How you can solve your erection
The European Association of Urology issued
updated guidelines on erectile dysfunction in 2006. These can be found
in European Urology, 49, pages 806 to 815.
The previously published guidelines for the
clinical consideration and treatment therapies for erectile dysfunction
were updated because of the scientific information accumulated since the
original guidelines were issued and the updated clinical practice such
as the administration of Viagra.
Other pages on this website about the diagnosis of erectile dysfunction and impotence
[ Home ] [ ED checklist ] [ The symptoms of ED ] [ Psychogenic or organic ED? ] [ Guidelines for the treatment of Erectile Dysfunction (1) ] [ Revised guidelines for the treatment of ED (2) ] [ Primary and secondary ED or erectile dysfunction ]
Other sections on erectile
[ Home ] [ Diagnosis of Erectile Dysfunction ] [ The Causes of Erectile Dysfunction ] [ Effects of Erectile Dysfunction On Men and Their Partners ] [ Treatment for Erectile Dysfunction ]
Such an update is particularly relevant in
view of the fact that a study of epidemiological reports suggest that
between 5 and 20% of men complain of moderate or severe erectile
In some ways, the risk factors for erectile
dysfunction are fairly well recognized. Smoking, hypertension,
atherosclerosis, and other conditions such as hyperlipidemia and pelvic
surgery are known to increase the chance of erectile dysfunction.
We also have clear evidence about
lifestyle factors and their impact on erectile issues. For example, in
the Massachusetts Male Aging Study, men who started physical activity in
their 40s and beyond showed a 70% reduction in risk for erectile
dysfunction compared to men who remained sedentary.
In addition, regular exercising showed that
erectile dysfunction could be significantly reduced in a longitudinal
study over a period of eight years.
Again, there is plenty of evidence to
suggest that reduction in body mass index and increase in physical
activity score correlated with lower levels of erectile dysfunction.
As far as the management of erectile
dysfunction is concerned, there are several implications in everyday
clinical practice. For one thing, the number of men who are seeking help
with these issues has increased due to the publicity around the
availability of effective and safe oral medications.
Nonetheless, certain aspects of medical
treatment remain the same: initially, a detailed medical history should
be taken, including specific attention to the presence or absence of
hypertension, myocardial disease, lipid levels, kidney function,
hypogonadism, and any neurological or emotional disorders.
As has been observed on several occasions in
the literature, the atmosphere in which the initial consultation is
conducted has major impact in creating a relaxed atmosphere which in
turn facilitates communication between the doctor, the man with ED, and
Only in such an environment would it be
possible to obtain detailed descriptions of such things as the number
and hardness of morning erections, whether erections develop in response
to masturbation, sexual arousal and ejaculation and the presence of any
other sexual dysfunctions.
Apparently, urinary tract symptoms and ED occur in
about half of men aged 50 years or over: fortunately, at this stage the
presence of ED is not necessarily an indication of diabetes and the other comorbidities such as hypertension, cardiac disease and
One of the problems here is that men over
the age of 50 are often required to undergo prostate surgery, and such
surgery is a well-established cause of ED.
Other factors known to be associated with ED
are chronic use of drugs, both legal and illegal, hypogonadism,
cardiovascular disease, and diabetes, among others.
investigation of the patient's condition, using the international index for
erectile function (IIEF), can be used to assess all aspects of sexual
function from development of erection, through sexual desire,
arousal, ejaculation, intercourse, and overall sexual and orgasmic
This document can also be helpful in
determining a specific treatment methodology and studying its impact.
If you are a man who is going for an
investigation of ED, you may expect that your doctor will give you a
complete physical examination with emphasis on the genitourinary,
and vascular systems.
Any condition that you are aware of such as
Peyronie's disease, prostatic enlargement, reduced sexual desire, or any
change in your health which may suggest that you're going through andropausal symptoms, should be reported to the doctor.
The cardiovascular system and sexual activity
As has been reported elsewhere on this
website, there is a high level of cardiovascular disease amongst men who
have sexual dysfunction and are seeking treatment for it. In general, we
know that sexual problems appear long before the potential cardiac
risks, so erectile dysfunction can be a useful indicator of forthcoming
What is of special interest to doctors
seeking to identify the correct treatment for ED are intermediate-risk
and high-risk men, two categories of patients that include (1) men whose
cardiac condition is uncertain or whose risk profile suggests that
further testing and evaluation should be undertaken, and (2) men whose
cardiac condition is either severe or unstable, to the extent sexual
activity may constitute a significant risk to health.
Indications for specific diagnostic tests are as follows:
primary erectile dysfunction which is not the result of some organic or
emotional disease or disorder
young men who have a history of pelvic or perineal trauma
men with penile deformities
men with complex psychosexual psychiatric problems
men with complicated endocrine dysfunction
The revised guidelines for the treatment of
ED suggest that the majority of men with ED can be managed within a
sexual care clinic, but the above situations suggest that specific
diagnostic testing may be required and this may take place outside the
environment of the clinic.
For example, nocturnal penile tumescence and
rigidity testing may be needed. This is a test to record any erection
that a man experiences during the night; any complete or partial
erection of at least 60% rigidity for a time equal to or greater than 10
minutes is considered to be an indication that the man's erectile
mechanism is functional.
Alternatively, an intracavernosal injection
that produces a rigid erection within 10 minutes, and which lasts for at least
30 minutes, also indicates a functional erectile mechanism, although in this
case there is less certainty that the man's erectile capacity is normal,
because such an erection can coexist with arterial insufficiency or a
problem in the mechanism of venal occlusion that prevents blood flowing
out of the penis.
In cases where there is doubt about the results of the
test or the diagnosis, ultrasound examination of the penile arteries can be
Men with conditions such as Peyronie's, congenital curvature
of the penis, or
hypospadias, may require surgery before treatment for
Treatment options for erectile dysfunction
The new guidelines suggest
that the primary goal of any treatment strategy for a man with ED is to
cure all the man's symptoms with a holistic approach. In other words,
treatment specifically for erection problems should be associated with lifestyle or
other changes to target modifiable or reversible factors.
treatment with drugs such as Viagra can be successful, it does not
necessarily cure the underlying problem, except possibly in cases where a
(young) man is
experiencing psychogenic erectile dysfunction or hormonally induced
erectile dysfunction that can be cured with specific treatments.
In other cases, testosterone deficiency may
be a cause of ED, or a contributory factor. Such a deficiency may be the result of primary testicular
failure or secondary testicular failure due to pituitary or hypothalamus
An excessive level of prolactin can be caused by a pituitary
In such cases, the advice of an endocrinologist is absolutely
For example, testosterone supplementation can be very
effective, but in some ways it is a last resort, and used only when other
possible endocrinological causes have been excluded. Men who receive
testosterone supplementation should also have a digital rectal
examination and a PSA test.
The revised guidelines suggest there is no reason
to avoid testosterone therapy if men have coronary artery disease and/or
a diagnosis of hypogonadism or erectile dysfunction. The only
aspect of the treatment that may be problematic is an increase in hematocrit. Unfortunately
however, testosterone supplementation, despite its
obvious benefits may not always cure erectile dysfunction.
For men who have significant psychological issues, an appropriate form
of psychosexual therapy and/or another therapeutic approach such as Viagra
may be necessary.