Impotence or Erectile Dysfunction is a medical condition in which a male is unable to reach and/or maintain an adequate level of erection required for the sexual intercourse to happen.
Erectile disorders are common among older men, and population studies show that about 10% of adult men have difficulty getting an erection. The problems increase with age, and at the age of 75 approximately 50% of the men suffer of erectile dysfunction. Diabetes, hypercholesterolemia, hypertension and atherosclerosis impair the ability of smooth muscle to relax, and therefore increase the risk of erectile dysfunction.
In 80% of patients who are looking for the treatment, a basic individual study with a history and status of the patient is done, but in younger patients, blood pressure, testosterone levels as well as diabetes screening are conducted.
As sildenafil (Viagra®), tadalafil (Cialis®) and vardenafil (Levitra®) have been introduced, the ability to help patients increased significantly. These drug work in about 80% of impotent men. Of course these are only a first choice treatment, with absolute contraindication to the concomitant use of nitroglycerin preparations. Be careful for severe heart diseases and give no medicines for 6 months after an infarction. Side effect of these drugs are mild headache in 15% of cases and mild flushing in 10%. If oral treatment is inappropriate or does not work, intraurethral administration of prostaglandin E1 (Bondil) or intracavernos treatment (Caverject) should be tested.
Patients with suspected hormonal imbalance should be referred to an endocrinologist. Patients who fail to respond to oral or intracavernos treatment, which may be applicable for more invasive procedures, should be referred to an urologist for evaluation. After urological investigation and satisfactory treatment initiation, the patient may be referred to primary care and the doctor may continue prescribing medication.
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