Summary

Erectile dysfunction currently appears to be the most common sexual problem in men. The incidence of the disorder increases with age. The disorder significantly negatively affects both intimate cohabitation and the quality of life and self-confidence of the affected individual.

The basis for making a correct diagnosis in most cases is to make a correct history.

In the first step of treatment, any current pharmacotherapy of the patient, which may be related to the occurrence of the disorder, is adjusted. Phosphodiesterase inhibitors are then the most effective treatment in the next step. Alternative approaches to treatment include: intraurethral and intracavernous injection of Alprostadil, vacuum extractor and surgically implanted penile endoprosthesis.

In cases where the problem arises on a psychological basis, cognitive-behavioral or partner sex therapy can help solve erectile dysfunction.

Key words: Erectile dysfunction, pharmacotherapy of ED, surgical treatment of ED, prevention of ED

Perex

One of the most common sexual dysfunctions in men is male erectile dysfunction, or erectile dysfunction. According to current findings, it is clear that up to half of all men over the age of 40 have experienced this disorder.

The problem is not uncommon in the Czech Republic, where, according to some surveys, every second man over the age of 40 has reported erectile dysfunction. However, occasional erection problems are quite common, so there is no need to worry immediately about such an experience of making an immediate diagnosis of erectile dysfunction.

Modern approaches and treatment options as well as a positive effect on this function are commonly available.

What is erectile dysfunction or ED

Erectile dysfunction can be characterized in men as persistent difficulties in achieving and maintaining an erection (stiffness of the penis) for sufficient time to have sexual intercourse.

Symptoms of the disorder

The disorder is manifested by a violation of one of the three basic elements that determine the quality of an erection. It is an impairment of the ability to get an erection, an impairment of the erection of the penis or an impairment of the ability to maintain an erection. The specific symptoms may look like this: the individual is able to get an erection from time to time, but not always when he wants to have sex; the individual is able to achieve an erection but is unable to maintain it long enough for sexual intercourse to occur or is unable to achieve an erection almost never (1,8).

Causes of erectile dysfunction

We currently know of many causes that may be related to erectile dysfunction. It is often a multifactorial problem, which means that several factors are involved in the emergence, both in the field of physical and mental health (1,4).

Common common causes of erectile dysfunction include:

• cardiovascular disease
• high blood pressure,
• diabetes
• obesity,
• high blood cholesterol
• low testosterone
• kidney disease
• drug use,
• high alcohol consumption,
• smoking,
• Parkinson's disease,
• multiple sclerosis,
• tumor,
• injuries and surgeries in the small pelvis, penis and testicles.

In the field of mental health, erectile dysfunction leads to:

• significant stress,
• anxiety, depression,
• relationship problems,
• fear of intimacy and low self-esteem,
• sleep disorders.

The use of certain medications associated with the treatment of high blood pressure or certain mental disorders can also significantly affect the quality of an erection. It is important to know that although erectile dysfunction is more common at an older age, age itself is not the cause and the disorder occurs at virtually any age (1,4,8).

Diagnosis of erectile dysfunction

The diagnosis of the disorder in our conditions is most often performed by a medical doctor, a urologist or a medical doctor, a sexologist. Seek professional if any of the above symptoms occur. The examination includes a general medical and sexual history, including current symptoms of the disorder.

This is followed by a general examination of physical health and examination of the penis and testicles. If the doctor finds the cause of the disorder in one of the organ systems of the body, he starts the treatment directly himself or sends the patient to another specialist for treatment (4). In case of suspicion of the connection between the disorder and the disorder in the field of psyche, a suitable specialist is recommended, most often a psychiatrist, psychotherapist or psychologist with knowledge of the given issue (8).

Treatment of erectile dysfunction

The good news is that we currently have many treatments for this disorder. The treatment of erectile dysfunction depends on the identified causes of this disorder. It is most often based on the administration of special treatments affecting the symptoms or a therapeutic interview is used, or it is a combination of both approaches. Highly specialized surgical care is also possible.

Erection pills

The first step of therapy is mainly the adjustment of the patient's lifestyle with a possible modification of the current pharmacotherapy, which the individual uses in connection with another disease. The current main method of choice for the treatment of erectile dysfunction is, in particular, the administration of drugs that stimulate blood flow to the penis, hormonal treatment or the application of a vacuum pump (4).

Significant success in treatment was recorded especially with the application of the so-called 5 phosphodiesterase inhibitors. These are preparations:

• Viagra (sildenafil),
• Cialis (tadalafil),
• Levitra (vardenafil).

Other treatment options for the disorder

Alternative approaches to treatment are intraurethral and intracavernous injections of Alprostadil. In severe cases, a surgical approach with the introduction of a penile endoprosthesis is also possible. Vascular surgery procedures are rarely used. Acupuncture can also be used to solve problems. However, many erectile disorders have a mental background and the solution to the problem is based on specialized sex therapy (4,8).

How to improve erection and prevent erectile dysfunction

As part of the prevention of the disorder, it is possible to take the following steps, which are focused on a positive change in the field of a healthy lifestyle. These lead not only to the promotion of healthy erectile function, but also to the improvement of the overall health of the individual in general.

1. Regular body movement to influence and maintain a suitable body weight according to age.
2. Try to compile a quality healthy diet.
3. Try to eliminate stress, if the stress is severe or there is anxiety or a long-term drop in mood, seek professional help.
4. Reduce smoking or do not smoke better.
5. Limit alcohol intake.
6. Attend regular medical checkups! Be aware that your GP will monitor the values of all important bodily functions, such as blood pressure and cholesterol, and early detection of negative changes and treatment will help resolve conditions potentially leading to erectile dysfunction in a timely manner (1.4).

Conclusion

Erectile dysfunction is one of the most common sexual dysfunctions in men. The causes of this disorder are based on both the organic health of the individual and the mental. There are many treatments commonly available in our conditions.

The main treatment approaches include pharmacotherapy and surgery. In the case of a disorder due to psychological reasons, the method of choice is individual or couple sex therapy. The recommended suitable preventive approaches can significantly prevent the possible development of the disorder.

PhDr. Jana Müllerová, Ph.D.

Clinical psychotherapist
psychologicka-pomoc.eu

I am a certified psychotherapist, a member of the Czech Association for Psychotherapy and the European Section for Psychotherapy with deep knowledge in the field of psychology, sociology, philosophy and comprehensive rehabilitation of people, sexologist, supervisor and university teacher. I am also currently researching at 1st Faculty of Medicine, Charles University.