What Are the Different Treatments for Erectile Dysfunction?

Erectile dysfunction (ED) is the most common type of male sexual dysfunction, which means that the penis continues to fail to reach or maintain sufficient erections to complete a satisfactory and satisfactory sex life, with a course of more than 3 months. In the past, men's "sexual incompetence" was generally referred to as "impotence", and its scientific definition was imprecise and discriminatory and derogatory. Until 1992, the US National Institutes of Health decided to replace erectile dysfunction with the term erectile dysfunction (ED), and defined penile erectile dysfunction as: the penis continues to fail to reach and / or maintains sufficient erection to obtain Satisfactory sexual life (sexual intercourse).

Basic Information

nickname

Impotence

English name

erectile dysfunction

English alias

ED

Visiting department

Andrology

Common locations

Penis

Common causes

Psychological factors, surgery and trauma, vascular lesions, neurological factors, etc.

Common symptoms

The penis continues to fail to achieve and maintain sufficient erections for satisfactory sexual intercourse.

Causes of erectile dysfunction

The causes of erectile dysfunction can be divided into:

1. Psychosocial ED

Refers to erectile dysfunction caused by mental and psychological factors such as tension, stress, depression, anxiety, and discomfort between couples. Such as uncoordinated daily husband and wife relationship, lack of sexual knowledge, bad sexual experience, life work or financial pressure, misreading and misunderstanding of media propaganda, anxiety and depressive psychological disorder and environmental factors caused by fear of disease and prescription drug side effects; Psychiatric disease is also one of the common causes of ED. The severity of psychiatric disease symptoms is positively correlated with dysfunction.

2. Organic ED

(1) Vascular causes Vascular lesions are the main cause of ED, accounting for nearly 50% of ED cases, including any diseases that may lead to reduced blood flow to the penile cavernosal artery, such as atherosclerosis, arterial injury, arterial stenosis, genital area Arterial shunts, abnormal cardiac function, etc., or penile leukomembrane and penile cavernous sinus smooth muscles that impede the venous return closure mechanism are reduced due to penile vein leakage. Almost all risk factors that can cause hypertension, such as smoking, hyperlipidemia, obesity, etc. can increase the incidence of ED

(2) Neurological causes Central or peripheral neurological diseases or injuries can cause erectile dysfunction, such as stroke, tumor, Parkinson's disease, spinal cord disease, lumbar disc disease, multiple sclerosis, multiple atrophy; peripheral neuropathy Such as diabetes, alcoholism, uremia, multiple neuropathy and so on.

(3) Surgery is related to traumatic large vessel surgery, pelvic or retroperitoneal surgery or trauma, such as radical prostatectomy, radical perineal rectal cancer and other operations, as well as pelvic fractures, lumbar vertebral compression fractures, or riding injuries that can cause penile erections. Damage to blood vessels and nerves leads to erectile dysfunction.

(4) Endocrine disorders, chronic diseases, and long-term use of certain drugs such as hypogonadism, thyroid disease, acromegaly, etc. Any condition that causes lower blood testosterone levels and changes the function of the hypothalamus-pituitary-gonadal axis, drugs such as anti- Hypertension drugs (diuretics and -blockers), antidepressants, antipsychotics, antiandrogens, antihistamines, drugs (heroin, cocaine, methadone, etc.) can cause erectile dysfunction.

(5) Diseases of the penis itself: Anatomy or structure of the penis is abnormal, such as Peyronie's disease, small penis, deformity of the penis, severe phimosis and balanitis.

3. Mixed ED

Refers to erectile dysfunction caused by psychological factors and organic causes. In addition, because organic ED is not treated in a timely manner, patients' psychological pressure increases, and they are afraid of sexual intercourse failure, which makes ED treatment more complicated. ED can be caused by one or more diseases and other factors. Common diseases such as diabetes, hypertension, cardiovascular and cerebrovascular diseases, trauma, and surgical injuries, as well as psychosocial, drug, lifestyle and social environmental factors. Various diseases and pathogenic factors cause ED through different or common pathways.

Clinical manifestations of erectile dysfunction

The penis continues to fail to reach or maintain a sufficient erection and lasts for more than 3 months.

Erectile dysfunction test

(A) physical examination

In addition to a detailed medical history, especially a history of sexual life, a physical examination is necessary to diagnose ED. Focus on the examination of neurological, endocrine, cardiovascular system and reproductive organ defects and abnormalities related to ED.

General situation

Attention should be paid to body shape, hair and subcutaneous fat distribution, muscle strength, secondary sexual characteristics, and whether there is male sex. This pair is related to the presence or absence of gonad dysfunction such as cortisol disease, thyroid disease, hyperprolactinism, and testis.

2. Cardiovascular system

Measurements of blood pressure and extremity pulses, disappearance or weakening of the femoral and iliac artery pulsations suggest the possibility of abdominal aorta, iliac artery embolism or stenosis.

3. Nervous system

Pay attention to changes in the lower back, lower limbs, perineum and penis, sensations of touch and temperature, vibrations of the penis and toes, and corpus cavernosum reflex (when stimulating the glans of the penis, inserting the fingers in the anus should feel anal sphincter contraction) Happening.

4. External genitalia

(1) Whether the penis size, shape and foreskin are abnormal. The cavernous body of the penis should be touched carefully. If there are fibrous plaques, it is indicated that the cavernous body of the penis is sclerosing. Phimosis, foreskin adhesion, or short foreskin lacing can affect normal erectile function;

(2) Testicle size and texture, with or without hydrocele, epididymal cysts and varicocele. Huge sheath fluids and hernias can also affect normal sexual intercourse;

(3) Digital anal examination of prostate size, texture, nodules and tenderness, anal sphincter tension, etc. For an ED patient over 50 years of age, more attention should be paid to digital anal examination.

(Two) laboratory inspection

Laboratory examinations should be individualized according to the patient's other major complaints and risk factors.

1. Blood, urine routine, biochemical and liver and kidney functions

Fasting blood glucose, high and low density lipoprotein, and liver and kidney function tests are necessary to detect diabetes, abnormal lipid metabolism, and chronic liver and kidney disease.

2. Determination of hormone levels

Luteinizing hormone (LH), prolactin (PRL), testosterone (T), and estradiol (E2). For patients over 50 years of age or suspected prostate cancer, prostate specific antigen (PSA) should be tested. Should it be used as a routine test Controversial.

(Three) special inspections

A small number of patients with erectile dysfunction (approximately 15%) are not responding to non-traumatic treatment. To further understand the exact etiology or mechanism of erectile dysfunction, some of the following tests need to be selectively performed.

1. Nocturnal penile erection test (NPT)

Clinically, it can help distinguish between psychological and organic ED.

2. Penile cavernous body injection vasoactive drug test (ICI)

Penile cavernosal injection of vasoactive drugs can induce penile erections in patients with psychotic, neurological, hormonal, and mild vascular ED, especially in patients with neurogenic ED.

3. Color dual function ultrasound (CDU)

The test is non-invasive and can be performed in an outpatient setting.

4. Penile cavernosal manometry (CM)

This method is an effective method to diagnose venous erectile dysfunction.

5. Penile cavernosal angiography

In 1981, Wespes et al. Used penile cavernosal perfusion angiography for the first time in the clinic, which improved the understanding of venous ED and also provided a basis for the treatment of venous ED.

6. Selective penile arteriography

Arteriography remains the primary method for assessing the location and characterization of abnormal penile blood supply.

7. Nerve testing for erectile dysfunction

The autonomic nervous system plays an important role in the nerve conduction process of erectile response.

8. Cavernous Biopsy

Pathological changes of corpus cavernosum smooth muscle cells and corpora cavernosa, such as the decrease in the number of smooth muscles, changes in the ultrastructure of cells, and the proliferation of a large number of fibrous tissues can reduce the compliance and elasticity of smooth muscle cells and cavernous sinuses, resulting in insufficient arterial filling and venous insufficiency. This leads to a weak erection. Penile cavernosal biopsy can directly evaluate cavernosal function, which is necessary in the diagnosis of the etiology of some impotence patients.

Diagnosis of erectile dysfunction

The diagnosis can be made based on the patient's lack of erection stiffness or duration not enough to complete sexual life during sexual life, and more than 3 months. Types can be further distinguished by asking medical history, related laboratory tests, and erectile function scores.

Many international questionnaires have been developed to evaluate erectile dysfunction. The most authoritative is the international erectile function index questionnaire (international index of erectile function (IIEF)), which was designed by Rosen in 1997 and has 15 questions. The following year, Rosen et al. Further simplified it into five questions (IIEF-5), which were widely used internationally. In addition, the brief functional questionnaire compiled by O'Leary et al. And the erectile dysfunction quality of life assessment form by Wagner et al. Can also reflect the erectile function status of patients from different aspects. These scales are helpful in diagnosing erectile dysfunction and its extent, and can be used to evaluate efficacy.

Erectile Dysfunction Treatment

Sexual psychotherapy

As most patients with erectile dysfunction have psychological factors, psychological treatment is very necessary, and it is best that both spouses participate in psychological treatment together. Sexy concentration training is currently the most important treatment for psychological erectile dysfunction. It is applicable to the treatment of almost all sexual dysfunctions. The purpose is to relieve anxiety, improve communication and communication between husband and wife, and improve skills from verbal to non-verbal communication. Gradually improve marital relations and sexual function. The improvement rate of this method in treating erectile dysfunction is 20% ~ 81%.

2. Drug treatment

Oral medication is the simplest and most acceptable first-line treatment for erectile dysfunction.

(1) Non-hormonal drugs can be roughly divided into the following categories based on the site where the drug acts. Oral drugs acting on the central system: such as adrenal receptor antagonists; dopamine drugs; serotonin receptor antagonists. Oral drugs acting on the periphery: PDE5 inhibitors (such as sildenafil, tadalafil, vardenafil, etc.) are specific phosphodiesterase inhibitors, which can inhibit the degradation of cGMP and increase the concentration of cGMP, thereby making smooth muscle Relaxation, causing erection of the penis. This class of drugs is currently the drug of choice for the treatment of ED, with a total effective rate of more than 70%. Topical drugs: Creams and ointments are the oldest method in the treatment of erectile dysfunction, but the effect is not exact.

(2) Hormonal drugs Androgen replacement therapy is mainly used for the treatment of endocrine erectile dysfunction, including ED caused by primary and secondary hypogonadism. Primary hypogonadism: Testicular tumors, Creutzfeldt-Jakob syndrome, trauma, surgery, and other lesions can lead to a decrease in testosterone levels and an increase in FSH and LH levels. Exogenous testosterone replacement therapy is most effective in these patients. Secondary hypogonadism: secondary to hypothalamus and pituitary lesions, due to the lack of gonadotropin and stagnation of gonadal development, the levels of testosterone, FSH and LH in the body are reduced. After supplemented with gonadotropin or gonadotropin-releasing hormone, it can increase sexual desire and improve erectile function. Testosterone undecanoate pills, injections, and patches are the main androgens used in ED treatment. For patients with prostate cancer or suspected prostate cancer, androgen replacement therapy is contraindicated.

3. Vacuum constriction device (VCD)

Vacuum constriction device (VCD) can be used for erectile dysfunction caused by any reason, and is a second-line method for treating ED. But the hemodynamics that cause erections are different from those of normal erections. It does not have active relaxation of corpus cavernosum and smooth muscle. Animal tests have shown that arterial blood flow does not increase after VCD, but venous return is significantly reduced. Blood filling of the cavernous body and penile skin leads to penile enlargement. This method is suitable for patients who are ineffective with PDE5 inhibitors or cannot tolerate drug treatment, especially for elderly patients who occasionally have sex. Adverse reactions include penile pain, numbness, delayed ejaculation, etc. The patient should be informed. Negative pressure should not exceed 30 minutes. Contraindications include patients with spontaneous abnormal erections, intermittent abnormal erections, and severe penile deformities.

4. Cavernous body injection therapy (ICI)

Cavernous drug injection is the injection of vasodilator drugs into the cavernous body of the penis to congest the cavernous body to achieve the purpose of penile erection. At present, the most commonly used drugs for the treatment of erectile dysfunction by cavernous injection are papaverine, phentolamine, and prostaglandin E1. The method has obvious effects and fast onset of effects. With the widespread use of oral drugs, as the method is an invasive procedure, it has caused side effects such as pain, bleeding, abnormal penile erections, and penile fibrosis, and it has become less and less clinically used.

5. Surgical treatment

With the advent of new drugs and increased understanding of the pathogenesis of erectile dysfunction, surgical treatment has gradually decreased. However, there are still some patients with erectile dysfunction that need to be addressed by surgery, and generally are those who have failed other various treatments. Surgical treatments include prosthetic implantation, arterial revascularization, and venous ligation.