Erectile Dysfunction

What is erectile dysfunction?

Erectile Dysfunction is the inability to maintain an erection rigid enough to allow a satisfactory sexual intercourse.

In Egyptian papyri of the year 2000 a.C. The first description of impotence has been found. Subsequently, Hippocrates described many cases of male impotence in rich men and concluded that the cause was due to an excess of horseback riding.

Is erectile dysfunction very common?

All men can have problems getting erections at some point in their lives, especially when they are tired, under stress, are under the influence of alcohol or suffer from a serious illness.

In our country, the EDEM study showed that 19% of men between 25 and 70 years have problems with erection. This means that more than two million have impotence.

The frequency of erectile dysfunction increases with age and affects 14% of men aged 40 to 49 years, 25% of men 50 to 59 and 49% of 60 to 69 years.

Men with diabetes, hypertension, smoking, etc. often suffer from erection problems.

Why does erectile dysfunction occur?

The penis consists of two columns of erectile tissue that are called corpora cavernosa (produce the erection) and a conduit (urethra) through which the urine exits. (Figure 1). During erection, this erectile tissue is filled with blood, the penis increases in size and becomes rigid.

Anatomy of the penis

In the cavernous bodies there are cavities that are called sinusoids and in flaccidity they are empty. When an erection occurs, a large amount of blood reaches the corpora cavernosa and these sinusoids relax and store the blood. Proper entry and storage of blood produces an increase in the size and rigidity of the penis. (Figure 2). If the blood does not enter properly, or it escapes from the sinusoids, then there is a difficulty to achieve and / or maintain the rigidity.

Figure 2. How the erection occurs

Erection physiology

The erection is a neurological and vascular phenomenon. Pro-erectile stimuli and inhibitory stimuli arrive to the brain. The brain processes all the information and transmits the orders to the penis through the spinal cord and the erector nerves. Any disease or disorder that affects the brain, spinal cord, erector nerves and pudendas can cause impotence.

Erectile dysfunction can be organic (physical origin) or psychological (psychological origin). However, in many patients with erectile dysfunction of organic origin is added a psychological component (performance anxiety) that aggravates it.

Organic impotence is the most common and is caused by a disorder of the penis or the mechanisms related to erection. There are several types of organic impotence:

a) Vascular

It's very common. It occurs when little blood reaches the penis (arterial) or is not adequately retained within the corpora cavernosa (veno-occlusive), causing a blood leak that prevents reaching and maintaining adequate rigidity.

The most frequent causes of vascular impotence are: diabetes, hypertension, increased cholesterol, smoking, and cardiovascular diseases. In these men with cardiovascular risk factors, erectile dysfunction may be the first "sentinel" symptom of cardiovascular disease that will progress with time. In these men it is necessary to treat the problems of erection and it is very important to correct these vascular risk factors that can trigger a more serious cardiac or vascular event.