What is erectile dysfunction?
Traditionally, this condition has been known as impotence, but the medical term is "Erectile Dysfunction (ED)". It involves a persistent inability to achieve or maintain a penile erection that is adequate for engaging in satisfactory sexual activity. Erectile dysfunction is very common; it is estimated that it affects half of all men aged between 40 and 70 to some degree. In the past this condition has been attributed to psychological problems, however, significant advances in this field have shown that 60% of erectile dysfunction cases are caused by organic problems, typically related to the supply of blood to the penis; 30% are caused by psychological issues; and in the other 10% of cases the cause is unknown or idiopathic.
- Type 2 diabetes
- Vascular diseases or surgery
- Chronic conditions like kidney failure
- Some medications
- Hypogonadism or low testosterone
- Endocrine system pathologies
- Persistent difficulty achieving or maintaining an erection.
- Insufficient rigidity of the penis.
- The time it takes to achieve an erection is longer than before.
- Morning erections are less rigid or non-existent.
At the Serrate & Ribal Institute of Urology, we consider the identification of risk factors to be essential for establishing a diagnosis that allows us to provide each patient with a personalised treatment that fits their needs. For this, our medical team will compile a basic clinical and sexual medicine history that will address:
- Sexual habits.
- Coital frequency.
- The patient’s relationship with their partner.
- Erection characteristics during sexual activity.
- Presence and characteristics of involuntary erections.
Presence and characteristics of involuntary erections.
General and specific physical genital examination is essential for the detection of potential morphological alterations such as areas of fibrosis in the corpora cavernosa, phimosis or atypical penile characteristics that may cause erectile dysfunction. An analysis will be used to rule out testosterone deficit syndrome.
The specific treatment that is used to treat erectile dysfunction will be determined by our medical team in accordance with the cause of the condition. Factors such as the patient's age, general health, and the degree to which the condition has progressed will be taken into consideration, alongside the provision of guidance on eliminating avoidable risk factors such as:
- Unhealthy dietary habits.
- Excessive alcohol consumption.
- Drug use..
There are currently various alternative therapeutic treatments for erectile dysfunction:
All sexual dysfunction will involve associated psychological alterations. In the case of erectile dysfunction, at the Serrate & Ribal Institute of Urology we try to reduce the patient’s anxiety or fear of failure during the development of a sexual relationship. In situations such as these, the brain can inhibit the physiological response—in this case, the rigidity of the penis—to sexual arousal. To do this we use innovative planned methods to re-educate sexual behaviour so the patient can learn to understand himself and take advantage of opportunities.
First-line treatments include drugs that inhibit phosphodiesterase 5—such as Sildenafil (Viagra), Tadalafil (Cialis) and Vardenafil (Levitra)—which naturally assist with erections in the presence of erotic stimuli. They have been shown to be highly effective, well tolerated and have few adverse effects provided that their administration is performed under medical supervision. Our specialists will individually define the medication type and optimal dose for each patient.
In cases where analysis shows that testosterone has decreased significantly, a treatment can be used to increase levels of this hormone. This is one of the drugs with the highest levels of effectiveness.
Other therapies are also available, such as vacuum constriction devices (VCDs) which cause a passive dilation of the corpora cavernosa of the penis, thereby facilitating an erection. The effectiveness of this technique is around 90% irrespective of the cause of the erectile dysfunction.
Treatment of the penis with shock waves has demonstrated improvement in the quality of erections. The application of ultrasound on the blood vessels of the penis can cause changes in the endothelium (the inner lining of the vessels) and improve blood flow to the penis during erections.
We offer an alternative technique for patients who do not respond to oral medications. This technique has a success rate of 85% and consists of intracavernosal injections of vasoactive substances which promote blood flow to the corpora cavernosa of the penis.
The surgical implantation of a penile prosthesis is an effective and satisfactory treatment for Erectile Dysfunction, although it is only considered for patients who have tried other treatments without success or who prefer to opt for a permanent solution to their problem. The surgery consists of placing biocompatible cylinders in each of the corpora cavernosa of the penis, these cylinders are able to produce sufficient rigidity for satisfactory sexual relations. Penile prostheses are classified in two groups: semi-rigid or malleable and inflatable or hydraulic.
- Semi-rigid or malleable prostheses consist of two cylinders of soft silicone that, when positioned in the corpora cavernosa, are able to restore penile erection. They can be manipulated by the patients themselves to orient the penis in three different positions: straight or elevated to engage in sexual relations, downwards for urination, or a normal or bent position.
- Inflatable or hydraulic prostheses can be comprised of two or three components. Those with two components consist of two flexible cylinders filled with sterile saline solution which are inserted into the corpora cavernosa and connected to a pump device that is implanted in the scrotum, the function of which is to act as a reservoir. An erection is achieved by squeezing the scrotal pump, which transfers the liquid from the reservoir to the cylinders. To empty the reservoirs and facilitate the softening of the penis, bending the cylinders downwards for a few seconds is all that is required, which causes the liquid to return to the reservoir. The three-component prostheses are the most sophisticated. They are also composed of two cylinders which are implanted in the corpora cavernosa, but with this type of prosthesis the pump is independent of the reservoir. The pump system is placed in the scrotum, while the reservoir is typically placed in the peritoneum or the lateral vesical space.
The urologist will determine which type of prosthesis each patient requires depending on their problem, lifestyle, age and the risks to their health.