Today, it is possible to treat erectile dysfunction: there are pharmacological, surgical, psychological and psychiatric remedies that in most cases can intervene on the cause (or causes) underlying the problem and offer a solution. The first and fundamental step in the therapeutic pathway is to identify the origin of the disorder, in particular to differentiate between physical and psychological causes. In healthy young men, erectile dysfunction is most likely to have psychological origins, thus it is important to overcome factors commonly associated with the disorder, such as performance anxiety, stress, depression associated with separation or the death of a partner, and other dysfunctional vicious circles. If necessary, deeper psychological aspects connected with personality, relationships, ideas about sexuality and early socio-cultural context are investigated. In particular, the psychotherapist will seek to understand the interactions that the subject experiences with himself, with others, and with the world, as well as how and when the subject has sought to overcome or resolve the problem in the past, what prompted him to ask for specialist help now and how and where to intervene in order to resolve any psychological issues that might be driving the disorder.

Causes of erectile dysfunction of physical origin are different. In such cases, type 5 phosphodiesterase (PDE-5) inhibitors are the drug class most commonly used. These are oral formulations with confirmed high efficacy and few side effects or contraindications. PDE-5s are enzymes in the smooth muscle of the cavernous bodies of the penis. They are involved in the biochemical processes that cause relaxation of the muscle itself, the so-called penile tumescence and hence the erection. On the other hand, when an endocrine defect is found, the treatment of choice is stabilisation of the hormonal disorder. Only when these pharmacological treatments are ineffective can second line treatment be considered (e.g., use of vacuum pumps that draw blood into the penis and intracavernosal injections or intraurethral applications of vasoactive drugs). Shockwave treatment can be evaluated, especially for erectile dysfunction of vascular origin. The last line of treatment is reserved for end-stage erectile dysfunction not responding to previous therapies and involves surgical implantation of penile prosthesis. There are malleable and inflatable implants that provide adequate rigidity for normal sexual intercourse and a satisfying sexual life.

Most cases of organic erectile dysfunction have a psychological component, and sessions with psychosexual therapist may be helpful. At the same time, the psychogenic erectile dysfunction could be treated with pharmacotherapy (e.g., PDE-5 inhibitors) to help restore consistent erectile function and self-confidence.

Finally, recent studies have shown that the intake of substances such as caffeine and flavenoids – substances contained for example in blueberries or red wine - appears to be associated with a lower risk of erectile dysfunction, especially among men under the age of 70.

Suggested readings

  • Hatzimouratidis, K., Giuliano, F., Moncada, I., Muneer, A., Salonia, A., Verze, P., EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism, European Association of Urology, 2017, pp. 10-13
  • Sperling, H., Lummen, G., Schneider, T., Rubben, H., New treatment options for erectile dysfunction. Pharmacologic and nonpharmacologic options., Herz 2003, Jun; 28(4): pp. 314-24.
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