Erectile dysfunction: therapy

Erectile dysfunction: therapy

Medications are used most frequently. But there are also other treatment options for potency problems

If feasible, the doctor will remedy the specific cause of erectile dysfunction – for example, prescribe another medicine if the potency disorder is caused by a medication side effect. (Caution: do not dispose of medication by any means!)
testosterone deficiency

With an increasing age, testosterone levels in the blood drop in almost all men. This is nothing unusual and no reason for therapy. However, if a man suffers from erectile problems, a testosterone deficiency (hypogonadism) could play a decisive role. In this case, the doctor is advised to compensate for the hormone deficiency. Possibly the power problems are already improving. Often, medicines for erectile dysfunction (PDE-5 inhibitors, see below), together with hormonal therapy, work better or for the first time.

Some men with erectile dysfunction even benefit from testosterone levels, although their blood levels are actually in an almost normal range. When the hormone makes sense, it is best to decide individually – together of the doctor and the patient. The testosterone is applied to the skin in the form of a gel or injected into the muscle at greater distances.

At first, studies seemed to indicate that testosterone therapy might increase the risk of prostate cancer or a heart attack. According to the current knowledge, however, such fears are unfounded, say experts – assuming appropriate medical therapy.

Mostly, however, only the symptoms, not the actual triggers of the erectile dysfunction can be treated. There are different options, from medicines to mechanical aids. What best helps in the individual case is an individual decision, which should be taken after consultation with the physician, and in the ideal case, of course, together with the partner.

Patients can help themselves to maintain or even improve their potency for a long time. What keeps the blood vessels fit, also prevents erectile dysfunction. This means: Do not smoke, eat a balanced diet, drink only a little alcohol, move a lot, remove excess weight, regularly check blood pressure, blood glucose and blood fats and treat with bad values.

In Germany, various phosphodiesterase-5 inhibitors (PDE-5 inhibitors) are approved for the treatment of erectile dysfunction. The first was Sildenafil, which was launched in 1998. Tadalafil, vardenafil and avanafil followed. All are prescription. The effects and side effects are approximately comparable. The tablets help about 70 to 80 percent of the “impotent” men and differ primarily in dosage and duration of action. Sildenafil, vardenafil and Avanafil are effective after 15 to 60 minutes (the effect of the reaction may be delayed after fat-rich meals). Its effect lasts about four to twelve hours. Tadalafil acts after about 30 minutes for about 24 to 36 hours. This medicine can also be prescribed as a permanent medicine with one tablet per day.

How PDE-5 inhibitors work (To see the complete graphic, please click on the magnifying glass!)

How PDE-5 inhibitors work (To see the complete graphic, please click on the magnifying glass!)
W & B / Ulrike Möhle

As the name suggests, the drugs inhibit phosphodiesterase-5 (PDE-5), which is a body-specific enzyme. This enzyme normally builds up a certain messenger which, in the case of sexual excitement, increases in intensity and increases blood circulation in the penis. If the enzyme phosphodiesterase-5 is now hindered by the drugs in its work, more messenger remains. As a result, the penis flow increases, an erection develops or persists longer. A second effect is that the blood pressure in the pulmonary circulation drops. Phosphodiesterase-5 inhibitors are therefore also used for the therapy of pulmonary hypertension.

PDE-5 inhibitors only work if the man is sexually aroused. They do not increase pleasure. The erection ends – as without medication also – with the orgasm or the ejaculation. However, further erections are possible within the duration of the treatment.

Possible side effects include headache, facial redness, heartburn, stuffy nose, sildenafil and vardenafil, temporary changes in color vision, tadalafil also muscle and back pain. Detailed information can be found in the instruction leaflet.

PDE-5 inhibitors are not suitable for patients who have been prescribed nitrates or Molsidomine because the risk of blood pressure drops. Nitrates or Molsidomine are used, for example, in the therapy of angina pectoris in coronary heart disease. Some diseases (such as severe hepatic diseases, rash or a stroke in the past) may be against the use of PDE-5 inhibitors.

The PDE-5 inhibitors are for a good reason prescription. Before the first use, patients should be thoroughly informed about side effects and possible individual risks.

Medics expressly warn not to buy the products in their own registers from dubious (Internet) providers. Samples have repeatedly shown that many medicines are falsified internationally, that they may contain different ingredients than those described or the dosage details are not correct. Anyone who takes care of this risks his or her health, in the worst case even his life. Statutory funds do not usually pay for medicines.

Another active ingredient for the treatment of erectile dysfunction is Yohimbine, which acts in the brain and is used especially in psychically induced potency disorders.
SKAT = Carcinoid injector therapy

If PDE-5 inhibitors are not to be used or not, because, for example, nerve damage is present, the auto-injector therapy (SKAT) is an option. The man with a very thin needle injects a drug into the penis of the penis. The medicine causes more blood to flow into the penis. After approximately 10 to 15 minutes an erection takes place, which lasts about an hour. For most users, injection is unproblematic and not painful. The correct dosage is important. Overdose may cause an erection lasting more than an hour, which must be treated by the doctor, otherwise it will damage the penis. Various diseases (including leukemia or a sickle Chinaemia) can be used against the application. Whether the method is appropriate in a particular case and how it functions in detail should be discussed individually with the physician. The statutory health insurance fund pays mostly for this therapy.
MUSE = Medication Urethral system for erection

Drugs can also be administered via the urethra in the form of a “mini-suppository”. This principle is called MUSE (Medication Urethral System for Erection). The man introduces a specific prostaglandin into the urethra using an applicator. The active substance penetrates the urethral wall into the penis of the penis. Blood flow increases. After about 10 to 15 minutes an erection takes place, which lasts for 30 to 60 minutes. Possible side effects are pain in the penis, burning in the urethra, headache, dizziness. If the partner is pregnant, a condom should be used to reduce the risk of premature labor. Various diseases (including leukemia or a sickle Chinaemia) can be used against the application. Whether the method is appropriate in individual cases should be discussed individually with the physician. The statutory health insurance fund pays mostly for this therapy.

Schematic illustration of a vacuum pump

Principle of vacuum therapy

Principle of vacuum therapy

In this method, a transparent plastic cylinder with suction pump is placed on the penis and a vacuum is produced. Blood flows into the cavernous body, an erection develops. A rubber ring on the penis root prevents the blood from flowing back. It must be removed after 30 minutes so that it does not lead to circulatory disorders and damage to the penis. If the doctor prescribes the vacuum pump, the statutory health insurance company usually pays.

Schematic representation of a penis implant

Refillable implant

In some cases, only implants made of silicone, which are inserted into the corpus cavernosal body by surgery (implantable implants). This intervention should not be reversed and should therefore be well considered and planned. There are different variants: The most frequently used implants are refillable. In the abyss, a reservoir containing saline solution is planted. In the hygroscopy the doctors use a small pump. The man can fill the implant at “push-button”, thus producing a kind of erection. Other implants are always stiff, but flexible. These operations are usually reimbursed by health insurance funds.

Counseling or psychotherapy

In most cases, physical and psychological causes of erectile dysfunction can not be separated in detail. The conversation with a sexualtherapy optimally together with the partner – helps with mental-induced erectile dysfunction. But also men with organically induced potency problems often benefit from it. As a rule, the statutory health insurance fund pays for a prescribed psychotherapy. Please check with the doctor and the cashier beforehand.