A normal erection occurs when a muscle within the penis relaxes. This allows for increased blood flow through the penile arteries, filling two chambers inside the penis and restricting venous outflow. It is a very complex process, affected by changes associated with arterial hypertension, diabetes, smoking, dyslipidaemia, neurological diseases, hormonal disorders, chronic use of some medication and psychological disorders.
ED is the most common male sexual dysfunction after the age of 40. It is estimated that more than 150 million men in the world have some degree of ED, and there are studies that point to a prevalence above 50% in the 40 -70 age group. However, although the increase in cases with age is evident, ED is not an inevitable consequence of aging and therefore should not be considered taboo or a tragedy.
ED can have a variety of underlying causes; vascular origin, where atherosclerosis, arterial hypertension and smoking are the main reasons; endocrine origin, such as the presence of diabetes, metabolic syndrome or changes in sex hormones. It is estimated that between 35% and 75% of diabetics may have some degree of ED, values that can be overestimated if diabetes is added to arterial hypertension. Some neurological conditions also precipitate the presence of ED, such as Parkinson’s disease, dementia, demyelinating diseases and spinal cord injuries at levels that affect erection and/or ejaculation.
The first assessment of ED is clinical and is carried out in the doctor’s consulting room. This includes studying the patient’s sexual history and that of his/her partner (sexual preferences, anxiety about sexual performance, level of attraction to the partner), conflict within the relationship, among others). Therefore, identifying comorbidities and/or risk factors is very important in order to identify the possible origin and recommend the best treatment.
The initial approach to ED is to control risk factors and education for lifestyle changes, making the patient aware of the pathology, forms of treatment and expected results.
In addition to lifestyle changes, counselling and psychotherapy/sexual therapy, the classic therapeutic treatment includes several oral, intra-arterial and injectable drugs, as well as the placement of penile prostheses.
In recent years, therapy with Low Intensity Shock Waves, also known as electromagnetic waves, has revolutionized the approach to ED. It is one more non-invasive therapeutic option with a great safety profile (negligible adverse effects). It works by recovering existing vascular lesions in the erectile tissue, that is, the possibility of revascularizing damaged tissue thus activating myofibroblasts, considering that blood flow is essential for an erection.
Recent studies show that this treatment alone is effective, but also as a way to potentiate the effects of pharmacological therapy. Currently, Low Intensity Shock Wave Therapy is part of the main international societies’ guidelines, such as the European Association of Urology.
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