What are the causes? Today we know that in the majority of cases there are numerous elements at play - physical, organic and, contrary to what was formerly believed, non-psychological. It is indeed so true that in most cases, the physical causes unavoidably amplify the emotional and physical elements. In sum, we can say that erectile dysfunction may depend on HORMONAL factors, from a pathology of the VASCULAR type (arterial or venal), from NEUROLOGICAL factors (that is, from the nervous system which participates in the erectile mechanism), from SURGICAL OPERATIONS (for example, radical surgery of the prostrate), and BAD HABITS of LIFESTYLE such as excess smoking, alcohol, the consummation of drugs and narcotics, and conditions of chronic stress. Often diabetes, hypertension, cardiopathology and chronic renal disease in the male are accompanied by erectile dysfunction. In a limited number of cases, PSYCHOLOGICAL factors are truly present. |  |
Today, by means of a choice of INSTRUMENTAL or LABORATORY EXAMINATIONS (hormonal dosages, penile ecodoppler, erectile drug tests, penile biotesometry, nocturnal rigidometry, etc.), Andrology can pinpoint the causes of the disturbance with precision and the subsequent choice of the most suitable therapy.
PROSTAGLANDIN E1 (ALPROSTADIL): This medical injection is taken inside the corpus cavernosis through a painless puncture. It is particularly useful in the kind of impotence which is caused by vascular and diabetic problems. A "gymnastic" vascular cure for the corpora cavernosa progressively becomes enriched by oxygen; sometimes it may precede a successive phase in which the Patient can undergo less invasive therapy.
PROSTAGLANDIN E1 in Gel: This entails introducing a small gelatine capsule without needles into the penis through the urethra, always at the base of Prostaglandin E1. These are not sold in Italy and the efficiency is clearly limited to the administration of such small injections.
HORMONAL DRUGS: Such medicine can integrate with or substitute for the hormones lacking in the organism. Only in such cases of deficiency can efficiency be shown in restoring healthy sexual activity. They are available only in pills, intramuscular injections, nasal spray, and adhesive patches. Medical checks during the treatment are indispensable.
VACUUM DEVICES: These are devices that allow for the drawing back of blood inside the penis prior to intercourse. They are very widespread in the US. In Europe, they never encountered great success due to frequent resistance on the part of the Patient to effect the preparation before sexual activity. They hold the advantage of constructing a system that is practically deprived of counter-indications and are applicable in the few cases in which other kinds of therapy are ill advised.
VASCULAR SURGERY: This is applied in the case of arterial obstruction (a by-pass for the improvement of the filling up of the corpus cavernosis during erection or "venal leakage", that is, the incapability of maintaining the blood 'seized' inside the corpus cavernosis during sexual relations with the consequence of a loss of rigidity: in this latter case, the technique of ligature of the malfunctioning venal sections is used.
PENILE PROSTHESIS : This deals with the substitution of the natural erectile mechanism with a mechanical or a hydraulical structure that realises the state of erection when desirable. In the conditions of erection or repose, the penis maintains a completely natural aspect. This is a surgical therapy reserved to the cases in which there is serious vascular or anatomical damage of the penis (for example, serious and multiple stenotic arteriopathy of the penis, or serious fibrosis of the corpus cavernosis which irreversibly compromises functioning). The choice of this treatment must come necessarily after a scrupulous diagnostic study of the Patient and would have had indubitably excluded other possibilities of less invasive care.
" In synthesis, today through correct diagnosis we are able to choose and apply pharmacological
or surgical therapy which allows for the recovery of the capability of the erection in 100% of the cases."
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