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April 2017
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Questions and answers

What it is and what causes it

Erectile dysfunctions: not just a problem for men
An erectile dysfunction is the persistent or reoccurring inability to get or maintain an erection during sexual intercourse.

Erection problems can be present every time a man has sex or just sometimes, for example, it can happen three times out of ten.
An erectile dysfunction triggers a vicious circle that causes sufferers to become anxious about their performance which, in turn, contributes to gradually aggravating the dysfunction itself and creating further frustration for both the individual and his partner.

The causes of an erectile dysfunction can be:

- Organic, that is, caused by a change to the anatomical structure or physiological functioning of the systems involved in the erection process. The most common organic causes are:

  • those affecting the vascular part of an erection: atherosclerosis of the arteries of the penis, life style factors, such as smoking, activeness, obesity, and/or chronic illnesses like hypertension, diabetes and hypercholesterolemia, which inhibits the increase in the blood flow needed to bring on and maintain an erection;
  • endocrine diseases and, in particular, a lack of testosterone;
  • neurological and psychological illnesses such as depression and traumatic injuries to the neural pathways that transport erective signals to the penis, for example, following a trauma of the spinal cord or operations on abdominal organs, such as the bladder, prostate, kidney or abdominal aorta;
  • psychogenic illnesses, that is, when there has been a psychological alteration that has affected the cognitive and emotional processes that guide an erection.

- In many cases both organic and psychogenic causes can coexist and, in this case, we talk about a mixed origin of erectile dysfunctions.

How to diagnose it

Diagnosis is necessary before proceeding with treatment.
In order to diagnose the causes of an erectile dysfunction, the patient’s medical and sexual history must be looked at because it contains precious information that makes up more than a quarter of the entire clinical picture that the urologist will look into. This may take quite a long time. Following this, other important information may be derived from a urological check-up which will involve examining the genital organs.

At this point, the specialist will be able to decide if specific assessments are necessary, which vary from patient to patient, and which can consist of questionnaires that will allow the specialist to gain more extensive and relevant information.

There is then the possibility of carrying out routine blood tests, such as those for glycaemia and cholesterol, and providing hormones like testosterone and prolactin.

Instrumental analyses can also be carried out to verify the anatomical and functional condition of the systems involved in an erection, the most relevant being the vascular system of the penis via a Doppler ultrasound. This exam allows the doctor to get precise information about the state of the arteries of the penis and their ability to manage arterial blood flow and get an erection.

There is a pill that can help

Today there is a pill available that may help sufferers have better sex.
Thanks to modern, scientific research, there is now a pill available that can help men to get back to normal erectile functioning. The more modern and efficient pharmacological remedies are called ‘phosphodiesterase type 5 inhibitors’, or PDE5i. They have revolutionised erectile dysfunction therapy because they are easy to take (orally) and because they are able to significantly improve erectile functions, both in terms of getting an erection and maintaining it. How do they work? Simple: by enhancing the effect of cyclic GMP, the main substance responsible for an erection. In fact, these drugs inhibit an enzyme that is made to destroy the cyclic GMP erection messenger, thus creating an increased concentration of it in the smooth muscle tissue of the penis. The result is a more efficient erectile mechanism.  

The names of these drugs are Sildenafil, Vardenafil and Tadalafil. From 1998 to today, millions of patients from all around the world have taken PDE5i, showing that these drugs are safe, even when taken regularly and for a long time, as long as the precautions and contraindications outlined on leaflet are followed. Taking this medication must be done under the guidance and control of a doctor, who will also work on all the causes responsible for the erectile dysfunction by helping the patient to correct his lifestyle (smoking, laziness) and by treating any associated illnesses (diabetes, hypertension, high cholesterol in the blood and hormonal changes).


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