Erectile dysfunction (ED), commonly referred to as “impotence”, is the persistent or recurrent inability to achieve and maintain an erection with sufficient rigidity to allow satisfactory sexual activity. It is a very common condition that affects millions of men worldwide, with a profound impact on self-esteem, quality of life, and a couple’s relationship.
It is important to emphasise that occasional difficulties are normal and may occur due to factors such as stress or fatigue. However, when the problem becomes frequent and persistent, it requires medical assessment.
An erection is a complex haemodynamic process involving the brain, nerves, hormones, and blood vessels. A failure in any of these systems can lead to erectile dysfunction. The causes are essentially divided into two main groups:
The main objective of diagnosis is to characterise the situation and identify the underlying cause—which may have an impact on a man’s overall health.
Erectile dysfunction is treatable, with high success rates. The therapeutic approach is stepwise, starting with the least invasive options, tailored to each patient’s circumstances.
Stop smoking, lose weight, strictly control diabetes, and begin aerobic exercise. Sometimes, simply switching a long-term medication to an alternative with fewer sexual side effects is sufficient.
The first-line medical treatment. Medicines such as sildenafil, tadalafil, vardenafil, and avanafil work by facilitating dilation of the penile arteries in response to sexual stimulation. Tadalafil, in its daily-dose formulation (5 mg), also allows greater sexual spontaneity and simultaneously treats urinary symptoms associated with benign prostatic hyperplasia (BPH).
For patients who do not respond to oral medication. The patient is taught to administer a small, painless injection at the base of the penis with an ultra-fine needle a few minutes before intercourse, producing a firm and predictable erection that lasts around 30 to 60 minutes.
The definitive solution when all other treatments fail. It involves the surgical placement of silicone cylinders inside the corpora cavernosa of the penis. Hydraulic (three-piece) prostheses have a small pump placed in the scrotum; when activated, the penis becomes completely rigid. When deactivated, it returns to its natural flaccid state. There are also simpler prostheses (semi-rigid or malleable) that have a lower risk of complications and are less expensive, although they never become flaccid and are therefore less “natural”. Prosthesis placement provides the highest satisfaction rate (over 90%) among all treatments for ED.
Book your urology appointment with Dr Frederico Furriel, a urologist with consultations in Leiria, Caldas da Rainha and Porto de Mós. Select your preferred location and submit your appointment request.