Male sexual disorders are divided into 5 categories:
- Disorders of male desire (sexual overstimulation, understimulation)
- Disorders of erectile function (erectile dysfunction, potency problems, penile curvature)
- Disorders of ejaculation (premature, retrograde – no ejaculate)
- Orgasm disorders (no orgasm)
- Sensitivity disorders (pain during erection, hypersensitivity, sensitivity disorders)
According to the WHO, erectile dysfunction is defined as “the inability to get or maintain an erection sufficient for sexual intercourse.”
How does an erection work?
Erotic stimuli (visual, tactile, imaginary ones) cause a stimulation of neural receptors in the central switching points of an erection. It is dopamine receptors as well as melanocortin receptors, and, to some extent also serotonin ones that play a decisive role with the erectile induction. By stimulating the receptors sexual switching points are being activated while simultaneously an emission of erection stimulating via spinal tracts happens. In the first plays this goes to the reflexogenic parasympathetic erection centre in the sacral marrow.
After the erotic stimulus signals have been transformed there, they are transmitted via special nerve pathways (the nervi erigentes and subsequently via the plexus hypogastricus inferior and the nervi cavernosi) to the nerve endings in the corpus cavernosum of the penis. Nitric oxide (NO), the most important transmitter substance for erection, is released at these nerve endings. The release of NO activates the enzyme “guanylate cyclase” in the corpus cavernosum muscle cell. After various processes, the level of a special substance (cyclic guanosine monophosphate (cGMP)) is increased. causes the relaxation of the smooth muscle cells. This, finally, causes the arterial blood flow to increase in the cavernous body and the initiation of the erection is started.
What causes erectile dysfunctions?
In over 70 percent of cases, there are physical causes such as arteriosclerosis, diabetes mellitus or high blood pressure, which can cause changes in the small blood vessels (capillaries) and thus lead to circulatory problems. But smoking or excessive alcohol consumption also cause similar changes. Neurological diseases, side effects of medication, thyroid diseases or anatomical changes to the penis (induratio penis plastica) are also responsible.
In more than 20% of cases, psychological changes such as non-specific anxiety, fear of failure or psychiatric illnesses (depression…) are responsible.
Of course, a combination of both causes often leads to this condition, which is extremely stressful for men, because masculinity in our culture is still defined by the ability to have an erection.
What about its frequency of occurrence?
You are not alone with this condition. The frequency of erectile dysfunction is clearly age-dependent. As part of the “Cologne Study”, over 8,000 men aged 30 to 80 in the Cologne area were surveyed. 4,489 cases were evaluable (responder rate approx. 60%). The percentage of ED in men aged 30 to 80 was 19.2%. In the 40-49 age group, almost 10% of men were affected Between the ages of 60 and 70, one in three of those surveyed suffered from ED, and between the ages of 70 and 80, more than half. (Braun et al. Int J Impotence Res 2000; 12: 305-311 )
What happens in the surgery?
First, you have got to be ready to talk. Wrong shame, fear, and wrong information cause men to push aside this problem, partnerships to erode or even break up and, more often than not, alcohol is taken as the only way out.
Profound conversation and a routine check-up follow. If necessary there is also a blood analysis done and special medication prescribed. (Sildenafil, Vardenafil, Avanafil, Tadalafil) Erection reliably improved by them. Also shock wave treatment is offered by me. Ultra-sonic waves on the penis further the local blood circulation. Depending on the symptoms, a blood test is then ordered and, if necessary, a prescription for special medications (sildenafil, vardenafil, avanafil and tadalafil) is issued. These medications lead to an improvement in erection. I can also offer shock wave therapy (ESWT) in my practice. In this therapy, ultrasound waves are applied to the erectile tissue of the penis and lead to an improvement in local blood flow. This procedure has been available for several years and its effectiveness has been confirmed in numerous studies. This procedure has been available for several years and its effectiveness has been confirmed in numerous studies.
