General News
Erectile Dysfunction (ED) is defined as the inability to achieve and/or maintain an erection sufficient to complete satisfactory sexual intercourse.
It is a very common sexual disorder that increases with age, which has a significant impact on the patient’s self-esteem and especially on his or her overall quality of life. Italian epidemiological estimates indicate a prevalence around 13% of the adult male population.
Yet even young people suffer from it, suffice it to say that 1 in 4 ED patients is under 40 years old.
Long considered a disease per se, after a unga review of the scientific literature on the subject, Today there is a tendency to define ED as a symptom, a possible expression of other underlying pathologies of great clinical impact.
It is shown that ED sufferers have an increased risk of developing severe cardiovascular disease, including myocardial infarction and stroke.
Indeed Erectile deficit may be the first indicator of coronary and/or peripheral vascular disease.
Therefore in those who have risk factors (obesity, diabetes, hypertension) it must become a diagnostic opportunity (window) to perform a thorough cardio-metabolic evaluation.
It should be kept in mind that many patients with ED have a predisposing picture of metabolic syndrome, in the context of which concrete action can be taken with corrective lifestyle interventions as well as pharmacological therapeutics to mitigate the resulting cardiovascular risk in these individuals.
From an etiological point of view an organic form (when cardiovascular risk factors, diabetes, or other conditions that may lead to or contribute to the onset of the disorder are present) and a psychogenic form are distinguished; but almost always the organic and psychogenic components tend to coexist in the same patient, so an exact classification is very difficult to perform.
Very important, however, is the frequency with which it occurs, because there can be forms of pure ED in which the disorder is virtually constant throughout sexual activity, and episodic forms (also referred to as contextual) in which it occurs only in certain situations.
Emotional problems
In the context of erectile deficit, it should be taken into account that. there is a very strong emotional impact for the patient suffering from the disorder.
His self-esteem, relationship and social life are significantly affected, and there is ample evidence that it important psychological effects can ensue, which in some cases can spill over into the neuro-psychiatric realm with the onset of depression and anxiety disorders.
It is no coincidence that there has always been talk in this area of a veritable “iceberg,” where even from an epidemiological point of view it is estimated that the prevalence and incidence rates of ED reported in the literature, are strongly influenced by the patient’s unwillingness to externalize his disorder.
The patient encounters great difficulty, almost a kind of psychological barrier, in approaching the problem properly, in the sense of medicalizing it by resorting to the advice of a specialist.
Even today in many cases, especially among younger people, people resort to shortcuts such as sharing with a friend or relative, and consequently I attempt to acquire medications directly at the pharmacy or even worse on the web.
Certainly the arrival on the market of oral drugs for the treatment of ED, which is now more than twenty years old, has had a positive impact on the emergence of the disease’s underground, but still not totally and definitively.
Another crucial aspect that must be taken into account is the patient’s sharing of the issue with his or her partner, since this does not always happen or at any rate happens with a relative delay in the patient’s framing process.
Where all studies on the subject report an optimization of intervention effectiveness if the partner is “brought on board” with management.
Nutrition and physical activity
ED and metabolic syndrome (MS) have many aspects in common in the sense that a large proportion of patients with ED may also manifest risk factors that can be traced to MS (hypertension, diabetes, hypogonadism, obesity).
In all these cases, the patient’s cardiovascular risk increases significantly, so any action to mitigate this risk is of great clinical value.
Clinical studies have clearly shown that lifestyle modifications (weight loss of up to 10 percent of initial weight loss), increased frequency and intensity of exercise can benefit not only cardiovascular risk but also improved sexual performance.
For example, it has recently been shown that there is a direct correlation between improved sexual quality of life and a lowering of circulating cholesterol and triglyceride levels, achieved by drug therapy with statins.
Advice:
- Exercise regularly;
- Pay attention to body weight gain and possibly follow the advice of a nutritionist;
- If you are an obese person, get help from a nutritionist to lose weight (up to 10 percent of your starting weight).
The appropriate use of medications
ED therapy has been completely revolutionized since the advent of oral drugs in the late 1990s.
In fact, in 1998, sildenafil (Viagra) came on the market, a molecule that has proven over the years to have one of the most considerable impacts in pharmaceutical history, still remaining among the world’s best-selling drugs.
Sildenafil was the progenitor of a category of molecules, phosphodiesterase 5 inhibitors, whose mechanism of action is aimed at causing increased vascular flow at the penile level, improving stiffness.
All of the oral drugs (slidenafil, tadalafil, vardenafil, avanafil) act by the same mechanism of action, but differ in absorption profile and duration of action.
In fact, short- to medium-acting agents such as sildenafil, vardenafil, and avanafil (rapid absorption and residence time in the circulation up to 4-6 hours) and long-acting agents such as tadalafil (absorption in about 2 hours and residence time in the circulation for 24-36 hours) are distinguished.
In addition, each individual molecule has a different absorption profile, which may possibly be affected to a greater or lesser degree by the concomitant intake of food and/or alcoholic beverages.
Another extremely positive aspect is the high safety of these drugs, all of which have a very pronounced tolerability profile, with only rare and mild side effects that tend to diminish with continued intake.
The drugs, contrary to what patients mistakenly fear, are also very safe from a cardiovascular point of view, so they may not cause any side effects in this regard, unless they are used concurrently with nitroderivatives (patches for the treatment of angina pectoris), in which case they become dangerous due to the risk of cardiovascular collapse.
Oral medications are very well tolerated, with rare and mild side effects that tend to subside with continued intake.
But care must be taken not to use them at the same time as nitroderivatives (heart patches)! Otherwise they are absolutely safe from a cardiovascular point of view.
Regardless of the mode of intake and timing of action, all these drugs share a high therapeutic success rate of up to about 85-90% of treated patients.
The availability of a wide range of molecules has made it possible to arrive at a customization of drug therapy, based on the individual patient’s sexual needs and habits (frequency and mode of conducting sexual activity).
Advice:
- Oral drugs for ED treatment are effective in 9 out of 10 cases;
- Are safe drugs, including from a cardiovascular point of view;
- the only thing to pay attention to: strictly avoid taking heart patches at the same time!
Communicating effectively with the partner
In the context of sexual dysfunction, the involvement of the partner(s) in both the diagnostic and therapeutic pathway assumes a primary role.
Much scientific evidence underscores that a significant increase in treatment success rate can be achieved when there is a concrete sharing of the issue.
In the first instance, there is a positive implication on the possibility of bringing out the sexual disorder more quickly and effectively; numerous epidemiological studies, have clearly demonstrated the presence of the partner(s) at the first meeting with the referring physician, and especially his or her active involvement.
Involving the partner, making him or her share your feelings and reflections on the experience you are going through, is of great importance because it helps to reduce the distance in the couple and, above all, avoids the triggering of psychological isolation from which a far more complex picture to manage may result.
The woman faced with a less than expressive, less than complicit partner will begin to think that she is no longer the object of his desire and attention, and this is probably because of the presence of another partner.
At the same time, the male will find himself accentuating his sense of inadequacy, accentuating the loss of his self-esteem.
Even more than in the initial framing and in-depth diagnostic phase, the convinced participation of the partner(s) brings benefits in the therapeutic phase, when sharing the pathway helps the patient to optimize the results of the therapy itself.
There is scientific work showing that in the case of couples who have shared sexual problems, the duration of drug therapy tends to shorten, due to the very fact that a final and lasting resolution is quickly achieved.
Advice:
- Get your partner involved and bring her “on board” with the problem;
- it is important to share with her your anxieties, your feelings;
- In her you will find an ally, not a harsh judge;
- therapies will work better and your course of treatment will be shorter and more effective.
Make treatment decisions with reference to the information received and solve disease-related problems
As mentioned earlier, the evolution and expansion of therapeutic offerings in the field of ED treatment now makes it possible to speak of a true “tailor-made therapy.”
There are treatment solutions suitable for each patient, based on their sexual preferences and habits.
As previously specified, the drugs have different absorption and use profiles that allow them to be taken in conjunction with or after a meal, alcohol consumption, and especially with the possibility of scheduling sexual activity differently, depending on one’s needs.
The aspect that patients look to most is the preservation of the naturalness of the relationship, and the possibility of scheduling the activity without any particular “artifice.”
Advice:
- ask your doctor what is the best treatment for you;
- you can choose from many medications, all of which are effective and safe, to suit your sexual needs.
The night’s rest
Insufficient, misaligned or interrupted sleep causes hyper-somnolence and neuropsychological deficits.
It can adversely affect cardio-metabolic health and can cause hypogonadism, erectile dysfunction, and infertility in males.
High-quality, complementary epidemiological and interventional studies establish that abnormal sleep is associated with increased mortality, hypertension, and other cardio-metabolic disorders (insufficient, interrupted, and misaligned sleep), as well as reduced fertility with reduced total sperm count (insufficient sleep), erectile dysfunction (interrupted sleep), and low testosterone (both).
Circadian misalignment shifts the peak diurnal rhythm of testosterone so that it occurs soon after waking up, independent of the biological clock, but does not change the average concentration.
Laboratory studies have shown that sleep deprivation negatively affects the normal functioning of the hormone axis and testosterone production.
As a result, alterations may occur at the level of the penile cavernous tissue, possibly affecting the vascular dynamics underlying erection.
Preliminary studies show that sleep extension in subjects who are chronically sleep deprived may become a strategy to reduce insulin resistance and hypertension, as known typical factors of metabolic syndrome.
Advice:
- take care to preserve the rhythm and duration of your sleep;
- if you are not sleeping well and for a long time, ask your health care provider for advice.
