Erectile dysfunction (erectile impotence)

What is erectile dysfunction?

Doctors speak of erectile dysfunction when a man does not get an erection despite being sexually aroused or when this is not sufficient for sexual intercourse. Other words for erectile dysfunction are erectile dysfunction and erectile impotence. On average, five out of 100 men suffer from erectile dysfunction. The majority of them are older men. Potency problems occur much less frequently in younger men. The specialists responsible for potency problems are urologists.

Erectile dysfunction: causes and risk factors

There are various causes of erectile dysfunction, which often occur in combination. In younger men, stress and pressure to perform are often responsible for erectile dysfunction. Mental illnesses or the treatment thereof, such as depression, also reduce sexual interest and can cause potency problems. In most cases, however, erectile dysfunction is due to physical causes such as circulatory disorders, nerve diseases, nerve damage and hormonal disorders, sometimes also due to age.

Circulatory disorders are the most common causes of impotence

Circulatory disorders are most frequently responsible for potency problems in older men. In the case of circulatory disorders, the erectile tissue in the penis is not sufficiently filled with blood and the penis remains soft. There are essentially two possible “incidents”:

• Arterial circulatory disorder: Insufficient blood flows through the arteries into the blood vessels of the erectile tissue. Risk factors for an arterial circulatory disorder include metabolic diseases such as arteriosclerosis, diabetes mellitus or high blood pressure.
• Venous circulatory disorder: Normally, the veins in the penis act like valves. They close during an erection. The blood remains in the penis and it stiffens. In the case of a venous circulatory disorder, the blood flows out of the erectile tissue too quickly. A possible cause here is also elevated blood sugar.

Nervous disorders can also cause erectile dysfunction (H3)

An erection begins in the head, so to speak. The brain sends signals to the penis via nerve pathways. The nerve fibers located there release certain messenger substances during sexual arousal. As a result, the blood vessels in the erectile tissue dilate. If the signaling pathway from the brain to the penis is disturbed, the penis cannot stiffen or cannot stiffen sufficiently despite arousal.

Risk factors for a nerve disease are diabetes mellitus, alcohol addiction, stroke, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease or traumatic brain injury.

Impotence due to hormonal disorders is extremely rare

The male sex hormone testosterone and its regulation by other hormones play an important role in the development of an erection. Men with a testosterone deficiency have less desire for sex and are less likely to have an erection. An excess of prolactin can also cause erectile dysfunction. The hormone prolactin stimulates milk production in mothers. Certain diseases and medications also lead to increased production of prolactin in men – and therefore to potency problems.

Medication as a risk factor

Medications that can cause erectile dysfunction are:

• Antiandrogens
• Antidepressants
• Beta blockers
• Antihypertensives
• Anti-inflammatory
• Hair restorer
• Heart medication
• Gastrointestinal medications
• Medication for drainage
• Tranquilizer

Symptoms: Recognizing erectile dysfunction

In the case of erectile dysfunction, the male member does not stiffen sufficiently for sexual intercourse or the erection does not last. Some sufferers experience premature ejaculation (ejaculatio praecox) or delayed ejaculation (ejaculatio retarda).

Erectile dysfunction – diagnosis by a doctor

The doctor will ask you various questions about your medical history:

• How long have the erection problems existed?
• How does erectile dysfunction manifest itself?
• Are there situations in which these occur less or not at all?
• Are you taking certain medications?
• Do you have spontaneous nocturnal and/or morning erections? (Nocturnal and morning spontaneous erections speak against physical causes).
• Do you regularly drink alcohol and smoke?
• Do you have any previous illnesses (cardiovascular diseases, diabetes mellitus or neurological diseases)?
• Are there any injuries to the spine or pelvis?

You can prepare for the doctor’s consultation by making a note of any physical abnormalities and symptoms at home. Don’t be afraid to talk to your doctor about potency problems. He is familiar with the subject and handles it professionally.

How does the physical examination work?

The doctor may carry out various examinations as part of the diagnosis:

• Measurement of blood pressure: By measuring the blood pressure, the doctor can recognize whether there are circulatory disorders. To do this, he measures the blood pressure and pulse on the arms and legs.
• Palpation of the genitals: By palpating the external genitals and the prostate, the doctor can examine you for possible pathological changes and deformities. He can also test the reflexes in the area of the external genital organs and the anus to check the nerve status in the genital area.
• Blood test: A blood test can provide information about the hormone status, blood sugar level and blood lipid values. This should be carried out early in the morning and on an empty stomach.
• Color Doppler sonography: Color Doppler sonography is a special form of ultrasound examination. It measures the blood flow in the vessels of the penis.
• Cavernous body injection test (SKIT): During the cavernous body injection test, the doctor injects a male sex hormone into your penis, which triggers an erection. Based on the nature of the erection, the doctor can recognize whether the blood vessels in the penis are intact.
• Neurological examination procedures: Your doctor can use the neurological examination to clarify whether the nerves in your penis are capable of transmitting signals.

Erectile dysfunction: physical or psychological causes

If the doctor finds no evidence of a physical cause, he can refer you to a psychotherapist or a sex therapist. Together you can find out whether there may be psychological causes behind the erectile dysfunction. Therapy is possible alone and with a partner.

Erectile dysfunction: Prevention, early detection, prognosis

You can prevent potency problems by avoiding risk factors such as smoking and excessive alcohol consumption. Exercise regularly. This improves blood circulation. Sports such as cycling, running or swimming can prevent vascular damage.

It is also advisable not to put yourself and your partner under sexual pressure to perform. Do not hesitate to consult a doctor if you have potency problems. The earlier you start treatment, the better the chances of success. Erectile dysfunction can also be caused by other illnesses such as cardiovascular diseases, neurological diseases or diabetes mellitus, which need to be treated.

Erectile dysfunction: progression

Erectile dysfunction due to psychological causes disappears or improves when the conflict is overcome, the stress is reduced or the medication causing the erectile dysfunction is adjusted. Medication can help with physical triggers. If there is another disease behind the erectile dysfunction, the course of the disease depends on how it progresses. In any case, the earlier you start treatment, the better the chances of success.

Impotence: treatment with medication and aids

If there is a physical cause behind erectile dysfunction, then medication and other aids are available for treatment. Underlying diseases such as diabetes mellitus, which result in erectile dysfunction, must also be treated. Psychotherapy is recommended for psychological causes.

Viagra & Co. – sexual enhancers for impotence

Phosphodiesterase inhibitors (PDE inhibitors) improve blood flow to the penis and lower the threshold for achieving an erection. The products can cause various interactions and side effects and therefore require a prescription. A cardiological assessment is also advisable for patients with an increased risk of cardiovascular disease. PDE inhibitors are taken around 30-60 minutes before the planned sexual intercourse. They may only be taken once every 24 hours and a maximum of three times a week.

Possible side effects:

• Reddening of the skin with a feeling of heat
• Headache
• Dizziness
• Visual disturbances
• blocked nose

The active ingredient sildenafil in particular can lower blood pressure and enhance the effect of antihypertensive medication. Unstable coronary heart disease is a contraindication for therapy with phosphodiesterase inhibitors.

Cavernous body autoinjection therapy (SKAT)

If the effect of oral sexual enhancers is not sufficient, you can try erectile tissue autoinjection therapy (SKAT). In this method, the doctor injects an active substance into the erectile tissue of the penis to dilate the blood vessels. With a little practice, you can inject the product yourself. The medication works immediately and the injection usually leads to an erection lasting about an hour. The side effects are very minor when used properly, as it is only applied locally. If you administer the active substance yourself, you should undergo regular follow-up checks.

Caution: In rare cases, priapism may occur after the injection. This is a painful permanent erection that requires immediate emergency medical treatment. If left untreated, priapism can lead to fibrosis (hardening of the tissue) and permanent erectile dysfunction.

Transurethral therapy (MUSE)

Transurethral therapy (MUSE: Medical Urethral System for Erection) is also an option if oral medication does not lead to the desired results. In transurethral therapy, small “suppositories” containing active ingredients are applied into the urethra. These lead to an erection that lasts for around 70 to 80 minutes. Possible side effects:

• Drop in blood pressure
• Urethral injuries
• Headache
• Pain in the penis
• Pain during urination
• Dizzy spells and brief unconsciousness

Transurethral therapy is not advisable if the sexual partner is pregnant. This method is also not suitable for men with painful permanent erections, blood clotting disorders or urethritis.

Vacuum pumps

Vacuum pumps consist of a transparent plastic cylinder that can be connected to a hand pump via a hose. The pump generates a vacuum in the cylinder. The penis then fills with blood and stiffens. A rubber ring on the base of the penis prevents the blood from draining away again. The ring is removed after sexual intercourse.

Penile prosthesis (penile implant)

If medical and mechanical treatment methods fail, a penile prosthesis may be considered. With a penile prosthesis, the doctor inserts plastic implants into the corpus cavernosum during an operation. For example, hydraulic implants that fill with fluid are available. The fluid comes from a small fluid reservoir that the doctor inserts into the abdominal cavity. A pump ball is attached to the testicle, from which the man can pump the fluid from the reservoir into the implant.

Psychotherapy for erectile impotence

Stress, psychological strain, interpersonal conflicts or individual fear of failure can lead to impotence. In this case, psychotherapy may be useful. The doctor and patient decide together which form of therapy is suitable for the patient.

Non-prescription sexual enhancers

Quite a few men are reluctant to talk to their doctor about potency problems. That’s why they try over-the-counter sexual enhancers. The sexual enhancers available without a prescription include L-arginine, ginseng and homeopathic remedies such as Neradin.

Can L-arginine help with erectile dysfunction?

L-arginine is an amino acid that our body needs to form nitric oxide. Nitric oxide dilates the blood vessels. Whether the effect of L-arginine is sufficient to treat potency problems has not been proven. If you regularly consume nuts, pulses, soy and meat, you generally do not have to worry about an L-arginine deficiency.

Does ginseng help with potency problems?

Some studies suggest that extracts from ginseng root can help with erectile dysfunction. However, the scientific data is not sufficient for a clear recommendation. Caution: Ginseng can impair the effect of various medications. For this reason, ginseng must not be taken in combination with anticoagulants such as heparin, acetylsalicylic acid, phenprocoumon or evening primrose oil.

Do homeopathic remedies help with impotence?

In the case of homeopathic remedies, no effect beyond the placebo effect has been demonstrated to date.