Erectile dysfunction: from tablets to penile prostheses

Erectile dysfunction is not a rare age-related condition. According to estimates, around 4 to 6 million men in Germany are affected. It often occurs with increasing age, but younger men can also suffer from it. It is considered a medical condition when difficulties persist over a prolonged period and cause distress to the person affected. A single bad day, on the other hand, is not yet a cause for concern. Stress, alcohol, tiredness or relationship problems can temporarily prevent an erection from occurring.

For an erection to occur, several processes must work together. The brain, nerves and blood vessels must function correctly. Furthermore, sufficient blood must flow into the penis and be retained there. There is therefore often a physical cause behind it.

These include, for example:

• High blood pressure and vascular diseases
• Diabetes
• Obesity
• Elevated blood lipid levels
• Hormonal disorders
• Prostate or pelvic conditions or surgery

Psychological factors can also play a role. Pressure to perform, fear of failure, stress or relationship problems can make it difficult to achieve an erection.

The blood vessels in the penis are small and sometimes react to changes sooner than larger vessels. Therefore, newly occurring erectile dysfunction may be an indication of vascular problems. Particularly if high blood pressure, diabetes, smoking, being overweight or high cholesterol levels are also present, the cause should be investigated by a doctor.

For many men, medication is the first line of treatment. So-called PDE-5 inhibitors are frequently used. These include active ingredients such as sildenafil or tadalafil, which help the blood vessels in the penis to relax more effectively, allowing more blood to flow into the penis during sexual arousal. These medicines do not automatically trigger an erection – sexual stimulation is still required.

Which active ingredient and dosage are suitable depends on the individual’s circumstances. It is also important to mention any other medicines you are taking, as certain combinations – particularly with nitrates used to treat angina pectoris – can be dangerous. Lifestyle changes can also support treatment. More exercise, a balanced diet, weight loss if you are overweight, as well as reducing alcohol consumption and giving up smoking can have a positive effect.

Not every man responds adequately to tablets. Sometimes they do not work well enough; sometimes they cannot be taken due to other medical conditions. In such cases, there are other options. One of these is an injection directly into the erectile tissue. The active ingredient dilates the blood vessels and can thus trigger an erection. Another option is a vacuum pump. This uses negative pressure to draw blood into the penis. A ring placed at the base of the penis then helps to maintain the erection.

If other treatments do not provide sufficient relief, a penile prosthesis may be an option. This involves surgically inserting an implant into the penis. There are various systems available, with inflatable prostheses being particularly common. In an inflatable system, two cylinders are located within the penis. A small pump is placed in the scrotum. An erection can be achieved by operating the pump. After sexual intercourse, the system is deflated again.

A penile prosthesis is only considered if other treatment options have been unsuccessful or cannot be used. The decision should therefore be discussed in detail with an experienced specialist.

Erectile dysfunction can have various causes and is often easily treatable. It is crucial not only to improve erectile function but also to identify any underlying medical conditions or risk factors. From medication and aids to penile prostheses, several treatment options are available today.