Erectile Dysfunction in Men

ERECTILE
DYSFUNCTION IN MEN
SOURAV
PATHOPHYSIOLOGY
ETIOLOGY
Psychogenic: Erection is influenced by mental states; fear,
anxiety, and past negative sexual experiences can disrupt
mechanisms.
Vascular: Requires high blood flow in cavernous arteries
and proper veno-occlusive function. Dysfunction can result
from reduced arterial inflow or impaired venous outflow. Risk
factors include atherosclerosis, hypertension, diabetes, lipid
metabolism disorders, and smoking.
Neurogenic: Caused by spinal cord injuries, neuropathies,
and other nerve impulse disruptions.
Endocrine: Androgens regulate erection. Age-related
androgen deficiency and hypogonadism affect erection,
treatable with hormone replacement.
Drug-induced: Medications affecting the nervous system
and hormonal axis can cause erectile dysfunction.
DIAGNOSTICS
Anamnesis: Collect detailed history including risk

factors (vascular disease, hormonal imbalance,
neurogenic disorders, urological diseases, surgeries,
lifestyle factors). Use questionnaires like IIEF, AMS,
ADAM, IPSS.
Objective Examination: Assess secondary sexual
characteristics, external genitalia, blood pressure,
peripheral artery pulse, genital sensitivity, and
reflexes.
Laboratory Tests: Measure testosterone, prolactin,
LH, estradiol, sex hormone-binding protein, glucose,
and lipids.
Special Diagnostic Methods
Intracavernous Test: Involves injecting vasoactive drugs to assess
erectile function. Results indicate potential neurogenic, psychogenic,
arterial, or veno-occlusive issues.
Duplex Scanning: Combines Doppler and ultrasound to evaluate
penile blood flow and structure.
Penile Angiography: Visualizes arteries before reconstructive
surgery, mostly in post-traumatic cases.
Cavernosometry and Cavernosography: Measure intracavernous
pressure and identify venous leaks.
• Nocturnal Penile Tumescence and Rigidity: Monitors nocturnal
erections to differentiate between psychogenic and organic causes.
Treatment of Erectile
Dysfunction
• Treatment options for erectile dysfunction (ED) are determined based on
the patient’s complaints, medical history, and examination results. The
primary treatment approaches include conservative, minimally invasive,
and surgical methods. Each approach is tailored to address the specific
pathophysiological mechanism underlying the erectile dysfunction.
• Treatment
• Psychotherapy: Effective for patients with psychogenic ED caused by stress,
conflict, depression, relationship issues, or lack of sexual experience. Psychotherapy
involves both partners and aims to reduce anxiety related to sexual activity and
establish a healthier sexual relationship.
•
Hormonal Therapy: Used predominantly in elderly patients with androgen deficiency.
The therapy aims to maintain normal testosterone levels, supporting sexual function
and secondary sexual characteristics. Hormonal therapy is contraindicated in patients
wishing to maintain fertility, those with male infertility, or those with prostate or breast
cancer. Monitoring by an endocrinologist and urologist is essential during treatment.
Oral Therapy: Phosphodiesterase type 5
inhibitors (sildenafil, vardenafil, tadalafil,
udenafil) promote smooth muscle relaxation
in the penile arteries and cavernous bodies by
inhibiting the breakdown of cyclic guanosine
monophosphate. These drugs are effective in
40-80% of cases, with mild and transient side
effects like headaches, hot flashes, and
changes in color perception.
• Vacuum Erector: This device creates local

negative pressure to enhance blood flow
into the penis, followed by a constrictor ring
to maintain the erection. It is non-invasive
and effective regardless of ED etiology,
although some patients find the procedure
cumbersome and uncomfortable.
Minimally Invasive Treatment
• Intracavernous
Therapy: Involves the
injection of vasoactive
drugs (e.g., alprostadil)
into the cavernous
bodies, leading to an
erection. This method
has a high efficacy rate
and minimal systemic
side effects but carries a
risk of priapism and
potential fibrous changes
with long-term use.
Surgical Treatment
Penile Prosthesis:
Semi-Rigid Prostheses: Flexible
and mechanical rods inserted
into the cavernous bodies,
maintaining a constant state
suitable for sexual intercourse.
• Hydraulic Prostheses: Include
one-, two-, or three-
component systems that
simulate natural erection and
detumescence. The three-
component prosthesis is the most
advanced, providing the most
natural feel and function.
Revascularization: Used mainly in young men with
post-traumatic pelvic artery injuries. The procedure
involves creating an anastomosis between the
epigastric artery and the dorsal penile artery to restore
blood flow. This method has a risk of thrombosis and
priapism but can be effective when correctly indicated.
• Correction of Penile Curvature: For congenital
curvature or Peyronie’s disease, surgical methods like
plication or excision of the affected tunica albuginea
are used. This can involve grafting techniques to
correct the curvature and restore normal function.

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ERECTILE

Anamnesis: Collect detailed history including risk

• Vacuum Erector: This device creates local

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