Erectile dysfunction: Medical treatment

Erectile dysfunction (impotence) and premature ejaculation are the two main symptoms in male sexual medicine. The new oral treatments have completely changed the diagnostic and the therapeutic approach of the two pathologies, offering highly effective solutions in all clinical situations.

Erection is a neuro-vascular phenomenon undergoing hormonal control. It consists of an arterial dilatation, relaxation of the trabeculated detrusor smooth muscle and the activation of the veno-occlusive mechanism of the corpora cavernosa.

Erectile dysfunction (ED) has been defined as the persistent inability to achieve and maintain an erection firm enough to allow a satisfactory sexual performance. Although ED is a benign disorder, it affects the physical and psychosocial health and has an important impact on the quality of life of those who suffer it, as well as their partners (and families).

Some recent epidemiological data has revealed the existence of a high prevalence and incidence of ED worldwide. For example, a large-scale MMAS study (Massachusetts Male Aging Study) reported a global prevalence of ED in 52% in non-institutionalized men from 40 to 70 years of age in the American region of Boston.

Medical treatment for erectile dysfunction

The main objective of the treatment strategy for patients with erectile dysfunction is to determine the etiology of the disease and to treat the cause and not just the symptoms. 

ED can be associated with modifiable or reversible factors, among them, factors related to life habits or medications. These factors can be modified before using specific treatments, or at the same time that they are used.

As a standard practice, the dysfunction can be successfully treated with current therapeutic options, but there is no cure. The only exceptions are psychogenic ED, post-traumatic erectile dysfunction in young patients and hormonal causes (for example, hypogonadism or hyperprolactinemia), which can be potentially cured with a specific treatment.

Among the therapeutic options there are drugs that are administered orally as phosphodiesterase type 5 (PDE5) inhibitors (sildenafil, vardenafil, tadalafil and avanafil). Depending on the demands of the patient, we will use the drug that best suits their needs. Another therapeutic option is to use vaso-active agents (alprostadil) that can be injected intra-cavernously or intra-abdominally. In some patients with hormonal disorders, such as hypogonadism, replacement therapy will be required for their treatment.

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