Once all the pertinent studies have been undertaken, the therapeutic approach must be established, bearing in mind the factors presented by the patient (age, relationship status, illnesses, medical treatments, frequency of sexual activity, possible risks for certain treatments, etc..).
The first step of the treatment must be aimed at properly monitoring the patient’s existing conditions (high blood pressure, diabetes, hypercholesterolemia, etc) and suppressing, where possible, factors harmful to the erection (smoking, drugs, medications, etc). A healthy lifestyle is advisable (diet, physical exercise, etc), together with following a series of advice on sexual activity.
Wherever possible, the treatment for erectile dysfunction should be oriented towards evident problems (etiological treatment). Amongst them, of note are psychological treatment and hormonal treatment.
However, on many occasions the cause originating the dysfunction cannot be treated or the cause cannot be identified with certainty. In these cases a symptomatic treatment should be undertaken which consists in applying methodologies only at the moment in which an erection is required. Of them, worthy of mention are oral treatments, intracavernosal treatments (which are applied to the penis by injection) and vacuum erection devices.
The oral drugs are the easiest to apply. They are called phosphodiesterase type 5 inhibitors and they act at penis level by ensuring that during the erection an element fundamental to maintaining same (cGMP) is not degraded. Currently there are 3 drugs on the market: sildenafil (Viagra®), tadalafil (Cialis®) and vardenafil (Levitra®). Each of these drugs has its own characteristics in relation to how quickly they become effective and the duration of the effect. The one most suited to each individual patient should be selected. All these drugs are highly effective and safe, something which has been scientifically well proven in a large number of patients monitored over a long period of time. As with any drug, they have their contraindications which the patient must be aware of. The most notable is the taking of vasodilator drugs (nitrites) in patients with significant cardiac problems. The majority of cardiac patients who do not take these drugs may be candidates for the oral treatment, providing they are assessed and advised to do so by a doctor.
Intracavernosal treatment is based on self-injecting a vasodilator drug into the penis and would be indicated in those patients who cannot take oral medication or when they do not respond well to same. It is not difficult to learn how to inject oneself with this drug, attending periodic medical check-ups.
Vacuum erection devices consist of a plastic cylinder which is placed around the penis while the vacuum is created using a small pump, which draws blood into the penis. Once an erection has been achieved, the cylinder is removed and a compressive ring applied to the base of the penis to stop the blood from escaping.
On occasion there may not be a good response to the devices previously mentioned. In these cases the implantation of a penile prosthesis would be indicated. This consists in giving rigidity to the penis by the implantation of some small semi-rigid rods or cylinders that fill with liquid at the required moment inside the cavernous bodies. In hydraulic prostheses, the fluid deposit may be found in the testicular sac or in the hypogastrium (lower abdomen).
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Currently, it can be safely stated that practically all men with erectile dysfunction can receive some form of treatment that will enable them to continue maintaining adequate sexual activity.