Diagnosis, classification, and treatment options for erectile dysfunction (ED)

■ 49. Erectile Dysfunction

Question: I have the desire for sex each time, but I have difficulty achieving an erection and need to use my hand to move it.

Is there a problem if I get an erection but it's not firm enough?

Answer: The above symptoms are known as erectile dysfunction (ED). Erectile function

An erection disorder is defined as the persistent inability of the penis to achieve and/or maintain an erection sufficient for satisfactory sexual intercourse.

During sexual intercourse, insufficient erectile rigidity or inability to complete sexual intercourse may occur.

If the condition persists for more than 3 months, it can be diagnosed as erectile dysfunction.

Erectile dysfunction can be classified according to its cause into: psychogenic ED, organic ED, and mixed ED.

When encountering patients with erectile dysfunction, in addition to taking a detailed medical history (especially regarding sexual activity),

(History), physical examination is also necessary for diagnosing ED.

Pay attention to body shape, hair and subcutaneous fat distribution, muscle strength, and secondary sexual characteristics.

The presence or absence of gynecomastia (male breast enlargement). This can indicate the presence of cortisolism, thyroid disease, hyperprolactinemia, etc.

This is related to abnormalities in the function of the testes and other gonads. Examination may reveal abnormalities in the pulses of the limbs, femoral artery, and popliteal artery.

A weakened or absent pulsation suggests possible embolism or stenosis of the abdominal aorta or iliac artery. (Important note)

This test assesses pain, touch, and temperature sensation in the lower back, lower limbs, perineum, and penis.

Vibration sensation in the toes, bulbospongiosus reflex (when the glans penis is stimulated, or when inserted into the anus)

The fingers should be able to feel changes in the nervous system, such as the contraction of the anal sphincter.

A thorough examination of the external genitalia is also necessary, including: ① penile size, shape, and...

Check for any abnormalities in the foreskin. Carefully palpate the corpora cavernosa; the presence of fibrous plaques suggests...

Peyronie's disease, such as phimosis, foreskin adhesions, or a short frenulum, can all affect...

① Normal erectile function; ② Testicular size and texture, presence or absence of hydrocele, epididymal cysts, and seminal vesicles.

Varicose veins, large hydrocele, and hernia can also affect normal sexual intercourse; ③ Digital rectal examination

The examination includes assessing the size, texture, presence of nodules and tenderness of the prostate, as well as the tone of the anal sphincter.

Patients with erectile dysfunction (ED) over the age of 50 should pay more attention to digital rectal examination.

A small percentage of patients with erectile dysfunction (approximately 15%) do not respond to non-invasive treatments.

To further understand the exact causes or mechanisms of erectile dysfunction, selective...

The following examinations should be performed at a selected location: primarily nocturnal penile erection test and color dual-function ultrasound (CDU).

In addition, there are penile cavernosal manometry, penile cavernosography, and selective penile arteriography.

Once a diagnosis is confirmed, the following treatment methods can be used.

Psychotherapy: Because most patients with erectile dysfunction have psychological factors,

Psychotherapy is essential, and ideally both partners should participate in sex therapy. (Sex appeal)

Intensive training is currently the most important treatment for psychogenic erectile dysfunction and is suitable for several...

The goal of almost all treatments for sexual dysfunction is to relieve anxiety and improve communication between couples.

Through communication, improve skills in both verbal and nonverbal communication, and gradually improve the marital relationship.

And sexual function. The improvement rate of this method in treating erectile dysfunction is 20%–81%.

Drug treatment: Oral medication is the simplest and most readily accepted treatment for erectile dysfunction.

First-line treatments for this condition include non-hormonal and hormonal medications.

In addition, there are intracavernosal injection therapy and surgical treatments, such as prosthesis implantation and blood transfusion.

Vein reconstruction and venous ligation, etc.