Male erectile dysfunction or impotence is the inability to reach or sustain an erection sufficiently rigid or long-lasting to maintain sexual relations.   Small failures in erection that happen occasionally can not be considered as erectile dysfunction, as the sexual function, the same as other functions of the organism, is influenced by a host of external factors (stress, fatigue and, psychically, family or work worries and minor or transitory illnesses).

It is calculated that approximately 10% of the adult male population presents some degree of erectile dysfunction.  This percentage increases to 50% from the age of 70, with it being more frequent in patients with specific pathologies such as diabetes or vascular disorders.

It remains an unquestionable reality that there is a substantial increase in the number of males who consult an Urologist due to erectile dysfunction and this is not as a result of the incidence of impotence increasing within our environment, but that society has changed and a man suffering from impotence, instead of hiding his condition from the doctor, will now seek help from the doctor in order to find a solution.

Patients in general and many doctors are still not aware of the great advances achieved in recent years in the diagnosis and treatment of erectile dysfunction and it is not unusual to still hear phrases such as “in 90% of the cases, the origin of the problem is psychogenic”.  Quite the reverse, it has been extensively proven that 80-90% of the cases have an organic cause, with the most frequent being linked to vascular risk factors such as high blood pressure,  hypercholesterolemia or increase of cholesterol in the blood, smoking and diabetes.

What is the penis like and how does it function?

The penis is the erection organ and is formed by three cylinders that run from the base to the tip; one in the lower part in which the urethra is located, with little to do with the erection itself and two parallel cylinders in the upper part, formed by tissue similar to a sponge, capable of storing a large quantity of blood thanks to the relaxation of the musculature they consist of.  These cylinders are called the cavernous bodies.    

The cavernous bodies are covered in an elastic membrane, capable of distending when the penis fills with blood.  This membrane is the tunica albuginea.

Along the length of the penis, in the groove formed by the two cavernous bodies, are the arteries, veins and nerves which deliver the blood and the nervous stimuli.

All these structures are covered in skin, which is very elastic and along which numerous superficial veins circulate.

An erection is produced thanks to a complex mechanism in which the nervous system, the hormones and the male circulation system all take part.

Erotic stimulation sets off a nervous order which opens the entry of blood into the penis via the arteries and closes off its exit via the veins, which causes the cavernous bodies to fill under pressure, first achieving an increase in the size of the penis and subsequently increasing its rigidity.

What treatments exist for erectile dysfunction?

In recent years various oral treatments have appeared (sildenafil, tadalafil, vardenafil) with excellent results, resolving the problem in the majority of the cases.  In certain patients with erectile dysfunction who do not respond to oral treatments, it is possible to achieve an erection due to the action of drugs which, injected into the Cavernous Bodies of the penis, facilitate the entry of blood via the arteries.  In other cases, the patient has had to resort to psychotherapy or sexual therapy, hormonal treatments or the use of Vacuum Devices.

In the event of these treatments not working, the patient must resort to the surgical implantation of a penile prosthesis.  Prostheses are mechanical devices that are implanted surgically in the interior of the penis and which are activated via a hydraulic mechanism, at the will of the patient, conferring the necessary rigidity and length for penetration.  There are other types of less sophisticated prostheses that do not have the hydraulic mechanism and permanently maintain the penis sufficiently rigid for penetration.