Low libido and erectile dysfunction

What is erectile dysfunction? It might sound grim but these words - also known as low libido - is a word that causes discomfort to many men. The mere thought of not being able to 'stand your ground' during sex can cause psychological problems.

But what are the causes of erectile dysfunction - and what can men do about it? Here is an overview of how common it is, including erectile dysfunction causes, diagnosis and treatment options.

How does an erection actually work?

In order to understand the problem of erectile dysfunction, it can't hurt to take a physiological look at how an erection works.

Simply put, an erection occurs when the dilation of the arteries increases the blood supply and blood is pumped into the spongy tissue of the erectile tissue. The corpus cavernosum is surrounded by the firm connective tissue of the erectile tissue wall. The blood vessels that otherwise ensure the outflow of blood are thereby compressed, so that the pressure in the erectile tissue increases and the penis becomes stiff and erect.

What exactly is erectile dysfunction?

Erectile dysfunction, impotence, potency problems, sterility - many terms in this context are often lumped together.

A distinction must be made between the penis' lack of stiffness and inability to procreate. Of course, men who have no problems whatsoever during sexual intercourse can also be sterile.

What exactly is erectile dysfunction?

Erectile dysfunction, impotence, potency problems, sterility - many terms in this context are often lumped together.

What is the definition of erectile dysfunction?

Erectile dysfunction means that in more than two-thirds of attempts to get an erection, a man does not get one - or cannot maintain one. The penis does not become hard enough for sexual intercourse or it flaccid prematurely. This problem is called erectile dysfunction if it persists for at least six months. If, on the other hand, it only 'doesn't work' from time to time, this is not yet a disorder that needs to be treated. There can be completely harmless causes.

How common is erectile dysfunction?

Erectile dysfunction is not exclusively a question of age, but it does play a role in most cases. The risk of erectile dysfunction increases with age.

While studies show that about one in ten men between the ages of 40 and 50 suffer from erectile dysfunction, one in three men over 60 suffer from it. Researchers and doctors suspect that the number of unrecorded cases could be much higher, as many men do not talk about their erectile dysfunction or seek help because of shame.

Can erectile dysfunction indicate other illnesses?

In some cases, erectile dysfunction can also indicate a serious condition. This is why it is so important to have longer lasting potency problems medically clarified.

Doctors warn, among other things, that erectile dysfunction in men over 50 can be a first warning sign of vascular disease - and thus a harbinger of a possible heart attack or stroke. It is therefore important to take erectile dysfunction seriously and have it treated, because early medical therapy can prevent worse.

Where does erectile dysfunction come from?

In many cases this question is not easy to answer, because the causes can be very varied. The diagnosis becomes particularly difficult when physical and psychological causes are mixed.

Psychological triggers for erectile dysfunction
Psychological causes of erectile dysfunction are generally more likely to be found in younger men. Psychological causes can be

  • Depression
  • Anxiety disorders
  • Relationship problems
  • Stress and pressure in everyday life

That the triggers are psychological in nature can be seen from the fact that erectile dysfunction occurs suddenly - for example, after a stressful situation. As a rule, they are not permanent, but disappear again when you feel better.

Physical causes of erectile dysfunction

On a physical level, there are numerous things that can cause erectile dysfunction. Here is an overview of the most common ones:

Circulatory problems

The most common cause of erectile dysfunction: a disturbance in the blood flow to the penis. In this case, too little blood reaches the penis - usually because the arteries responsible for supplying it are calcified. Another possibility: the blood arrives but flows out again too quickly through the veins. The result: the amount of blood is not sufficient for a permanent erection. Diseases that result in circulatory disorders can also promote erectile dysfunction. These include diabetes mellitus, diseases of the fat metabolism or high blood pressure. An unhealthy lifestyle can also promote circulatory disorders (smoking, overweight, lack of exercise).

Medication side effects

In some cases taking medication may cause potency problems. If erectile dysfunction occurs while taking medication, it is essential to discuss this with the doctor treating you. Important: Do not simply stop or change the medication. These medications can cause erectile dysfunction:

  • Beta blockers for high blood pressure
  • Antidepressants
  • Appetite suppressants
  • Medicines with dehydrating effect
  • Gastrointestinal preparations
  • Muscle relaxants
  • Testosterone deficiency:

An important prerequisite for an erection is a sufficiently high testosterone level. This usually decreases with increasing age. A low testosterone level is not always the cause of erectile dysfunction, but it must be considered by the doctor as a possible cause.

Nervous disorders

For an erection to be possible, not only must the blood flow to the penis be ensured, but also the nerve tracts involved must be intact. Thus, various injuries, slipped discs, operations in the pelvic area, or craniocerebral trauma can trigger erectile dysfunction. As well as diseases affecting the central nervous system. These include for example a stroke, Alzheimer's, Parkinson's or multiple sclerosis.

Physical causes of erectile dysfunction are indicated when it does not occur suddenly, but when it develops gradually. Nocturnal erections during sleep are completely absent and erectile dysfunction occurs both during sex with a partner and during solo sex.

How is erectile dysfunction diagnosed?

The diagnosis is made in several steps. In addition, there are various examination options, as the causes can be so varied.

In the first step, an informative conversation provides an exact picture of the problem. Both triggers and symptoms are precisely determined. Standardised questionnaires are often used for this purpose. In addition, the attending doctor asks about previous operations, general illnesses and the intake of medication.

In the physical examination, the main focus is on the prostate and the sexual organs. Blood pressure is also tested, as circulatory disorders are a common cause of erectile dysfunction.
A detailed blood test focuses on blood sugar and blood lipid values. The testosterone level is also examined in this step. Ideally, this examination should take place in the morning, as the value is highest.
Additional examinations are necessary in rare cases
As a rule, the above mentioned examinations are sufficient to diagnose the reasons for erectile dysfunction. However, if no cause can be determined, there are other possibilities.

Doppler sonography: This ultrasound examination examines the blood flow in the vessels of the penis. Whether an erection is achieved can be determined by injecting certain drugs into the penis. This test is called 'erectile tissue injection test'.

Nerve tests: To rule out nerve disorders as the cause, doctors set weak electrical impulses and check whether these signals are transmitted by the nerves.

Nocturnal penile tumescence measurement: Spontaneous erections - such as those that occur at night in every healthy man - can be measured in a sleep laboratory. If the nocturnal penile tumescence measurement shows that an erection is possible, psychological causes are likely.

Heart examination: An examination of the heart is necessary if arterial circulatory disorders are frequently detected. The reason: erectile dysfunction can be the harbinger of serious heart disease.

What are the treatment options and is there an erectile dysfunction cure?

Affected men are primarily interested in one thing: What can be done about erectile dysfunction? Once the cause has been found, it can usually be treated specifically. In general, only the symptoms can usually be treated. How the therapy looks like is individually different. There are the following possibilities:

Changing medication: If erectile dysfunction occurs as a side effect of a drug, the treating doctor will prescribe an alternative.

Remedy testosterone deficiency: Testosterone levels decline with age. Basically this is not a problem. But if a man suffers from erectile dysfunction, the low testosterone level may be to blame and it is important to compensate for it. A combination of medication and hormone therapy is often particularly effective. There are cases of erectile dysfunction, where men whose levels are actually within the normal range benefit from testosterone supplements. However, this must be discussed individually with the doctor.

Psychotherapy: If there are psychological causes for erectile dysfunction, psychotherapeutic treatment can help. It is also useful as an additional treatment for organically caused erectile dysfunction, as physical and psychological causes cannot usually be precisely separated. Important: The partner should definitely be involved in the treatment. As a rule, the statutory health insurance company pays the costs for a medically prescribed psychotherapy.

Vacuum therapy: A transparent plastic cylinder with a suction pump is placed on the penis and a vacuum is created. Blood flows more strongly into the erectile tissue and an erection is produced. A rubber ring at the root of the penis prevents the blood from flowing back again. Important: It is essential to remove this ring after 30 minutes in order to avoid circulatory problems and thus damage to the penis. If the vacuum pump is prescribed by a doctor, the statutory health insurance usually pays.

Medication-based erectile dysfunction treatments

There are drug therapies that can be used to treat erectile dysfunction. Before prescribing medication, it must always be clarified whether the person concerned has a cardiovascular disease that speaks against the therapy.

PDE-5 inhibitors:

Effect: In the treatment of erectile dysfunction, the so-called PDE-5 inhibitors (phosphodiesterase-5 inhibitors) are considered standard today. After sexual stimulation, they trigger a slackening of the muscles in the erectile tissue. This promotes blood circulation in the penis. In addition, the PDE-5 inhibitors prevent the blood accumulated in the erectile tissue from draining away too quickly. As a result, the erection is strengthened and prolonged.
What is to be considered? The PDE-5 inhibitors do not provide sexual stimulation. Ergo, they can only work if this has already taken place. The effect usually sets in after about 30 minutes and lasts for different lengths of time. Studies have shown that this medication helps about 60 to 80 percent of those affected. The health insurance does not cover treatment with PDE-5 inhibitors; the drug is only available with private prescriptions.

Possible side effects: Headaches are a relatively common side effect. It can also lead to a blocked nose, reddening of the skin, back pain and digestive disorders. In the case of certain diseases (e.g. cardiovascular disease), the medication must not be taken. Nor should it be taken in combination with antihypertensive drugs.

MUSE = Medicinal urethral system for erection:

Effect: Active ingredients for the treatment of erectile dysfunction can also be administered in the form of 'mini suppositories' via the urethra. With the help of an applicator the man introduces a certain prostagladin into the urethra. The active substance is then transported through the urethral wall into the erectile tissue of the penis. The result: The blood flow increases and after about 15 minutes an erection is achieved, which usually lasts 30 to 60 minutes.

What is to be considered? It is essential to consult with your doctor whether this medication may be used. If the partner is pregnant, a condom should be used to minimize the risk of premature labor.

Possible side effects: You may experience pain in the penis, burning in the urethra, headache, or dizziness. Certain conditions preclude use of this medicine, such as leukemia.

SKAT = erectile tissue autoinjection therapy:

Effect: In this therapy the man injects the medication into the erectile tissue of the penis with a very thin needle. Thereby more blood flows into the penis. After ten to 15 minutes an erection is achieved, which lasts for about an hour.

What should I be aware of? It is important to pay attention to the exact dosage. An overdose can result in an erection that lasts for hours. This must be treated medically, otherwise the penis may be damaged. If this therapy is prescribed by a doctor, in most cases it is prescribed by the health insurance company.

Possible side effects: If one takes care that no overdose occurs, this therapy is usually unproblematic and painless.

Surgical procedures

Erectile tissue implants:

If all other treatments have been unsuccessful, plastic cavernous body implants can be surgically inserted. There are various methods for this. In most cases, fillable implants are used.

Here's how it works: Using a pump and a reservoir of table salt, the man can fill the implant so that a kind of erection is achieved. As with any surgical procedure, there are some risks. For example, the operation damages the erectile tissue. Therefore, after such an operation, it is not possible to switch back to other therapy options (tablets, SKAT). However, 60 to 80 percent of patients are permanently satisfied with this method.
Vascular surgery:

In the event that the penile arteries are not permeable enough or are even closed, a special vascular operation can be used to create a new connection between the arteries. Another method is used when there is increased blood flow in the penile veins. This involves closing one or more veins, thus preventing the accumulated blood from draining away too early.