation of signs of vascular, hormonal or neurological diseases. .
Specialists recommend measuring testosterone levels, especially if impotence is associated with lack of desire.
Laboratory tests should include assessment of thyroid function. Determining lutein hormone can also be helpful, as it is difficult to diagnose hypogonadism based on testosterone values alone.
In the case of young patients with specific problems, it may be necessary to carry out more complex tests in addition to the physical examination, such as an overnight measurement-monitoring of the penis, the injection of drugs into the penis, or an echo – Doppler.
Determining vascular indices is especially beneficial for making a correct diagnosis, such as the penile pressure-brachial pressure index that indicates the risk of other more serious vascular disorders, even in asymptomatic patients.
When the cause is not clear, a nocturnal penile tumescence (NPT) test can be effective, although it does not usually work in elderly patients. NPT episodes are usually associated with REM sleep phases. The patient’s erections can be monitored in a special sleep laboratory; their absence is highly suggestive of an organic cause, although their presence does not necessarily indicate that they have valid erections during the day.