Symptoms and causes

Erectile Dysfunction

Erectile Dysfunction Symptoms

Some of the most common symptoms of erection problems are:

• Decreased erection rigidity: this is the basic symptom. Some men notice that their erection is not as rigid as it used to be. The partner tends to notice this decrease in rigidity later than the man. It usually corresponds to mild erectile dysfunction.
• Decreased duration of sexual intercourse: linked to the above, the man may notice that he is not able to maintain an erection for as long as he used to. It is usually indicative of mild to moderate erectile dysfunction. For this reason, some men report erectile dysfunction as premature ejaculation. Some studies suggest that treatment of erectile problems may lead to an increase in intercourse time, a phenomenon that could be caused either by an increase in penile rigidity or by a direct action of erectile drugs on sexual response and control over the timing of orgasm.
• Premature ejaculation: closely related to the previous one. In some cases, the man will subconsciously advance the moment of orgasm and may have the sensation of lack of control and premature ejaculation. This is known as secondary premature ejaculation. It corresponds to mild to moderate erectile dysfunction.
• Impossibility to penetrate: when there is insufficient rigidity to prevent penetration. Although desire, erection, ejaculation and orgasm are often associated, they are different phenomena. Therefore, it is possible that a man with erection problems and inability to penetrate can reach orgasm and ejaculate. When we reach this stage, it is moderate/severe erectile dysfunction.

Some men present typical symptoms or behaviors produced by the emotional response to erectile dysfunction, such as decreased sexual desire, anticipatory anxiety or the phenomenon of self-observation.

It is necessary to establish a climate of trust and communication to enable each man to express himself freely and to understand the symptoms. On the other hand, given the variety of terms and turns of language related to sex, it is important to understand the story exactly and to establish a clear clinical diagnosis where there is no confusion and to define the problem as precisely as possible.

Causes of Erectile Dysfunction

It is vital to identify the cause of the erection problem in order to opt for the best treatment to quickly and effectively solve erectile dysfunction. There are six main causes of erection problems:

• Psychological causes: this is the most common reason before the age of 50. It is characterized by fluctuating erections depending on the situation, sexual partner or mood. The main causes of this type of problem are external stressors, low sexual desire or performance anxiety.
• Vascular causes: this is the most common cause after the age of 50. It can be produced by all those diseases that favor arteriosclerosis (of the penile artery) such as smoking, sedentary lifestyle, obesity, hypertension, diabetes, hypercholesterolemia and prostate problems. A different type of vascular dysfunction is venous leakage, when the mechanism of "closure" of the corpora cavernosa fails.
• The consumption of medications: although there are many drugs that can cause erectile dysfunction, the three types of drugs that typically produce more problems are pills against high blood pressure (diuretics and beta-blockers), drugs to treat benign prostatic hyperplasia (5-alpha-reductase inhibitors such as finasteride and dutasteride) or advanced prostate cancer (enzalutamide, abiraterone, androgen blockade), and most antidepressants and neuroleptics (to treat anxiety, depression and schizophrenia).
• Neurological causes: diseases that prevent the nerves from correctly transmitting the information generated in the brain to the penile arteries cause sexual desire to exist but the penis does not respond to it. Diabetes, multiple sclerosis, spinal cord injuries and prostate problems are examples of this type of problem.
• Hormonal causes: mainly hypogonadism, which is the decrease of testosterone, sexual desire and levels of this hormone. It is closely related to some medications (morphine, corticosteroids) and metabolic syndrome (hypertension, diabetes, obesity, hypercholesterolemia).
• Penile causes: some serious diseases of the penis can cause penile malfunction. The main ones are Peyronie's disease (penile incurvation, which affects 5% of men) and penile fracture. In general, this is an important and difficult to treat erectile dysfunction.

It is important not only to understand the root cause of the problem but also its impact on the sexual life and quality of life of the man and his partner. Also, the urologist should know the preferences of each person and the types of treatments he would like to avoid.

Only in this way will it be possible to attack the origin of the problem in an efficient and sustainable way, improving the quality of sexual life with a treatment that fits that person and his or her scale of values.