Erectile Dysfunction (ED) – Causes and Treatment of Erectile Dysfunction

Erectile dysfunction is diagnosed when at least 70 percent of all attempts at sexual intercourse fail. About 20 percent of men are affected by this condition. The actual number of cases is likely much higher. This type of sexual dysfunction is not a disease in itself, but rather a symptom of another condition. It can, for example, indicate developing heart problems. If you suffer from erectile dysfunction, you should therefore definitely get checked out so that treatment can be started early.

Sexual dysfunction can also have a negative impact on quality of life and the couple’s relationship. For these reasons, a visit to the doctor is strongly recommended. Many men affected by this condition are reluctant to seek medical help out of embarrassment. However, erectile dysfunction is not an isolated case: a study found that 52% of all men aged 40–70 are affected by erectile dysfunction at least occasionally.

Confide in a doctor—you are not alone in facing this problem. Today, there are also several options available to address the underlying causes and regain your self-confidence.

The occurrence of erectile dysfunction depends largely on age. At age 30, only about 2.3 percent of men suffer from erectile difficulties. By their 70s, well over 50 percent are affected. At age 40, the figure is still around 10 percent, but it rises more sharply after age 50. There is no reason to feel ashamed about this. The causes can be both psychological and physical. Often, various factors play a role.

Erectile dysfunction often has multiple causes. These can be attributed to various factors that are interrelated.

Psychological Causes

In younger men—for example, those aged 25—psychological problems and stress are usually the cause of erectile dysfunction. In many cases, the fear of sexual failure plays a role here. This fear is often accompanied by

• relationship conflicts
• breakups
• professional setbacks

Erectile dysfunction can lead to dissatisfaction with one’s sex life and thus place a heavy strain on the relationship © drubig-photo / Fotolia

Organic causes and indications of impending serious heart disease

As men age, organic causes play an increasingly significant role in erectile dysfunction. Typical risk factors include, for example

• Smoking
• Diabetes
• High blood pressure
• Injuries to the erectile tissues
• surgery in the pelvis
• Long-term use of various addictive substances such as alcohol or pills, which can cause damage to the erectile tissues or blood vessels
• Calcification of the blood vessels (atherosclerosis)
• Leaks in the veins that carry blood away
• Family history of the condition

Vascular problems are a relatively common phenomenon. Nevertheless, this cause is rarely investigated—even by experienced doctors. However, there are successful treatment options available for this cause of erectile dysfunction as well.

Erectile dysfunction is particularly common among patients with diabetes. It occurs in about 75 percent of diabetics over the age of 60 and continues to increase as the disease progresses. About 50 percent of patients with heart disease are also affected by erectile dysfunction. Over 70 percent of patients who have suffered a heart attack also exhibit this symptom.

Most heart diseases are caused by atherosclerosis. In this condition, the diameter of the blood vessels narrows due to deposits on the vessel walls. This results in impaired blood flow. A heart attack occurs when the heart’s coronary arteries become so narrowed that the heart muscle is no longer supplied with blood. The coronary arteries have a diameter of 3–4 mm.

Atherosclerosis: Deposits in the blood vessels reduce blood flow.

Even before this, the smaller arteries in the erectile tissue of the penis (1–2 mm in diameter) may already be affected. For this reason, erectile dysfunction can be an early warning sign of developing serious heart disease. Nearly all patients experience this symptom for about three years before developing circulation-related heart problems.

Therefore, anyone affected should have the cause of their erectile dysfunction investigated and, if necessary, begin treatment. This may require consultation with a specialist, such as an

• internist,
• angiologist, and
• a cardiologist,

be consulted. This approach allows serious conditions to be detected early on and severe consequences to be avoided.

Further information on the interdisciplinary approach can be found in the English-language scientific article “Interdisciplinary options for diagnosis and treatment of organic erectile dysfunction.” However, certain medications can also lead to erectile dysfunction, such as beta-blockers or antiandrogens. These medications inhibit the effects of male sex hormones.

In general, you should consult a urologist. If necessary, the urologist can consult with neurologists and psychotherapists. Interdisciplinary collaboration is often required. During the initial consultation, the urologist will determine the nature of the sexual problems and how long they have persisted.

Ideally, it will become clear at this stage whether psychological factors are causing the erectile dysfunction. The doctor will also review any medications the patient may be taking. Certain active ingredients can contribute to erectile dysfunction.

Other diagnostic options include an ultrasound and a blood test. An ultrasound examination can provide evidence of injury. The blood test can reveal hormonal imbalances. If the urologist detects organic damage, he will select additional methods to determine the cause of the erectile dysfunction.

These include, for example, the so-called NPTR measurement, which records any nocturnal erections that may occur. In a physically healthy man, these occur between three and six times per night and last up to ten minutes. If they also occur in a patient suffering from erectile dysfunction, this is a clear indication of psychological causes.

To rule out vascular problems, the doctor often recommends intracavernosal injection therapy. In this procedure, medication is used to induce an erection. If the erection lasts for more than 15 minutes, vascular damage is highly unlikely. Duplex sonography (also known as Doppler sonography) can be used to rule out vascular problems. This method provides a wide range of data on blood flow in a man’s body.

Since September 2012, medical guidelines have recommended treatment options for erectile dysfunction. However, these guidelines are not binding and must be adapted to each individual case. In addition, there are several approaches to treating erectile dysfunction.

For psychological causes, psychotherapy or counseling-based sex therapy are the best forms of treatment. If appropriate, the partner should also be involved. If a medical condition is indeed present, the costs are covered by health insurance.

Medication-Based Treatments

Erectile dysfunction can also often be alleviated with the use of medications that enhance sexual function. Mild side effects are possible. Affected patients should absolutely refrain from self-medication. Optimal adjustment of the medication for the patient is only possible under medical supervision.

Tissue hormones, known as prostaglandins, have also proven effective. They can be either injected or inserted into the urethra. Insertion is performed using a small stick soaked in the active ingredient, which releases it onto the mucous membranes in the urethra.

Mechanical Approach

Use of a vacuum pump

Vacuum pumps can help the patient achieve an erection. When placed over the penis, they create a vacuum that fills the erectile tissue of the penis with blood, thereby inducing an erection.

The medical literature reports a 70 percent satisfaction rate, although this figure is based on feedback from the couple as a whole, not just the man.

Revascularization Using a Balloon Catheter

In some cases, catheter treatment can mechanically reopen blocked arteries. Preliminary examinations determine whether the patient meets the criteria for this therapy. During balloon catheter dilation, the angiologist inserts a tiny tube into the small pelvic arteries, which supply blood to the penis. Once in place, he inflates a small balloon to open the narrowed areas.

This procedure has long been used in the treatment of coronary heart disease. Thanks to the miniaturization of the catheter, the method is now suitable for even smaller blood vessels. For the majority of patients, the treatment can be performed on an outpatient basis under local anesthesia.

However, severely calcified vessels would narrow again afterward. For this reason, the angiologist inserts drug-eluting stents into the at-risk sections. These are mesh-like supports that keep the vessel open.

For about 60 percent of patients, the treatment is successful and erectile dysfunction is reduced. In this way, the blood flow essential for an erection can often be restored in a very gentle, minimally invasive manner. Further information on this procedure can be found in the scientific article “Erectile Dysfunction and Cardiovascular Medicine.” However, after 6 months, one-third of patients experience a recurrence of vascular narrowing.

Balloon catheter dilation and stent placement, shown here in the coronary arteries

When is surgery recommended?

Erectile dysfunction can also be treated surgically under certain circumstances. This is necessary when there is vascular damage or when the patient has had a hernia. Overall, about 80% of patients are satisfied with the surgical treatment.

Other treatment options

Shockwave therapy

Shockwave therapy is another treatment option for erectile dysfunction. However, the available data is still too limited to provide a clear picture.

This therapy is intended to promote local blood flow to the erectile tissues. About two-thirds of patients who have undergone this treatment report positive results.

Surgical treatment with a penile prosthesis

A penile implant (also known as a penile prosthesis) can produce an erection on demand and is inserted during surgery. However, this procedure irreversibly destroys the body’s natural erectile tissue. This option is therefore only used when no other treatment is effective.

The psychological burden on men suffering from erectile dysfunction remains enormous. In German-speaking countries, this condition is still not properly recognized. This has an additional negative impact on the mental well-being of those affected and can further exacerbate their problems. Furthermore, neither private nor public health insurance plans are required to cover the costs of treatment or erectile dysfunction medications.

Erectile dysfunction is also often equated with infertility, i.e., impotence. However, this is incorrect. Patients suffering from erectile dysfunction can still ejaculate and father children naturally. Intensive efforts are currently underway to break the taboo surrounding this issue.

Since lifestyle can have a decisive influence on libido and sex life, both psychological and organic erectile dysfunction can often be effectively prevented. A balanced diet, maintaining a healthy weight, regular exercise and sports, as well as relaxation and stress-reduction techniques, promote overall health and help prevent conditions such as high blood pressure and type 2 diabetes—two of the risk factors.

Avoiding smoking and excessive alcohol consumption also helps prevent erectile problems. All of the factors mentioned can also help improve the treatment of an existing condition.

What is erectile dysfunction?
Erectile dysfunction refers to a persistent inability to achieve or maintain an erection. The condition is also known as ED or impotence and can interfere with satisfying sexual intercourse.

What are the causes of erectile dysfunction?
The most common causes of ED are circulatory disorders, diabetes mellitus, high blood pressure, or vascular disease. Psychological factors such as stress, mental health issues, or fear of failure can also trigger erectile dysfunction.

How is the diagnosis made?
The medical history is followed by a physical examination focusing on the genital organs and the prostate. Among other things, the urologist assesses spontaneous erections during sleep, blood flow, and possible organic or psychological causes.

What treatment options are available for erectile dysfunction?
Treatment options for erectile dysfunction include medication containing active ingredients such as sildenafil or tadalafil, psychotherapy, and mechanical aids. These include a cylinder, a pump, or a hydraulically operated vacuum pump that draws blood into the penis.

When should you seek medical help?
If men experience problems with erectile function over an extended period, a medical evaluation is advisable. Particularly in older men or as men age, risk factors such as obesity, diabetes, or side effects of certain medications can contribute to erectile dysfunction.