"Sexual health is a state of physical, emotional, mental and social health related to sexuality, and is therefore an integral component of this". "It is inherent to the entire body and is one of the areas that sustains the human being, a fundamental right and is beneficial to human health. It is influenced by biological, cultural, ethical, historical, economical, political, legal, religious and spiritual factors".
(Dr. Rafael Prieto Castro. Guías de actuación en Salud Sexual)
Nowadays, the term 'erectile dysfunction' is used in preference to 'impotency', because it focuses on the problem rather than being a derogatory term.
It is considered a public health problem all around the world and is also indicator of health, in other words it can be one of the signs of more serious disease.
There are thought to be between 1.5 and 2 million men in Spain, aged 25 and 70, suffering from some degree of erectile dysfunction.
Erectile dysfunction can be organic or psychogenic. An interview with the patient can be very helpful to uncover its origin, but this requires good communicatio between patient and doctor.
Some of the characteristics of the ED give clues to its origin: When the origin is organic, the onset is usually progressive; if it is acute, its relationship with determining factors tends to be clear; nocturnal erections do not occur, i appears after the age of sixty years, orgasm and ejaculation are normal and there are risk factors for ED. When the ED is of pyschogenic origin, it appears suddenly for no apparent reason or when there are relationship problems. It tends to affect young people, orgasm and ejaculation can be affected and there are no evident risk factors.
Generally speaking, for the erection mechanism to work correctly, there must be some kind of stimulus that activates the physiological erection mechanism, for which good functioning requires neurological and cardiovascular systems. Psychological conditions (that affect simulation) or which interfere with the neurovascular erection mechanism, can lead to erectile dusfunction.
On the other hand, erectile problems may be a sign of more neurovascular problems that are more severe the erectile dysfunction itself.
To determine the treatment, good information and sex education are necessary, with patient's partner taking part in both diagnosis and treatment.
From a pharmacological point of view, since the so-called phosphodiesterase type 5 inhibitors (PDE5Is) appeared, the treatment of ED has changed radically, because the percentage of therapeutic success varies between 75% and 85%. The treatment to be used is evaluated and selected togetjer by the patient and doctor, who will offer information about the specific charcteristics of each of the drugs.
Other treatment options are constriction rings and vacuum systems. Both may cause penile erosions or ulcers.
Treatment with vasoactive substances (Postglandin E1) are injected into the cavernous bodies. Patients must be trained to inject themselves and their partners can also be taught to administer the injection and individually adjusted doses. There are other substances that can be injected into the cavernous bodies or through the urethra, but they are not yet marketed and require pharmaceutical formulation.
When these treatments fail, there are several models of penile prothesis that can be implanted.
To summerise, ED is a common problem that has a significantly damaging effect on quality of life and wich can be part of and a sign of a more serious disease. There are numerous causes and treatment options.
Dr. Luís Pérez Llorca – Urology Specialist
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