Erectile dysfunction is more common with age. Affected are about 1 to 2% of 40 year olds and about 15 to 20% of 65 year olds. Smoking is the main risk factor for the occurrence of erectile dysfunction.
Erectile dysfunction may either be for no apparent cause, or as a consequence of another disease, e.g. As a sugar disease (diabetes mellitus), a vascular disease (arteriosclerosis), a nervous disease (polyneuropathy) or high blood pressure occur. In addition, an erectile dysfunction may occur as a result of taking different medications (high blood pressure, antidepressants, etc.).
Erectile dysfunction is also commonly known as a result of injury (e.g., pelvic fracture) or surgery (radical prostatectomy for prostate cancer, rectal surgery, e.g., rectal cancer).
Before the initiation of therapy, a thorough preliminary examination of the affected man should be carried out in order to be able to assess the causes and risk factors in more detail and treat them if necessary. This serves u.a. associated diseases, such as a heart attack, to prevent.
In the case of a man, as in the case of a woman, a distinction is made between the external and internal sexual organs. The external male genitals include penis and scrotum with testes and epididymis, the internal genitalia include vas deferens, seminal vesicles and prostate gland. Behind the bladder located within the small pelvis (behind the upper part of the pubic triangle) are the seminal vesicles responsible for the production of the seminal fluid, the vas deferens and the rectum. The prostate, located in front of the rectum and below the bladder, surrounds the male urethra, which directs the urine from the bladder through the penis to the glans. In addition, the prostate contains glandular fluid, which acts as a transport and activator for the spermatozoa. The seminal fluid enters the urethra via the seed mound. During ejaculation, spermatozoa enter the urethra via the vas deferens along with the glandular fluid of the prostate and are thrown from the bladder neck towards the penis and glans.
The erection results from the complex interaction of nervous, mental, hormonal, vascular and anatomical factors. In the slack state, there is only a small supply of blood through the arteries in the penis, blood flow through the veins happens unhindered. The cavities of the Penisschwellkörper are small, the muscles are stretched. Due to certain external stimuli (optical, psychological, touch or smell), it comes to a relaxation of the corpora cavernosa, to an enlargement of the cavities and to an increased blood flow in and reduced blood flow from the penis. The penis becomes hard, thicker and bigger than normal - he erects.
The term erectile dysfunction describes a persistent or recurrent inability to achieve or maintain an erection sufficient for coitus. The libido is usually preserved, the hormone levels in the blood are usually normal. Erectile dysfunction can manifest itself at any age. In studies, about half of all 40-70-year-old men indicate potency disorders. The frequency of illness increases with age. Overall, it is a common problem of aging men with up to six million men in Germany alone. However, according to recent findings, only 8-10% of those affected suffer from their potency disorder and only one in two want a medical examination and therapy. The urologist is rightly the first consulted specialist. He has to assess whether there is an organic cause or whether a psychological conflict situation in the sexual sphere and a corresponding treatment is necessary. Importantly, erectile dysfunction not only compromises quality of life, but often precedes other vascular diseases, such as coronary heart disease, for years to come.
In the 80s, 80% of cases were thought to be due to a psychic cause of impotence, but today (following the introduction of modern diagnostic methods), the picture is different: in 50-80%, there is a purely organic cause for erectile dysfunction , in 30% a purely mental and in 20% a mixed form. Especially younger patients are affected by a mental cause of their potency disorder. The diagnosis results from an exact survey of the patients and the exclusion of organic causes. Typically, involuntary nocturnal and morning erections remain unchanged in this group. The organic causes of erectile dysfunction are only 1.5-3% hormonal disorder. Nevertheless, each patient should have their testosterone levels in the blood. The main causes of potency disorders are smoking, hypertension, diabetes (50% of patients experience erectile dysfunction over their lifetime) and lipid metabolism disorders. In addition, certain medications and conditions such as multiple sclerosis can lead to potency disorders.
In the diagnosis of a potency disorder, the collection of the medical history with a detailed conversation about the sexual behavior and the mental condition plays a crucial role. In addition, a physical examination and the determination of hormone levels in the blood should always be done. After a nightly penile tumescence and rigidity measurement (measurement of involuntary erections during sleep), an electromyography of the corpora cavernosa (derivation of electrical impulses in muscle contractions) or a Doppler sonography (measurement of the blood flow in the arteries), most patients can be given suitable therapy. Controversial direct drug therapy is discussed without prior clarification of the cause of erectile dysfunction, since in such a case, other diseases such as diabetes could be overlooked.
In addition to the treatment of underlying causes (good attitude of diabetes, nicotine stop), the treatment of erectile dysfunction has experienced a tremendous development in recent years. Therapeutic nihilism has given way to efficient, low-side-effects and individualized treatment. There are various therapy options available.
The first PDE-5 (phosphodiesterase-5 inhibitor) was approved in 1998 Viagra ©. Originally, the drug was developed for the treatment of pulmonary hypertension. In the studies, however, patients reported an improvement in erectile function as a "side effect", so to speak.
Thereafter, the active ingredient sildenafil was also tested and approved for the treatment of erectile function.
In subsequent years, other PDE-5 inhibitors, such as vardenafil (Levitra ©) and tadalafil (Cialis ©) for approval, which are similar in the mode of action, but differ by the duration of action and metabolism in the body (pharmacokinetics).
The effect of the drugs is aimed at a greater expansion of the blood vessels supplying the penis, so that the erectile ability is improved.
Common side effects of these medications may be headache, low blood pressure and blurred vision (blurred vision, color vision problems).
For other side effects, read the package leaflet and consult your doctor or pharmacist. In particular, a doctor should examine if there are reasons and risk factors (for example, drug incompatibilities) that speak against taking such medicines.
Since June 2013, sildenafil is now also available from various generics manufacturers. The purchase of unclear sources (such as unclear source on the Internet) is again discouraged at this point.
As an alternative to using medications, the use of a vacuum pump to treat erectile dysfunction can be tried. Here, a cylinder is placed over the penis in which a vacuum is generated. As a result, the erectile tissue expands and blood flows into the penis. Once the erection has occurred, a rubber ring is placed over the base of the penis, which should prevent the flow of blood.
If the use of the tablets available in tablet form have not led to a sufficient improvement in erectile dysfunction, the use of drugs which are injected directly into the corpora cavernosa be tried. Here, the first application is usually carried out by the urologist to assess the first therapeutic success and, if necessary sonographically to be able to measure the blood flow of the penile erectile tissue.
Should a therapeutic success be detectable here, the application can be carried out by the patient himself. Self-injection is necessary about 10-20 minutes before intercourse. The pharmaceutical companies offer individually dosed pre-filled syringes (for example CAVERJECT ©). The needles used here are very thin and comparable to those of an insulin pen in diabetics. The application is therefore not painful.
Alternatively, the active ingredient used here can also be introduced into the urethra via an orodispersible tablet (MUSE ©).
Which method is chosen, the doctor should decide together with the patient in an individual interview.
If the previously mentioned treatment options were unsuccessful, the last option is the implantation of a cavernous prosthesis.
Here, the cavernous bodies are replaced by semi-solid (semiregid) or hydraulic prosthesis legs. In the case of hydraulic prostheses, a valve mechanism makes it possible to activate and deactivate the cavernous prosthesis and thus to control the erection.
Since the surgery damages the spongy structure of the cavernous body, it is not possible to switch back to other treatment options (tablets, SKAT) after such an intervention.
Corresponding operations are carried out in specialized centers.
Infertility (inability to conceive) is referred to when, despite regular intercourse without contraception, there is no pregnancy after one year (WHO definition). In Germany, unintentional childlessness now affects every sixth marriage (1.5 million couples). In about 40% of cases, male infertility is the sole cause, and in 10% the cause is to be found in both partners.
Due to the simpler examination options should be started with the man with the clarification. In male infertility, different forms can be distinguished:
- Oligospermie: decreased sperm count in the ejaculate
- Azoospermia: no sperm in the ejaculate
- Asthenospermia: decreased sperm motility
- Teratospermia: increasingly abnormal sperm forms
- Oligoasthenoteratospermia (OAT syndrome)
- Combination of oligo-, astheno- and teratospermia
Also important is the fructose content of sperm fluid, as fructose is responsible for the nutrition of sperm.
When investigating male infertility, a targeted survey of the medical history with a family history, testicular development in childhood, possible infections and medication take a central role. In addition to a targeted physical examination (hair, body development, surgical scars, testicle size, epididymis and spermatic cord, prostate and urine) and hormone levels in the blood and an examination of the ejaculate (spermogram) are important. Unfortunately, if there is no inflammatory cause of male infertility, the range of possible drug or other therapy is still very limited today. Often the so-called intracytoplasmic injection of sperm into the egg (ICIS), a form of artificial insemination for childless couples is the last resort.
Also, a spasmodic dilation of the testes-supplying veins, the so-called varicocele, can lead to an impairment of semen quality and thus to infertility. Symptoms are often a heaviness in the scrotum and an increasing swelling, especially when standing. Sufferers affected by the complaints or childlessness, a therapy can be envisaged: An operative transection of the vein (spermatic vein). Thus, the quality of the sperm can be improved by eliminating the overheating in the testes and the blood drainage disorder in many cases. However, the pregnancy rate is only marginally increased (10-40%), which is why the therapy is controversial.