Treatment

Erectile Dysfunction

Erectile Dysfunction Treatments

After identifying the cause of erectile dysfunction and understanding the patient's desires and expectations, the most appropriate treatment will be applied to match the patient's sex life to achieve positive, effective and long-lasting results.

The main treatments for erectile dysfunction are:

Lifestyle and risk factor modification

This is especially important in cases of arterial vascular erectile dysfunction and testosterone deficiency. An adequate diet, regular physical exercise and weight loss can normalize most erectile problems. In some studies, especially with men with obesity and diabetes, diet and physical exercise, and sometimes even bariatric surgery (surgery aimed at helping obese people to lose weight), managed to normalize erectile function without the need for medication. In the case of vascular problems - such as arteriosclerosis - or hormonal problems, lifestyle modification is a fundamental measure to prevent erectile problems from worsening.

Low intensity shock waves

It is a regenerative treatment, indicated in mild to moderate vascular erectile dysfunction, which produces blood vessel growth. This treatment for erectile dysfunction is performed in the doctor's office, without the need for admission or anesthesia, with a very low probability of complications (the most common is a minimal hematoma). Several sessions (4-8) are usually necessary to achieve results. Its efficacy is approximately 70%, but it loses efficacy in other types of erection problems or if the problem is not vascular.

Oral drugs

It is the most widely used alternative, since it improves erection regardless of the root cause of the problem. Chemically they are known as phosphodiesterase-5 inhibitors, commercially known as Viagra, and are usually used on demand (with a few exceptions). They are very safe and are up to 70% effective, although some men respond somewhat worse if they have diabetes, venous leakage or erectile dysfunction after prostatectomy. Currently, four such drugs are available: sildenafil, vardenafil, tadalafil and avanafil. They can be classified into short-acting phosphodiesterase-5 inhibitors (sildenafil, vardenafil and avanafil), with an action time of between 30 and 60 minutes and a duration of between 6 and 10 hours; and long-acting (tadalafil), which requires taking between 1 and 2 hours before sexual intercourse with an effect that lasts up to 36 hours.

Local treatment with alprostadil

A vasodilator drug that is applied directly to the penis in different ways. In Spain there are three presentations of this product, with an efficacy ranging from 50 to 90% of cases depending on the strategy and the type of erectile dysfunction.

• Cream: applied in the urinary meatus without introducing any cannula.
• Suppositories: they are applied inside the urethra with the help of a small device, thus increasing their effectiveness. The medication is absorbed into the tissue surrounding the urethra (corpus spongiosum) and transferred to the erectile chambers (corpora cavernosa) through small blood vessels. The erectile tissue relaxes and allows blood to pass through, producing the erection. It begins to act in the first 5 to 10 minutes and the effect lasts between 10 and 30 minutes. The erection may continue after ejaculation, but will subside within an hour, depending on the dosage indicated by the physician.
• Injection: this is the most effective non-surgical method. The medication is applied inside the corpora cavernosa.

Hormonal treatment

It is the most effective for erection problems caused by hypogonadism (a disorder affecting the testicles and ovaries). This treatment can be combined with the administration of other drugs. It is a very safe and effective supplementation, but results may take months to become apparent. There are two formulations of testosterone:

• Transdermal: the transdermal gel formulation is applied every morning to the shoulders and abdomen, and is the method of choice for initiating treatment.
• Injectable: after 3-6 months of treatment, and having ruled out the presence of side effects, we can switch to quarterly injectable treatment, which facilitates application.

Psychological therapy

Indicated for men with psychological erection problems. It also helps many men with long-standing organic problems who have developed a negative emotional response as a result. Its efficacy in psychological erection problems reaches 95%.

Penile prosthesis

It is the placement of a penile implant, a device that is implanted inside the corpora cavernosa in order to give the penis the ability to achieve and maintain rigidity. It is indicated in some cases of severe erection problems or when other treatments have failed. It is a very effective and safe surgery and the degree of patient satisfaction is very high.