ERECTILE DYSFUNCTION
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INTRODUCTION

Erectile Dysfunction (ED) has been defined as “the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance”. Although ED is a benign disorders, it is related to physical and psychological health , and has a significant impact on the quality of life of both sufferers and their partners and family. Recent epidemiologic data reported in Italy a prevalence of 12.5% ED in 40 to 70-year-old men. In the 60's ED was defined psychogenic in 90% and organic only in 10 % of the cases. Actually, it has become clear that ED shares common risk factors with cardiovascular disease, such as a lack of exercise, obesity, smoking, hypercholesterolaemia and the metabolic syndrome. Therefore ED should be considered a true disease, and as any disease ED should be accurately diagnosed, in order to understand why it happens and how it can be treated.

DIAGNOSIS

From a diagnostic and therapeutic point of view the key which has changed the approach to this type of problem has been the discovery that a few drugs, once injected in the penis, could cause an erection. The first drug to be introduced was Papaverine Hydrochloride. The drug most used today is Prostaglandin E1 (PGE1). The intracavernous injection test with PGE1 (ICPGE1 test), offers preliminary informations regarding vascular status of ED’s patients and after injection may be performed a particular examination so-called penile echo-colour doppler to see better penile vascular status in ED’s patients. In order to understand the organic or psychogenic etiology of ED today, it is very useful the nocturnal penile tumescence assessment (NPT test). This assessment is done with an instrument called (Rigiscan®) given to the patient and should take place for at least two nights. Laboratory testing must be tailored to the patient complaints and risk factors. All patients must undergo a fasting glucose and lipid profile. Hormonal test must include a morning sample of total testosterone bio-available or calculated-free testosterone is more reliable to establish the presence of hypogonadism. Sometimes in certain circumstances in highly selected ED’s vascular cases, specific diagnostic test may be needed: arteriography and dynamic infusion cavernosometry or cavernosography (DICC). These assessments should be performed only for patients who are considered potential candidates for vascular reconstructive surgery. Patients with psychiatric disorders must be referred to a psychiatrist particularly interested in ED. For younger patients (< 40 years) with longstanding primary ED, psychological counselling may be helpful before any organic assessment is carried out.

 

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