Impotentia coeundiN48.49
Synonym(s)
Erectile dysfunction
DefinitionThis section has been translated automatically.
Man's inability to have intercourse.
ClassificationThis section has been translated automatically.
A distinction is made between:
- Organic impotence due to anatomical changes of the penis, e.g.: Hypospadias and epispadias, induratio penis plastica, injuries or thrombosis of the erectile tissue.
- Functional impotence as a result of hormonal, central nervous or psychological disorders, e.g. male men's menopause.
- Loss of libido and erection, also in hypo- and hypertension, chronic liver disease, diabetes mellitus, severe physical or mental stress, abuse of alcohol, nicotine, etc.
EtiopathogenesisThis section has been translated automatically.
Mostly multifactorial causes. Triggered also iatrogenically by long-term use of drugs such as ACE inhibitors, alpha-blockers, antiandrogens, antidepressants, antiepileptic drugs, beta-blockers, calcium antagonists, diuretics, hallucinogens, H2-antagonists, cardiac glycosides, hypnotics, lipid-lowering drugs, neuroleptics, nitrates, NSAIDs, proton pump blockers, estrogens, tranquilizers.
General therapyThis section has been translated automatically.
- It is important to differentiate between psychologically or organically caused impotence by anamnesis, physical examination and, if necessary, attempts to provoke an erection by changing conditions.
- For psychological causes: psychotherapy or partner therapy.
- Organic: treatment of the underlying disease, avoidance of alcohol. In case of venous cause and anatomical changes, surgical measures may be necessary.
- Treatment in cooperation with urologists, if necessary internal medicine specialists.
- In case of increased venous outflow: ligation of the dorsal penile vein and its lateral branches under short anaesthesia.
External therapyThis section has been translated automatically.
Vacuum pump (vacuum erection system): Can be used as a supportive procedure for all forms of erectile dysfunction. Application 1 time/day.
Internal therapyThis section has been translated automatically.
- PDE-5 antagonists, e.g. sildenafil (Viagra) 50-100 mg p.o., vardenafil (Levitra) 10-20 mg p.o., tadalafil (Cialis) 10-20 mg p.o. are highly effective (in up to 80% of patients).
- If a testosterone deficiency is detected, substitution via testosterone patches (e.g. Adroderm), gel (e.g. Testogel) or via depot injections (e.g. Testoviron).
Operative therapieThis section has been translated automatically.
- For erectile dysfunction due to vascularisation or insufficiency of the erectile tissue: SKAT/cavernous body autoinjection therapy (second-line therapy if PDE-5 inhibitors are ineffective or not available).
- Surgery is only useful if other therapeutic options have failed. If pharmacotherapy shows no improvement, a penile prosthesis can be considered as the ultima ratio in cases of severe suffering. Despite the availability of three-component systems (fluid reservoir, pump, artificial erectile tissue), the option of a penile prosthesis or penile implants should be considered carefully, because the natural structure of the penis is irreversibly destroyed during surgery. Treatment in cooperation with urologists, possibly internists is necessary.
NaturopathyThis section has been translated automatically.
Yohimbine, a centrally acting herbal alpha-2 blocker (e.g. Yocon-Glenwood, Yohimbine levels) is sufficiently effective in many men with psychogenic or borderline organic erectile dysfunction.