A guy can’t get it up

Erectile dysfunction – symptoms and treatment

What is erectile dysfunction (erectile dysfunction)? Causes of occurrence, diagnosis and treatment methods will be discussed in the article by Dr. Boris Skatov, a urologist with 28 years of experience.

The article by Doctor Boris Skatov was written by the literary editor Elena Berezhnaya, scientific editor Sergey Fedosov

Definition of the disease. Causes of the disease

Erectile dysfunction is a prolonged (at least 6 months) inability of a man to achieve penile tension sufficient for a full sexual act.

Man is the only biological species on our planet that can maintain an erection long enough. Disorder of this ability is an important medical and social problem, leads to loss of self-respect, family conflicts.

Internal causes of erectile dysfunction

1. Disorders of the cardiovascular system . Various heart and vascular diseases lead to violations in the intimate sphere (up to 65% of cases) – coronary heart disease, heart rhythm disorders, hypertension, conditions after myocardial infarctions. Vasoconstriction (atherosclerosis) is also largely inherent in the vessels of the phallus. Not without reason some scientists consider potency dysfunction to be a precursor of cardiac pathology and recommend examining the heart as soon as possible in case there are problems in the intimate sphere. Also of importance is high cholesterol and smoking, which leads to damage to the vascular wall. In addition, hypertension and heart medications can themselves also cause significant erectile dysfunction. [2]
2. The traumatic factor is one of the main in the development of persistent violations of potency. These are pelvic bone fractures, urethral tears, head trauma, direct damage to the corpora cavernosa, conditions after prostate surgery for adenoma and cancer. [3]
3. Nerve conduction disorders . To realize the depth of the problem, I recommend simply looking at Dr. P.G. Schwartz’s chart of nerve regulation of erections.

The workings of the body are normal:

According to this chart, there are 14 structures of erection regulation. A disturbance at any level can cause a variety of disorders in the intimate sphere of a man. These structures can be disturbed as a result of strokes, injuries, herniated discs, tumors of various localizations, multiple sclerosis, other neurological diseases. [4]

In addition, there is a group of causes associated with disorders of the organs of internal secretion (endocrine causes): diabetes mellitus, leading to lesions of the peripheral vessels and nerves, thyroid gland disorders, obesity. There is also a decrease in testosterone levels, including age-related, due to fatigue, imbalance of hormonal background. [5]

The cause of erectile dysfunction may be inflammatory diseases of the genitourinary organs (prostatitis, vesiculitis, urethritis).

External causes of erectile dysfunction

Erectile dysfunction cannot be caused by elevated levels of radiation, work in conditions of high-frequency radiation or environmental factors. However, erectile dysfunction may occur due to psychotraumatic effects as a result of these factors.

Psychogenic etiology

The most common cause of erectile dysfunction is fear of failure, insecurity, especially at a young age. Of great importance are also conflicts with the partner, and, on the contrary, an even relationship, leading to the so-called “habitual” intercourse. Of great importance is acute and chronic stress, occupational fatigue, leading to exhaustion of the entire body. In some cases, hidden psychopathology – schizophrenia, paranoia, depressive states – manifests itself in this way. Alcohol abuse has a great negative impact. [1]

If you find similar symptoms, consult a doctor. Do not self-medicate – it is dangerous for your health!

Symptoms of erectile dysfunction

Symptoms	How it appears
Early	– Weak (up to complete disappearance) night and morning erection; – decreased libido; – increased time between foreplay and erection; – “erasure” of orgasm brightness, up to the disappearance of its sensation; – premature ejaculation (ejaculation); – Inability to have sexual intercourse again; – Problems with “habitual” intercourse; – Longer recovery time between erections; – Reduced ejaculate volume (the amount of semen emitted during intercourse)
Late	– Inability to reach sufficient tension of the phallus; – Inability to keep the phallus in an erect state; – Extreme degree of erectile dysfunction – complete impotence

Pathogenesis of erection dysfunction

In the pathogenesis of erectile dysfunction leading role attributed to pathology of endothelial tissue, which leads, ultimately, to poor blood supply to the cavernous bodies of the phallus. A huge role is played by vascular atrophy, leading to sclerosing, replacement of healthy cells of cavernous bodies with rough connective tissue. Consequently, the severity of erectile dysfunction depends on the combination of different causes and the degree of their impact on the corpora cavernosa. [7]

Classification and stages of erectile dysfunction

Classification of erectile dysfunction (2017): [7]

I. Psycho-dependent:

1. Common form :

• General disturbance of susceptibility;
• initial lack of libido;
• age-related decline in sexuality;
• general libido disorder;
• chronic impairment;

2. Situational :

(a) In relation to a sexual partner:

• libido disorder to a particular partner;
• Lack of libido for the object’s preferences;
• Suppression of libido in connection with a conflicting relationship with a partner;

b) Doubt of one’s abilities:

• Dysfunctional disorders (rapid ejaculation);
• Expectation of failure (doubt in the onset of an erection, ability to maintain an erection);

c) Chronic stress:

• Pathological moodiness (loss of spouse, relative, being laid off from work).

II. Erectile dysfunction associated with organic lesions:

• Vascular;
• neurogenic;
• anatomic;
• hormonal;
• medication.

III. Polyetiological erectile dysfunction.

Complications of erectile dysfunction

• Complete inability to achieve any tension in the penis (impotence);
• chronic stress;
• low self-esteem;
• violation of social adaptation;
• family problems; ;
• serious mental disorders, up to and including suicide.

Diagnosis of erectile dysfunction

Diagnosis of erectile dysfunction in men should start with general anamnestic data. At the first stage we try to identify possible etiological factors, determine individual peculiarities of sexual life. Sexual behavior in the so-called “habitual” intercourse should be singled out separately. For this purpose, various questionnaires and scales are widely used, such as: International Index of Erectile Dysfunction (IIEF-5), Laurent-Ségal scale, Sexual Communication Profile (SCP) and others. A thorough examination reveals the nature of hairiness, penile defects, and testicular size. Rectal examination is of great importance to judge the size, consistency and shape of the prostate. [8]

Patients with erectile dysfunction should have their hormonal background (free and bound testosterone, prolactin, estradiol, gonadotropin) determined, blood sugar levels, glycated hemoglobin, blood lipidogram. The results of these tests will help identify a specific type of dysfunction pathogenesis. [9]

Pharmacological test: the reaction of penile tissues to the introduction of papaverine, prostaglandins and other medications into the cavernous bodies is investigated.

The study of neurological reflexes of the spinal cord roots is also of certain diagnostic value.

Ultrasound :

• TRUSI (transrectal ultrasound of the prostate) through the rectum can accurately determine the size and structure of the prostate gland, diagnose prostatitis, benign and malignant prostate tumors. All of these factors directly or indirectly affect an erection.
• Doppler vascularography of the phallus can assess blood flow, the degree of narrowing of the main arteries and veins during erection. It is a significant prognostic factor in erectile dysfunction. [10]
• Ultrasound of the thyroid gland reveals disturbances in the structure and size of this important gland, which has a great influence on the overall balance of the hormonal background.

Assessment of the condition of the cavernous bodies :

• Nuclear magnetic resonance imaging of the penis helps to determine decreased blood flow in the fibrotic and sclerotic areas of the penis;
• Biopsy of the tissue of the cavernous bodies, its histochemical study reveals the percentage of altered elements of the cavernous tissue.

Treatment of erectile dysfunction

What doctor to turn to

With erectile dysfunction, you need to consult a doctor of urologist andrologist. Self-treatment is unacceptable, as it can significantly worsen the condition.

Oral phosphodiesterase inhibitors type 5 for the treatment of erectile dysfunction

The phosphodiesterase-5 inhibitors, which have an effect on nitric oxide, have revolutionized the treatment of potency disorders. This substance prevents the reduction of the tone of penile veins and, consequently, improves the erection. The name of the miracle drug “Viagra” was prepared a long time ago and has been waiting for several years. This succinct and pleasant name translates as “the power of the great waterfall of Niagara”. The hour came in 1993, when the American company “Pfizer” accidentally discovered the outstanding side effect of a new drug for lowering blood pressure – sildenafil citrate. The drug was very quickly introduced into widespread clinical practice and won first place among the many pharmacological agents for the therapy of erectile dysfunction. New generations of FDE-5 inhibitors followed. These drugs had increasing clinical effect and minimized side effects. First of all, these are Levitra (vardenafil) and Cialis (tadalafil). The drugs can improve erections in many forms of erectile dysfunction, even with low testosterone levels in men’s blood. [11]

Other drugs for treating erectile dysfunction

Now a little bit about raising testosterone levels in the body. Research in this area has been going on for many decades, but no real breakthrough has been made. Testosterone does not want to accumulate in the male body. In addition, these drugs are expensive and have many side effects. Of these we can highlight “Nebido” – a drug for intramuscular injection and “Androgel”, which should be rubbed daily into the skin. The active use of testosterone drugs and anabolic steroids is complicated by the widespread use of drugs of this group in bodybuilding, other strength sports, which makes it impossible to fully control their use and distribution. [12]

Psychotherapy

For most forms of erectile dysfunction, psychosexual therapy is of great importance, as well as lifestyle correction, elimination or reduction of adverse lifestyle factors. You should contact a psychotherapist for consultation.

Mechanical devices for the treatment of erectile dysfunction

A certain role in the treatment of erectile dysfunction plays a vacuum-constrictor therapy (LOD therapy). The main mechanism of this type of therapy is to create, with the help of special devices, a negative pressure (vacuum) on the cavernous body of the penis. Vacuum devices provide an adequate erection in 60% of cases. [14]

Surgical treatment of erectile dysfunction

Surgical treatment for erectile dysfunction is used when conservative means have been exhausted:

• creation of a suture (anastomosis) between the supracostal artery and the lateral artery of the phallus, performed when this artery is narrowed;
• operations on the veins of the penis are performed in case of violation of the veno-occlusive apparatus;
• Phalloprosthetics (implantation of prostheses) is the final stage of erectile dysfunction treatment when other methods are ineffective. This technique allows to achieve results (full-fledged erection) in 70-80% of cases. [15]

Shockwave therapy (SWT), magnetic laser therapy (MLT), ozone therapy and prostate massage have no proven clinical efficacy in the treatment of erectile dysfunction and the reasons for their use are purely commercial.

Diet and physical activity

A balanced diet and physical activity play an important role in the prevention and treatment of erectile dysfunction.

Physical exercises are aimed at improving blood circulation in the male pelvic organs (especially in people with sedentary lifestyle), improving blood flow to the penis and testicles, where testosterone production occurs, necessary for a full erection.

Exercises are the simplest: walking – at least 6 thousand steps per day, squats (at least – 50 times a day). Not a bad effect showed a urological complex of Strelnikova breathing gymnastics. Some exercises from yoga practice are also used: janu shirshasana, paschimotanasana, uttanasana, baddha konasana, dhanurasana.

Massage

Massage of the pelvic and pubic areas is quite effective for treatment and prevention. Massage perfectly activates the vascular tone of the male genital organs.

Treatment with folk remedies

Interesting in terms of gentle stimulation and accumulation of their own testosterone a variety of herbal remedies. This Altai “Red Root”, African “Vuka Vuka” and “Yohimbe”, Thai “Butea superba” and other natural remedies. However, the coefficient of effectiveness of these remedies is unclear, and clinical trials have not been conducted to the required extent. [13]

Prognosis. Prevention

The prognosis of the effectiveness of erectile dysfunction therapy depends on the etiological factor, the neglect of the process (the degree of fibrosis of the cavernous bodies), the age of the patient. Modern methods of treatment allow, in general, to restore potency. If even therapy proves ineffective, erection can be provided surgically.

Prevention:

1. Elimination of destructive habits – the use of nicotine, alcoholic beverages, drugs, masturbation and others.
2. Physical activity plays a huge role. Constant physical activity is required, since erectile dysfunction develops as a result of an inactive lifestyle. This leads to congestion in the prostate and other male organs. Very effective are considered regular squats. They are recommended to perform 60-90 per day. This helps to normalize blood circulation in the pelvic vessels. Very effective way of prevention – alternating tension and relaxation of the perineal muscles. Excellent results in the fight against inadequate erection gives walking, running.
3. A balanced diet plays a leading role in the prevention of erectile dysfunction. Thus, seafood is rich in essential micronutrients such as potassium, zinc, magnesium, calcium, and omega acids that are essential for a full erection. They are especially rich in oysters, crabs, red caviar, mackerel, flounder fish, sea crustaceans. Honey and nuts contain a significant amount of zinc, increase immunity, prevent the development of prostatitis, increase male power. Parsley, asparagus have significant reserves of tocopherol, the strongest antioxidant that has a regulatory function for potency. Spices such as cardamom, ginger, red pepper are unique for male strength. They are rich in vitamins E, C, B2, B6, which improve blood flow to the male organs, favor a full erection.
4. Timely diagnosis and treatment of inflammatory diseases of the genitourinary tract.

All these preventive measures will help to push back erectile dysfunction, up to a very advanced age.

Weak erection

In medicine, a weak erection is also called erectile dysfunction. An erection depends on many factors, such as a person’s age, general health, hormone levels, nerve fiber conduction, blood flow, mental state, and emotions. Weak erection is caused by one or more of these factors: for example, just because of strong stress the hormonal balance has changed or the blood flow of the penis has deteriorated in addition to the effect of stress.

If a weak erection occurred after cancer treatment or removal of the prostate, read this text.

Responsible editor: Konstantin Anatolievich Menshchikov , urogenital surgeon.

The information on this page was updated in May 2022.

Why can an erection be weak?

The likelihood of erectile dysfunction increases with age. That is, the older a man is, the more likely he is to have erectile problems. However, age itself is not the cause of weak erections. But the accumulation of conditions and diseases can cause erectile dysfunction. For example, atherosclerosis.

Important

A 2013 study published in The Journal of Sexual Medicine found that one in four patients seeking help for erectile dysfunction is younger than 40 years old.

Content

Most men experience erectile dysfunction from time to time. Single cases should not cause concern. Sometimes a good rest is enough to recover. But some men suffer from permanent erectile dysfunction (ED). This means that they have difficulty getting or maintaining an erection firm enough for intercourse.

If a weak erection is a persistent problem, it causes stress, can affect self-confidence and contribute to relationship problems.

Persistent problems achieving or maintaining an erection are a sign of an underlying medical condition that requires treatment.

If you are concerned about persistent weak erections, talking to your doctor is the best thing you can do for yourself, even if you are embarrassed. You shouldn’t procrastinate, because a regular erection is necessary to keep your penile tissues toned.

See a doctor if you are constantly experiencing:

• Problems with erection (weak erection)
• Problems with maintaining an erection
• Decreased sexual desire

What happens to the penis during erection

The penis contains two cylindrical, sponge-like structures, the corpora cavernosa. During sexual excitement nerve impulses increase the flow of blood to these cylinders. The flow of blood causes their expansion, straightening and hardness. This is what an erection is.

Relation of weak erections to testosterone

Men often ask about the treatment of weak erections with testosterone. Indeed, a decrease in testosterone levels and the development of erectile dysfunction can occur at the same time, but this does not mean that one becomes the cause of the other.

Testosterone is a male sex hormone. But its effect on the mechanism of erection is not fully understood. A critical drop in testosterone levels and the resulting hormonal imbalance can cause, among other things, erectile dysfunction, but this is not the only symptom of this condition. Studies show that many men who have an age-related decrease in testosterone do not have problems with an erection.

Therefore, if there are no other signs and symptoms of low testosterone, no testosterone treatment is used and other causes of ED are considered.

After 50 years of age the level of testosterone in men decreases gradually, but it does not always cause ED

Causes of weak erection (erectile dysfunction)

Here are the conditions and diseases that can lead to erectile dysfunction:

• Atherosclerosis (blockage of blood vessels)
• Type 2 diabetes
• Heart disease
• Obesity
• Benign enlargement of the prostate gland
• Hyperlipidemia (high levels of lipids or cholesterol)
• Hypertension (high blood pressure)
• Chronic kidney disease
• Liver disease
• Parkinson’s disease
• Sleep disturbances
• Low testosterone levels
• Trauma to the penis, prostate, or spinal cord
• Multiple sclerosis
• Peyronie’s disease (formation of scar tissue under the skin of the penis)
• Prostate cancer
• Radiation therapy
• Removal of the prostate
• Surgery for bladder cancer

Atherosclerosis is the number one cause of erectile dysfunction.

Certain medications may also cause erectile dysfunction as a side effect.

Therefore, read the side effect section of the medication instructions carefully. And if erectile dysfunction and decreased libido are on the list, report your condition to the doctor who prescribed the medicine. Sometimes an alternative can be picked up. If the medication cannot be replaced or cancelled, it is worth considering other methods of dealing with erectile dysfunction.

Medications that can lead to weak erections

• Antihypertensives (drugs to treat blood pressure)
• Anti-androgens (drugs used to treat prostate cancer)
• Antidepressants (medicines for depression)
• Sedatives (drugs that make you feel sleepy)
• Drugs for ulcers
• Antihistamines (medicines for colds and allergies)
• Appetite suppressants

The following types of addictions can also lead to erectile dysfunction:

• Smoking
• Heavy alcohol use
• Recreational drug use

Count how many of these factors are negatively affecting your blood flow and erections right now.

Psychological problems and emotional turmoil can also cause weak erections. A man may not feel sexually aroused because of problems such as: 1) Fear of sexual failure 2) Anxiety 3) Depression 4) Relationship problems such as misunderstanding, lack of communication or conflict 5) Low self-esteem 6) Stress (professional stress, financial stress, stress related to sexual activity) Psychologists and psychotherapists work successfully with these issues.

Konstantin Anatolievich Menshchikov. Doctor of urology, andrologist, genital surgeon

How to treat weak erection

Erectile dysfunction is treated by a urologist or andrologist. At the consultation, the doctor will ask questions that are aimed at finding out the nature and causes of erection problems. He will examine the penis and testicles to rule out or confirm visible trauma and check the nerves of the penis for sensitivity.

Treatment depends directly on the cause. Each treatment has certain risks and benefits, which the doctor will explain.

Making the right diagnosis requires expert diagnostics (equipment, techniques, examination algorithms). Here you can undergo a complete examination and clearly understand the cause of a weak erection. Read more about our unique ED diagnosis.

Various treatment options include:

Medicines (pills). Drugs that cause a strong erection successfully treat erectile dysfunction in most men. These drugs cause blood flow to the penis. Examples of drugs for weak erections:

• Sildenafil .
• Tadalafil
• Vardenafil
• Avanafil

If a man has been diagnosed with heart disease or suffers from frequent blood pressure swings, such medications are most likely contraindicated for him. Therefore, if you suffer from these health problems, consult your doctor before taking such medications.

Other medications to treat erectile dysfunction include

• Alprostadil injectable (shots)
• Alprostadil urethral suppository (injected into the urethra)
• Testosterone replacement therapy (when indicated)

Vacuum pumps. These are vacuum erection devices with hollow tubes that are put on the penis to suck air inside the tube. This mechanical action increases blood flow in the penis and causes a strong erection during sex.

Exercise: Moderate or vigorous cardio exercise can help improve erectile dysfunction. Talk to your doctor to find out which exercises are best for the individual.

Consult a psychologist for a weak erection

If the cause of weak erections is psychological problems such as stress, anxiety and depression, see a therapist, counselor or sexual therapist with your partner. There are effective techniques that help get rid of psychological problems.

Konstantin Anatolievich Menshchikov. Doctor of urology, andrologist, genital surgeon