Erectile dysfunction, impotence,
medical: Erectile dysfunction (ED)
Drug therapy: Drug therapy for erectile dysfunction takes place (via the mouthorally) in tablet form. The substances used here are phosphodiesterase 5 inhibitors (PDE-5 inhibitors) with the active ingredient name Sildenafil (probably best known by the name Viagra) and its further developments Vardenafil (Levitra) and Tardalafil (Cialis). They act specifically in the penis to expand vessels and thus enable an improvement in the blood flow and thus the erection in the case of vascular erectile dysfunction, provided that both the erectile tissue and the nerve tract are functional and there is no isolated psychological cause.
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The individually required dose can be determined empirically and can be adjusted again and again in the course of the erectile dysfunction therapy. The positive effects can be seen both in the improvement in the quality and in the duration of the erection, but an erection that was previously completely impossible cannot be re-generated.
The tablets have to be taken an average of half an hour before sexual intercourse, which of course takes away a little of the spontaneity. The duration of action extends from 4 hours depending on the preparation (Viagra, Levitra) after up to 36 hours (Cialis). The latest therapeutic findings even show that long-term therapy with low-dose PDE-5 inhibitors, which are taken every or every other day, can bring about a long-term improvement in the vascular condition. In this way, in some cases, vascular impotence could be cured and after some time the patients were able to achieve an independent erection again without medication.
Possible side effects of the drugs can be: a headache,Indigestion, Facial flush (Flush), nasal congestion and dizziness. With regard to the undesirable side effects, there is a reduction in the frequency in the comparison between sildenafil and tardalafil or vardenafil. However, these drugs must not be used if drugs containing nitrate or molsidomine are also taken, such as for example Nitroglycerin spray, as there is a risk of a life-threatening drop in blood pressure. Even with diseases that prohibit physical exertion, such as a heavy one Heart failure, PDE-5 inhibitors must not be used. If necessary, oral drug therapy can be combined with other options if there are other causes of impotence.
Cavernous autoinjection therapy (SKAT): The one hand to Diagnosis of erectile dysfunction perished SKAT technology can also be used to treat erectile dysfunction. The man squirts (injected) the vasodilating substance into the erectile tissue, where this then leads locally to an increase in the diameter of the arteries and thus to an improvement in blood flow and an erection. The substances used here are the same as those used for SKAT test: First choice is prostaglandin (PGE1) called alprostadil; if there is no response, that too can Opium alkaloid papaverine or the alpha receptor blocker Phentolamine to be used.
This form of therapy is attempted in men who do not respond adequately to the tablets or who have contraindications for the active ingredients.
The success rates of the SKAT technology are included when used correctly 94%. The disadvantages of this form of therapy are the possibly painful injection, which can be avoided by injecting the substance slowly, and the risk of a prolonged erection (Priapism) (approx. 1%) or the Hematoma formation (approx. 8%).
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Hormone therapy: If the erectile dysfunction is based on a hormone deficiency, this can be caused by the substitution be resolved. If there is an existing hypogonadism, testosterone administered. If the testosterone deficiency is due to a prolactin level that is too high, which suppresses testosterone production, this is treated by the dopamine agonist cabergoline.
The effects on erectile function are rather minor, but the loss of libido associated with the disorder can be significantly reduced. Thus, there is an indirect improvement in potency, since the sexual stimulability and the psychogenic component are improved, which in connection with pharmacological therapy leads to good results.
Operative therapy: If there is only venous insufficiency in the penis, the additional or excessively enlarged vessels can be surgically ligated (tied). This ensures that the flowing into the erectile tissue blood there can be better stowed, which increases the quality and duration of the erection. The success rate is initially at 70%but cannot be well maintained over the long term. Nevertheless, this measure is viewed as a therapeutic option in suitable cases.
Erectile dysfunction caused purely by the arteries can also be treated surgically by expanding the constricted supplying vessels again. However, if the underlying disease such as Diabetes mellitus not treated, the success rate is very low. The long-term results are also rather moderate.
Technical aids: One way to provide technical help for better erectile function is to use one Penile implant. This can be the last resort to treat severe erectile dysfunction that does not respond to medication or other therapies, or is caused by a damaged erectile tissue.
Even if the annoy this method can be indicated. There are three variants of the Implant:
A one-piece, rigid (it only consists of a cylinder), a two-part hydraulic (In addition to two interconnected cylinders, it also contains a pump) and a three-part hydraulic (it consists of an erectile tissue implant, a pump and a reservoir).
The urologist inserts the cylinders into the erectile tissue in an operation, which is then preserved. In the two-part variant, the pump is planted in one of the two scrotums. If the three-part variant is used, an additional liquid container is placed behind the Abdominal muscles attached in the lower abdomen.
If the patient now actuates the pump in the scrotum by squeezing it several times, sterile saline solution is released from the lower end of the cylinder (two-part implant), or from the reservoir (three-part implant) is pumped into the cylinders and thus creates an erection that appears from the outside like a physiological one. By pressing the pump for several seconds, the solution flows back into its container and the penis relaxes. In the rigid version, the cylinders always have the same strength and size, but can be bent flexibly. In this way, the penis can be straightened up for sexual intercourse, but is just as big and stiff in its normal state as at the time of the reproduced erection.
The advantage of this variant is the comparatively small intervention and the lower costs. Otherwise, the multi-part and therefore more flexible version, which is better based on nature, is more suitable. The ability to orgasm and ejaculation should not be influenced by this procedure, but it can be temporarily disturbed. The implants will last a lifetime provided they are not infected or damaged.
Another technical aid that is used externally is the Vacuum pump, too easy Penis pump called. The plastic cylinder is placed over the flaccid penis and sealed at its base, then a vacuum is generated inside it by repeated pumping, which results in a passive flow of blood into the penis and thus an erection. This is maintained with the help of a rubber ring that is placed around the base of the penis shaft. However, there is a risk of a painful erection or ejaculation difficulties. In addition, the application is rather unpleasant and somewhat difficult compared to other therapy options, which leads to a low level of acceptance among those affected. The effect of the vacuum pump can, however, be improved by taking additional medication.
Sex therapy / psychotherapy: Since a high proportion of erectile dysfunction is psychological and organic causes usually result in a psychological component due to the emotional burden, there is one in such cases psychotherapy, or sex therapy is indicated.
This can be done individually or with your partner and aims to uncover and treat the mostly subconscious psychological causes of impotence. One advantage is that it can attack the cause of the problem, but only a few people take advantage of this option because the Erectile dysfunction still a taboo subject these days and it is not easy for a man to open up to someone about it.
