Erectile dysfunction is the persistent inability to obtain or maintain an erection sufficient to complete sexual intercourse. It is not a rare complaint and it is not, as was believed for a long time, almost always psychological: recent studies show an organic cause in roughly half of the cases. At CIFS in Florence the assessment starts from this fact and looks for the mechanism before proposing a treatment.
How an erection works
An erection is a physiological response that depends on the integration of vascular, endocrine and neurological mechanisms. Two stimuli trigger it: the psychic one, through images, fantasies and erotic stimuli, and the direct stimulation of the genitals. Both produce a relaxation of the smooth muscle of the penis; peripheral resistance drops, blood flows rapidly into the corpora cavernosa, which expand and compress the veins, preventing the erection from fading. If any step of that chain is interrupted — a narrowed artery, a venous leak, a damaged nerve pathway, a hormonal imbalance — the result is a deficit.
How the disorder presents itself
Patients describe three different pictures: the inability to obtain an erection from the beginning of the sexual experience; the loss of the erection during penetration; a reduction of tumescence during the thrusts that follow penetration. The disorder is frequently associated with sexual anxiety, concern about performance and a reduced sensation of arousal or pleasure, and it is a common source of interpersonal difficulty.
Diagnosis
The first step is an accurate assessment of the problem through examinations such as nocturnal electrometry, hormone dosages and the penile echo-doppler, all available at the centre. The vascular study shows whether arterial inflow is reduced or venous outflow is excessive; the hormonal profile reveals testosterone deficiency or an excess of inhibitory hormones such as prolactin. Where an inflammatory component is suspected, the microbiology laboratory completes the picture with the appropriate swabs.
Treatment
If organic causes are identified, it is possible to proceed with pharmacological, hormonal or surgical remedies. If the problem has a psychological matrix, a cognitive-behavioural psychotherapy path can be started: it is the only psychological therapy with demonstrated effectiveness in the treatment of this disorder. In many men the two components coexist, and the best results come from treating both. Related conditions are described in the pages on impotence, premature ejaculation and andropause.
Booking
Consultations are by appointment: +39 055 470521 or +39 055 485524, [email protected], Monday to Friday 09–13 and 14–19:30, Via della Fortezza 6, Florence.