Erectile Dysfunction: Causes and Treatment

“Erectile dysfunction is defined as the inability to maintain an erection sufficient for sexual intercourse. This is a disorder that affects millions of men around the world in different ways and with various causes.”

What is?

Erectile dysfunction is a medical term used to define the inability to obtain an erection rigid enough for penetration and/or maintain it for a period of time suitable for the satisfaction of both partners during sexual intercourse. It is important to understand that it can occur even with desire and orgasm (ejaculation) present.

Erectile dysfunction (ED) affects approximately two thirds of men over 50 years of age, which represents between 10 and 20 million Brazilians.

Most men, at some point in their lives, have experienced episodes of erectile dysfunction, usually due to exhaustion, stress, or alcohol abuse. Occasional failures should not be overestimated. However, if the problem persists, a urologist should be sought.


Erection ability is just one of several aspects of male sexual function. The sexual response cycle has four stages of the man’s main desire, erection, orgasm, and relaxation. Each one can change differently.

The causes of ED are divided into organic, psychogenic and mixed, being able to find combined factors. Organic problems such as diabetes, cancer, arteriosclerosis, and neurological lesions can often lead to psychological complications, for example. It can also be secondary, and appear as the first manifestation of various disorders such as hypertension, diabetes, cardiovascular diseases and kidney failure.

ED of psychological origin can manifest itself in various ways, be it delayed ejaculation, painful ejaculation, and even impotence. There may also be loss of libido (sexual desire), lack of orgasm, and phobias (fears) of sex, all due to anxiety, depression, or guilt. An individual who has an unpleasant experience, such as losing an erection for sexual intercourse or ejaculating too early, tends to the next intercourse, remembers these “failures” and becomes anxious. This provides a new fault, creating a vicious cycle.

Organic causes are subdivided according to etiology. Vasculogenic ones are more prevalent, particularly flow disturbances, arteriosclerosis, and trauma (resulting in blood vessel injury). Venous flow abnormalities are less common. Neurogenic causes are diabetic neuropathy, multiple sclerosis, alcohol abuse, trauma, spinal cord and nerve damage from radical prostatectomy (surgery to remove the prostate). Since the causes are primary or secondary hormonal hypoandrogenism (disorders of male hormones).

ED can also occur due to the use and abuse of drugs such as marijuana, alcohol, heroin, cocaine, barbiturates, antidepressants.

Associated disorders

ED has several risk factors such as advanced age, diabetes, arterial hypertension, peripheral vascular diseases; neurological diseases, endocrine disorders, spinal cord injuries, radical pelvic surgery, radiation therapy, alcoholism, smoking, marijuana and/or cocaine use; use of antihypertensives, tranquilizers and psychotropic substances; relationship problems with the couple, stress, anxiety and fear of failure, depression, obsessive-compulsive personality, sexual deviation.


The objectives of the initial evaluation of the patient are to determine the probable cause of the ED and to identify organic or psychological factors that may influence the associated therapy.

A detailed medical interview is the most important factor in the evaluation of patients with this problem. The history should identify the duration, progression, and severity of erectile dysfunction and associated factors.

Once you have identified a problem in the patient’s sexual performance, the next step is to differentiate it from other sexual problems such as loss of libido and ejaculation disorders.

The physical examination aims to assess the health status of the patient, with special attention to cardiovascular, neurological and genitourinary, due to their contribution to erection. The neurological evaluation should include a perception of your patient’s anxiety or depression. Since the evaluation of genital herpes is aimed at the detection of local abnormalities.

Some are basic laboratory tests to identify disorders that can cause erectile dysfunction.


In cases of psychogenic ED, psychotherapy is indicated. Several factors must be evaluated by the urologist and, if possible, by an expert in psychology or psychiatry. Factors such as the physical, psychiatric, psychological, conflictive relationship with the partner and sexual inadequacy must be addressed by the couple.

Injections into the penis have been the first efficient and objective, with few or no side effects, with a significant improvement in erection, even in severe and organic OF. They were the main complication, painful erections. It also had the disadvantage of limiting the time of limitation of erections and the frequency of application (3 times a week). This method tends to be abandoned with the advancement of technology.

With the advancement of treatment, some oral medications are available in the market. Is it so:

viagra (Sildenafil) from Pfizer: acts on the penis by relaxing the muscles and increasing blood flow to the region. Effective in cases of partial impotence, providing an erection 40 to 60 minutes after ingesting the drug, with stimulation of the penis. Its effect can last up to six hours.Tem side reactions such as headaches, nasal congestion, facial flushing and dyspepsia. Cardiac patients, especially on nitrate drug treatment (Sustrate, Monocordil, Isordil, Nitradisc, Nitroderm TTS, Isocord, Isosorbide, nitroglycerin) cannot take this medication.

press (apomorphine), from Abbott Laboratories, acts on the central nervous system, facilitating the conduction of sexual stimulation from the brain to the penis. It generates an erection 10-20 minutes after oral administration by sublingual route. It may cause headache, nausea, dizziness, fainting, and hot flashes, but heart patients can use it.

cialis (Tadalafil), made by Eli Lilly, works directly on the penis by inhibiting the enzyme phosphodiesterase. It leads to an erection in 30 minutes and lasts up to 36 hours. It can cause headache, gastric intolerance, nasal congestion, back pain, muscle pain, dizziness and flushing. Like Viagra, it cannot be used for heart disease in the use of nitrates.

Levitra (Vardenafil) from Bayer and Glaxo, also acts directly and selectively on the penis by inhibiting the enzyme phosphodiesterase, with fewer side effects (headache, hot flashes, and runny nose). It leads to an erection in 15 minutes and lasts up to 8 hours. Like Viagra and Cialis, it cannot be used for heart disease in the use of nitrates. One of the main advantages is the more affordable price and its sale in individual packages.

Although pharmacological treatments are mentioned, some patients may not adapt and require treatment with mechanical devices such as vacuum erection devices or inflatable or malleable penile implants. Others may need surgery to repair the vascular arteries that supply blood to the penis, in specific cases.

Because erectile dysfunction can have many causes, there are various treatments that act by different mechanisms, with specific contraindications, a urologist should be consulted.

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