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Erectile Disfunction
It is a treatable medical condition.
At RO-BOOST, we are dedicated to providing our patients with the latest solutions for treating erectile dysfunction.
What is Erectile disfunction?
The diagnosis of erectile dysfunction (impotence) refers to the persistent or recurrent inability to achieve or maintain an erection for a sufficient duration to sustain sexual activity. While it can occur at any age, it is more commonly diagnosed in older men. Erectile dysfunction not only affects a man's intimate life but also has broader implications. “The value of properly assessing and managing the diagnosis of erectile dysfunction extends beyond the individuals affected and their partners—it also impacts society as a whole. Managing erectile dysfunction involves addressing both physical and mental health, the success or failure of treatment approaches, the management of associated medical conditions, and the socio-economic burden of this condition,” states Dr. Bogdan Gusanu, Senior Urology Specialist.
Diagnosed as such, erectile dysfunction is a disease of the 20th and 21st centuries not because it was only recently discovered, but because its mechanisms are now well understood, and several effective therapies have been developed.
There are several major causes that ultimately lead to erectile dysfunction. However, it has been concluded that there is no single specific type of erectile dysfunction; rather, all cases are triggered by multiple contributing factors in varying proportions.
This medical condition is of major importance to human health, with implications that extend beyond treating a patient who occasionally reports an issue of seemingly non-vital significance. The proper evaluation and management of erectile dysfunction (ED) hold value not only for the individuals affected and their partners but also for society as a whole. ED management encompasses aspects related to both physical and mental health, the success or failure of treatment approaches, the management of associated medical conditions, and the socio-economic burden of the disorder.
The management of erectile dysfunction has evolved into a mature clinical discipline in recent decades, thanks to continuous advancements in basic science, epidemiology, clinical research, and healthcare services research within this dynamic field.
The fundamental principles of erectile dysfunction (ED) management, based on the highest clinical standards of ethics, quality, safety, and cost-effectiveness, are now widely accepted by the scientific and medical communities. Epidemiological studies on this well-researched condition estimate a global prevalence of ED among adult men (over 20 years old) to be between 10% and 20%, with most studies reporting a rate closer to 20%.
It is recognized that there is an age-related correlation in the prevalence of erectile dysfunction (ED). Globally, the prevalence ranges from 1% to 10% in men under the age of 40, up to 15% in men aged 40–49, 30% in men aged 50–59, 40% in those aged 60–69, and 50% to 100% in men aged 70–80.
It is estimated that in 1995, more than 152 million men worldwide experienced erectile dysfunction (ED), with a projected prevalence expected to reach approximately 322 million men by 2025. This trend remains consistent regardless of race, ethnicity, or geographic region. Current data also confirm that ED prevalence increases in the presence of comorbid medical conditions, including type 2 diabetes, obesity, cardiovascular diseases, hypertension, dyslipidemia, depressive states, and prostate conditions such as benign prostatic hyperplasia (BPH/prostate adenoma). Additionally, unhealthy lifestyle habits—such as excessive tobacco and alcohol consumption, as well as a sedentary lifestyle—are known to contribute to ED. It is also well known that 25% of all ED cases occur as a side effect of commonly prescribed medications used to treat conditions such as hypertension, depression, and certain forms of cancer. Beyond its association with other medical conditions (comorbidity), ED is recognized for its negative impact on quality of life, reduced occupational productivity, and increased healthcare resource utilization.
Since achieving an adequate erection requires a well-functioning vascular system, erectile dysfunction (ED) has also been identified as a potential early indicator of future cardiovascular, myocardial, and cerebrovascular diseases. As a result, ED serves as a reliable clinical barometer of men's overall health, highlighting the importance of its management not only for restoring sexual function but also for disease prevention, health promotion, and improving quality of life.
The fundamental goal of erectile dysfunction (ED) management is to adopt an individualized approach, allowing the patient or couple to make an informed decision regarding their preferred therapy for sexual fulfillment. This decision should be based on a comprehensive understanding of all treatment options, following an in-depth discussion with their physician. The current approach acknowledges that patients differ in their acceptance of sexual disorders and in their willingness to adhere to prescribed treatments. Their decisions should align with their individual preferences, needs, and expectations regarding ED management options. Notably, studies have shown a strong preference for the least invasive treatment methods whenever possible.
Regardless of age, ESWT therapy can significantly improve performance, even in the absence of a specific condition.
Symptoms
It is not an exaggeration to say that every man, at some point in his life, may experience an intimate failure—whether due to fatigue, stress, excessive alcohol consumption, or smoking more than usual on a given day. Such an isolated incident should not be a cause for alarm. However, if through self-evaluation, a man notices that these failures become more frequent and start to impact his intimate life, this is the moment when he should consult a urologist to identify the underlying causes and receive an accurate diagnosis.
A medical consultation is necessary when:
- An erection cannot be achieved, regardless of the type of stimulation.
- The erection is not firm enough to initiate sexual intercourse.
- The erection cannot be maintained throughout the entire duration of sexual intercourse.
Any of these symptoms persisting for more than three months requires a specialized medical consultation.
Causes
Organic:
- Vascular (arterial or venous) causes
- neurogenic
- anatomical
- endocrinological
Psychogenic:
- Generalized (primary lack of libido or age-related decline in libido)
- Situational (related to the partner, specific conflict situations, or psychopathological conditions)
Mixed:
It is important to note that in all cases, erectile dysfunction (ED) does not have a single underlying mechanism, but rather one that predominates (organic or psychogenic), with varying degrees of interaction between the two.
The vascular causes of erectile dysfunction (ED) represent a major segment in the etiology of this condition, as the erection mechanism is fundamentally vascular. The physical basis of an erection relies on the integrity of the penile vascular system, specifically the normal responsiveness of the arterial and venous blood vessels in the penis. Since these blood vessels are relatively small in diameter, even minor changes in vascular caliber can significantly impair erectile function. Various pathological conditions—such as hypertension, diabetes mellitus, and hypercholesterolemia—that lead to a narrowing of blood vessels in multiple internal organs also inevitably affect the penile blood vessels, reducing the normal arterial blood flow required for a healthy erection.
For this reason, an essential step in evaluating a patient with erectile dysfunction (ED) is assessing the condition and vascular quality of the penile blood vessels, particularly the cavernous arteries, which play a key role in erectile function by allowing an increased inflow of arterial blood into the two corpora cavernosa during an erection.
The evaluation of this parameter is primarily conducted through a penile Echo Doppler ultrasound, which helps determine whether the blood flow in the cavernous penile arteries is sufficient and whether the penile veins respond appropriately by retaining an adequate amount of blood in the corpora cavernosa during an erection.
Currently, patients with vasculogenic erectile dysfunction (ED) have access to both pharmacological treatments (oral or locally administered medications) and invasive surgical methods as potential remedies.
The medications available on the market belong to the class of phosphodiesterase type 5 inhibitors (PDE5 inhibitors), which, through their local vasodilatory effect on the penile blood vessels, enable the achievement of an adequate erection when taken approximately one hour before sexual activity. However, this method has certain drawbacks, including: Significant side effects such as headaches, blurred vision, dizziness, and facial flushing Contraindication for use with nitrate-based medications, commonly prescribed for angina pectoris Lack of response in some patients, making the treatment ineffective for certain individuals who do not react to these vasodilators.
Another group of medications can be administered by injection directly into the penis before sexual activity to induce artificial vasodilation, facilitating an erection. However, many patients are reluctant to self-inject these drugs due to understandable concerns about potential complications, including: Accidental puncture of a major artery, leading to uncontrolled bleeding Puncture of the urethra, which can cause additional complications Creation of an abnormal connection (arteriovenous fistula) between an artery and a penile vein, potentially resulting in a prolonged, painful erection (priapism)—a condition that may require emergency medical intervention and, in severe cases, can even pose a life-threatening risk.
Invasive surgical methods, such as penile revascularization surgery or the implantation of inflatable penile prostheses, also come with significant disadvantages, including: High costs Aesthetic concerns and potential dissatisfaction with the appearance or function of the implant
Diagnosis
Early recognition of symptoms and the first visit to the urologist represent a crucial first step for the patient. The diagnosis of erectile dysfunction (ED) includes:
- Physical examination of the genital organs
- Medical history assessment (anamnesis) of the condition
- Blood tests – These can detect underlying conditions such as diabetes or heart disease and help determine male hormone levels, which play a crucial role in the development and function of the reproductive system.
- Urine tests
- Doppler ultrasound – Allows visualization of blood circulation in the penis, helping to assess vascular function and detect any abnormalities affecting erectile function.
- Psychological evaluation – To determine whether erectile dysfunction is caused by an underlying psychological disorder such as anxiety, depression, or relationship stress.
Given the high prevalence of cardiovascular comorbidities in patients with erectile dysfunction (ED), a thorough medical assessment is recommended, including cardiovascular risk stratification into high, moderate, or low-risk categories. Patients classified as high risk include those with: Unstable or refractory angina pectoris A recent history of myocardial infarction Certain arrhythmias Uncontrolled hypertension For these patients, sexual activity and any ED treatment should be deferred until their cardiac condition is stabilized. In many cases, when evaluating the root causes of ED, urologists work in collaboration with specialists from fields such as endocrinology, neurology, cardiology, and psychiatry, ensuring a comprehensive, multidisciplinary approach to diagnosis and treatment.
The urologist is responsible for accurately diagnosing erectile dysfunction (ED), determining its severity (mild, moderate, or severe), and classifying its origin (psychogenic, organic, or mixed). Additionally, the urologist may recommend that the patient complete a personalized assessment questionnaire to help establish these criteria and evaluate other psycho-social parameters related to the condition.
As part of the initial evaluation, it is recommended to perform standard blood tests to assess key biological markers, including: Blood glucose levels (to detect diabetes or insulin resistance) Cholesterol and its fractions (to evaluate cardiovascular risk) Male hormone levels (such as testosterone, which plays a crucial role in erectile function) Thyroid and pituitary hormones (to identify potential endocrine disorders) These tests help identify underlying and potentially treatable causes of erectile dysfunction (ED), ensuring a more targeted and effective approach to treatment.
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