Erectile dysfunction or impotence



Erectile dysfunction, often referred to as impotence, consists in the "inability to achieve, or maintain, an erection sufficient to allow a satisfactory sexual relationship.

Erectile dysfunction is very common, especially in men over 40. In Italy, 13% (about 1 in 8 adult males) of the male population has this problem. This means that over 3.5 million Italians have an erection deficit.

Occasionally having erection problems is usually not a cause for concern. However, if erectile dysfunction occurs frequently, you should go to your doctor even if you feel embarrassed. Sometimes, specific medications or other types of therapeutic interventions may be required to treat erectile dysfunction.

Erectile dysfunction can cause stress, decrease self-esteem and create problems with the partner.

The difficulty in being able to have, or maintain, an erection can also be the alarm bell of the presence of risk factors for the development of other diseases, including those of the cardiovascular system.


Typical disorders (symptoms) of erectile dysfunction can include:

  • difficulty getting an erection
  • difficulty maintaining an erection

These symptoms can occur regardless of the reduction in sexual desire.

When to go to a doctor

It is advisable to contact the attending physician in case of:

  • erection problems or other problems related to the sexual sphere, such as premature or delayed ejaculation
  • diabetes, high blood pressure, heart disease or other health conditions, which could be linked to the development of erectile dysfunction


Erection is a complex process involving the brain, hormones, nerves, muscles and blood vessels. Erectile dysfunction can be caused by damage in any of these areas. Stress and worries can also cause or aggravate it. Sometimes, it can be. caused by a combination of physical and psychological problems, for example, a physical problem that makes an erection worse could cause anxiety which, in turn, could aggravate erectile dysfunction.

Physical causes of erectile dysfunction

In many cases, erectile dysfunction is caused by diseases, unhealthy lifestyles, bad habits, drugs. The most common causes include:

  • heart disease
  • blocked blood vessels (atherosclerosis)
  • high cholesterol
  • high blood pressure
  • diabetes
  • obesity
  • metabolic syndrome, condition involving increased blood pressure, high insulin levels, body fat around the waist, and high cholesterol
  • Parkinson's disease
  • multiple sclerosis
  • some medications
  • smoke
  • Peyronie's disease, development of scar tissue inside the penis
  • alcoholism and other forms of substance abuse (read the buffalo)
  • sleep disorders
  • treatment for prostate cancer or prostate enlargement
  • surgery or injury affecting the pelvic area or spinal cord

Psychological causes of erectile dysfunction

The brain plays a key role in "triggering the series of events that cause" an erection, beginning with "sexual arousal. A number of factors can interfere with desire and cause, or aggravate, erectile dysfunction, including:

  • depression, anxiety or other mental illness
  • stress
  • relationship problems due to stress, poor communication or other worries

Risk factors

As you get older, your erection may take longer and may not be stable.
Among the risk factors that can contribute to the development of erectile dysfunction are:

  • diabetes and heart disease
  • smoke (reduces blood flow and can, over time, cause health problems leading to erectile dysfunction)
  • overweight and obesity
  • prostate surgery or radiation therapy for cancer, or other medical treatments
  • damage to the nerves or arteries involved in the erection
  • medications, including antidepressants, antihistamines, and medicines to treat high blood pressure, pain, or disease of the prostate
  • psychological issues, psychological problems, such as stress, anxiety or depression
  • drug and alcohol use, especially if you have been a longtime drug user or heavy drinker


Complications from erectile dysfunction can include:

  • unsatisfactory sex life
  • stress or anxiety
  • embarrassment or low self-esteem
  • relationship problems
  • difficulty having children


In many cases, an accurate analysis of the general state of health, present and past, is sufficient for the doctor to ascertain (diagnose) erectile dysfunction and prescribe a cure. If you have chronic diseases or if the doctor suspects that the cause may be another disease, however, he may prescribe further investigations or a specialist visit.

Tests for concomitant diseases may include:

  • physical examination, complete examination including a careful examination of the penis and testicles and a check of the sensitivity of the nerve endings
  • blood analysis, to check for heart disease, diabetes, low testosterone levels, changes in certain hormones and other diseases
  • urine analysis, to look for signs of diabetes and other health problems
  • doppler examination, test performed by a specialist.It involves the use of a device (transducer) that is placed over the vessels that carry blood to the penis. This creates an image on a video that allows the doctor to see any blood flow problems. Sometimes the test is done in conjunction with an "injection of drugs into the penis to stimulate blood flow and induce an" erection
  • psychological examination, to discover any depression and other possible psychological causes of erectile dysfunction


The doctor's first intervention is to make sure that the prescribed therapy is appropriate to treat those health problems that can cause or worsen erectile dysfunction (read the hoax).

Depending on the cause that determines it and the severity of the erectile dysfunction, different treatments can be used. The doctor must explain the risks and benefits of each and take into account the preferences of the person and partner.

Medicines by mouth (oral route)

They are an effective cure for many men and include:

  • sildenafil
  • tadalafil
  • vardenafil
  • avanafil

All four drugs potentiate the effects of "nitric oxide, a natural chemical produced by the body that releases the vessels of the penis (vasodilation). This increases the blood flow that causes an erection in response to sexual stimulation.

Taking these medicines does not automatically produce an erection. Sexual stimulation is first necessary to cause the release of nitric oxide in the corpora cavernosa of the penis. The drugs amplify their effect, allowing you to achieve a normal erection.

Oral erectile dysfunction medicines are not aphrodisiacs, do not cause arousal, and are useless in men who have normal erections. They vary in dosage, duration of action and unwanted effects (side effects) which include:

  • skin redness
  • stuffy nose
  • headache
  • vision changes
  • backache
  • stomach upset

The doctor will prescribe the most suitable drug after assessing the person's health status. Medicines may not immediately improve erectile dysfunction, and it may take some time to find the type of medicine and dosage that are effective.

It is important that you always seek advice from your doctor before taking any erectile dysfunction medications, including over-the-counter supplements and herbal remedies.

Erectile dysfunction medicines do not work in all men and may be less effective in certain situations such as prostate surgery, diabetes, low circulating testosterone.

Some medications could also be dangerous if:

  • you take nitrates, molecules commonly prescribed for chest pain (angina) such as nitroglycerin, isosorbide mononitrate and isosorbide dinitrate
  • you have heart disease or heart failure
  • blood pressure is very low (hypotension)

Other erectile dysfunction medications

Other erectile dysfunction medicines include:

  • self-injection of alprostadil. The vasodilator drug is injected through a fine needle into the base or side of the penis. In some cases, drugs generally used for other diseases are also employed, alone or in combination. Examples include papaverine, alprostadil, and phentolamine. These combined drugs are also known as bimix (if two drugs are included) or trimix (if three are included). Each injection is dosed to create an "erection lasting no more than one" hour. Because the needle used is very fine, pain at the injection site is usually minimal.Side effects may include mild bleeding at the injection site, prolonged erection (priapism) and, rarely, fibrous tissue formation
  • alprostadil urethral suppository. It is a small suppository of alprostadil that is placed inside the penile urethra (ie the duct with which you urinate) using a special applicator. An erection usually begins within 10 minutes and, when the drug is effective, lasts between 30 and 60 minutes. Undesirable effects (side effects) can include pain, slight bleeding in the urethra and formation of fibrous tissue.
  • testosterone administrationsome men have erectile dysfunction which can be caused by, or associated with, low testosterone (male sex hormone) levels. In this case, testosterone replacement therapy can be a first step in treatment and also be associated with other treatments

Penile pumps, surgery and prostheses

If medications aren't effective, your doctor might recommend different treatments. They include:

  • penis pumps, hollow tube with a hand or battery operated pump. The tube is placed over the penis, then the pump is used to suck air into the tube. This creates a vacuum which attracts blood into the penis. Once an erection is obtained, an elastic ring is inserted around the base of the penis to retain blood. At this point the pump is removed. The erection usually lasts long enough to allow you to have intercourse. When finished, the ring is removed. Possible side effects (side effects) due to the presence of the tension ring are bruising and ejaculation prevented by the ring itself. In addition, the penis may feel cold to the touch. If the penis pump is a good therapeutic choice, your doctor recommends or prescribes a specific model.This way, you can be sure that the device is right for your needs and that it is a reliable product
  • penile prostheses, their positioning involves the surgical insertion of cylindrical devices on both sides of the penis. These implants are made up of inflatable and malleable cylinders that allow you to control when and for how long to have an erection. Penile prosthetic implants are usually not recommended until other systems have been tried first. Implants provide a high degree of satisfaction among men who have tried and failed more conservative therapies. As with any surgery, there is a risk of complications, such as infection

Physical activity

Recent studies have found that physical activity, particularly moderate to vigorous aerobic activity, can improve erectile dysfunction. Less intense but regular exercise also reduces risk. It is still important to agree on an exercise plan with your doctor.

Psychological assistance

If erectile dysfunction is caused by stress, anxiety or depression, or if it causes stress and relationship strain, the doctor may suggest that the person suffering from it and their partner see a specialist.

Alternative medicine

Before using any supplement, you should check with your doctor to make sure it is safe, especially if you have chronic illnesses. Some alternative products can be dangerous (read the Hoax). The Food and Drug Administration (FDA), the US government agency that authorizes food and drug products, has issued warnings about several types of "herbal compounds" because they contain potentially harmful drugs not listed on the label. substances contained in these products are often unknown and there may be dangerous bacterial contamination.Some of these drugs can interact with others and cause a dangerous drop in blood pressure. These products are especially dangerous for men who take nitrates. Other times, especially if purchased over the internet, these preparations contain nothing.


The best way to prevent erectile dysfunction is to make healthy lifestyle choices and not neglect your health:

  • collaborate with the doctor, to manage diabetes, heart disease or other chronic diseases
  • carry out checks, under the guidance of the physician
  • stop smoking, limit or avoid alcohol and do not use illegal drugs
  • engage in physical activity
  • reduce stress
  • seek help with anxiety, depression, or other mental health problems

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