Erectile dysfunctions

What is it?

Officially, an erectile dysfunction is the inability to obtain or maintain an erection for satisfactory sexual activity.

During sexual arousal, a substance (nitric oxide) is released from nerve endings and endothelial cells in the spongy erectile tissue, the corpus cavernosum of the penis. Because of this substance, the blood vessels that supply blood to the penis increase their flow rate, so more blood volume flows to the penis. This fills the erectile tissue of the penis with blood. Then, the blood drainage from the penis is cut off. The penis becomes and stays hard, erect.

Erectile dysfunction is very common. Approximately half of men over the age of 40 have erectile dysfunction to varying degrees. The frequency increases with age.

Which factors influence erectile dysfunction?

Many factors that can lead to erectile dysfunction are the same as the risk factors for general cardiovascular diseases:.

• too little exercise
• being overweight
• smoking
• high cholesterol

Some surgeries are often accompanied by erectile dysfunction:

• Operations in the lower abdomen with resection of the prostate, bladder or rectum
• Vascular procedures on the aorta, e.g. an aneurysm surgery
• Penis surgery

Traumatic factors:

• Fracture of the pelvis
• Penile fracture
• Spinal cord injury
• Radiotherapy on the lower abdomen

Certain medication:

• Anti-hypertensives
• Anti-depressants
• Anti-epileptics

Certain medical conditions:

Renal failure; diabetes mellitus; liver failure; alcoholism; thyroid problems; pituitary problems

Psychological factors:

Depression, (relational or professional) stress, anxiety, psychiatric issues

How is the diagnosis determined?

The doctor will first ask you about the duration and quality of your erections. He or she will also check whether morning or night erections are present and what happens in case of masturbation. In addition, the above risk factors will be asked about.

There will be a physical examination of the penis, scrotum (testicles), prostate and sometimes of the torso, blood vessels or anus.

This is followed by a blood test that measures sugar and fat levels, haemoglobin and the hormonal balance. This may be combined with a kidney, liver and thyroid test.

Treatment

First of all, the doctor tries to determine the likelihood of the erectile dysfunction being primarily due to psychological grounds or physical grounds.

If a primarily psychological cause is suspected, a visit to a sex therapist or psychologist is often suggested.

If primarily physical causes are suspected, an attempt will be made to correct them: for example, medication adjustment sometimes remedies the erectile problem. Most of the physical factors, however, cannot be corrected: the root of the problem cannot be remedied. In that case, only treatment with medication (sildenafil and similar pills) can be suggested. If this medication has an insufficient effect, or if it is poorly tolerated, one can opt for penile injections with a blood-vessel dilation substance. As a more far-reaching alternative, the surgical implantation of a plastic cylinder into the penis may also be considered. This cylinder can be ‘pumped up’ when an erection is required.

Latest publication date: 12/12/2023
Supervising author: Dr Ameye Filip