Men: how to keep your flag flying… high!

One in ten Greek men of all ages has difficulty, to a lesser or greater degree, keeping their… flag flying high. Erectile dysfunction is a condition with a significant impact on the quality of life of patients, of their partners and of their families.

What causes it? When should you see your doctor? Is there a treatment? The answers are in the article that follows.

What it is, how it develops and how it is treated

By erectile dysfunction we mean a man’s inability to achieve and/or maintain an erection sufficient for satisfactory sexual intercourse. It is a condition with a significant impact on the quality of life of patients, of their partners and of their families. According to the current medical literature, up to 20% of men will experience erectile dysfunction at some point in their lives.

An erection is, at its core, a vascular phenomenon. The chain of events involves impulses from the brain and the spinal cord, the release of muscle-relaxing substances within the corpora cavernosa (the erectile chambers) of the penis, and in turn an increase in blood flow into the penis and the achievement of an erection.

It is easy to see, then, that this is a complex process requiring the cooperation of several systems of the human body (nervous, muscular, vascular), and so damage at any point in the chain can affect the erection itself.

The aim of the urologist-andrologist is therefore to identify, through a very detailed medical history, where the problem lies and to focus on resolving it.

So what are the causes of erectile dysfunction?

They fall into 5 broad categories:

  • Vascular causes (problems achieving arterial filling of the penis, or failure of venous occlusion)
  • Neurogenic causes (Parkinson’s disease, stroke, multiple sclerosis, spinal cord injury)
  • Endocrine causes (diabetes mellitus, hypogonadism, thyroid disease, hyperprolactinaemia)
  • Medication-related dysfunction, and finally
  • Psychogenic causes, which are also the most common cause

The psychogenic causes of erectile dysfunction deserve particular attention, since up to 85% of cases are due to them, a proportion that is even higher among young men who develop the problem.

These causes include stress, fear of failure, depression, friction and tension in personal relationships, as well as cases of manic and compulsive personality (sexual coldness, perversion, psychotic behaviour).

In young, psychologically healthy men, then, the fear of and anxiety about succeeding play a very important role. It is worth pointing out that this is a situation that weighs particularly heavily on a young man, and it can reach the point of becoming an obsession, so that he avoids sexual intercourse for fear of “failing” again.

This condition is called performance anxiety. During intercourse the man turns all his attention to the quality of his erection rather than to his partner and to sexual stimulation, with the result that no erection occurs, or it is lost during intercourse.

So the urologist can very easily find himself taking on the role of a psychotherapist, trying to identify the root of the problem and giving the young man the courage to overcome his anxiety.

Quite often we will recommend a visit to a psychologist or psychiatrist, since it is easy to see that this speciality is able to help far more in these cases, and at some point the taboo around seeking psychological support has to be overcome.

So it seems that, where sex is concerned, men too are creatures of the mind, contrary to what many women would like to believe…

Treatment

In recent years there has been a great deal of talk about treating erectile dysfunction with the “magic” pills now on the market. It is true that they have revolutionised the treatment of the condition, and they are now the urologist’s first-line treatment option.

These medicines are phosphodiesterase type 5 (PDE5) inhibitors. They act within the penis and have an indirect muscle-relaxing effect.

In short, this means that sexual stimulation is needed for them to work: we do not take them and then, as if by magic and out of the blue, have an erection!

If the desired results are not achieved, there are intracavernosal (penile) injections, which were used before the pills appeared.

Another alternative, if drug treatment fails, is a vacuum erection device (pump).

The scene may sound comical, but these devices are a good alternative to try before moving on to surgical correction of the dysfunction. By creating negative pressure, they essentially cause the venous network to become occluded and produce an erection firm enough for penetration.

A constriction ring is placed at the base of the penis, which in turn prevents blood from draining back through the veins, and it is removed at the end of intercourse. The results are quite satisfactory, but a large proportion of patients give up the method after a while, as it causes bruising (haematomas) and can become quite painful.

More recently, a new method based on the application of shockwaves has been used in a few specialist centres to treat erectile dysfunction of vascular origin.

The shockwaves promise the formation of new blood vessels in the penis (neovascularisation) after a course of treatment lasting about 8-12 weeks. It remains to be seen whether this method can deliver the desired results and become a deliberate alternative option for the urologist.

The final solution is surgery. There are two kinds of operation: penile revascularisation surgery, which, however, is indicated only in cases of vascular injury, and the surgical implantation of the well-known penile prostheses.

For more information, do not hesitate to contact your urologist, who will guide you towards the right treatment for your problem.