Erectile dysfunction (ED) is the inability to obtain or maintain an erection of the penis, which is sufficient to be able to have good sexual intercourse. Erectile dysfunctions are very common and can occur at any age. Their occurrence, however, increases with age and especially men over 60 years have to deal with it.
Erectile dysfunction may have a physical or mental cause, or a combination of both. The distinction is usually not difficult to discern.
- High blood pressure.
- High cholesterol.
- Neurological disorders (for example paraplegia and multiple sclerosis).
- Prostate disorders.
- Certain medications (for example some beta-blockers and antidepressants).
- Defects of the penis.
- Surgery or radiotherapy to the pelvis.
- Uncertainty and fear of failure.
- Competitive spirit.
- Tension and stress in everyday life.
- Relationship problems.
- Past traumatic (sexual) events.
Some men cannot have an erection at all, while in other men the penis becomes slightly stiffer, but not hard enough for penetration. In other cases, the erection can weaken during sexual intercourse. Some men have sometimes a normal erection and other times no erection at all. How the problems manifest themselves, depends entirely on the cause.
The doctor will first analyze the medical history and do a physical examination. To arrive at the diagnosis of erectile dysfunction, further examination can be done:
- Blood test to measure the content of testosterone, prolactin and thyroid hormone.
- With angiography (X-ray after injection of a contrast agent), blood circulation in the penis can be measured.
- An injection of papaverine may be given to see if there are any vascular disorders.
Mental causes can be examined by excluding physical causes. Therefore, a piece of perforated tape is applied around the penis at bedtime. When an erection is encountered at night, the tape tears, which is proof that there’s no physical cause for the erectile dysfunction.
The following treatment methods can be applied:
- Sometimes, psychotherapy is recommended.
- If erectile dysfunction is caused by specific drugs, the doctor will prescribe other drugs, if possible.
- If the testosterone blood content is too low, injections with testosterone are given.
- Any thyroid disorders are treated.
- Elevated prolactin levels are treated with bromocriptin.
- There are special devices for achieving an erection on the basis of a vacuum pump.
- Inflatable implants can be applied by surgery.
- Vascular surgery can be carried out to improve blood flow to the penis.
- By self-administered injections with papaverin, a vasodilator, an erection can be achieved. The doctor can teach this technique to the patient.
- Administration of a drug that stimulates the erection in men.
The ultimate success of medical treatment depends to a large extent on the expectations of the man and how he and his partner are able to adapt to the treatment.