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"Erectile dysfunction is defined as the inability to maintain an erection sufficient to have sex. It is a disorder that affects millions of men around the world in different ways and with various causes.

What is it?

Erectile dysfunction is a medical term used to define the inability to achieve an erection with sufficient rigidity for penetration and / or to maintain it for a period of time adequate for the satisfaction of both partners during intercourse. It is important to understand that this can happen even with desire and orgasm (ejaculation) present.

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Erectile dysfunction (ED) affects approximately two-thirds of men over the age of 50, or 10 to 20 million Brazilians.

Most men, at some point in their lives, have experienced episodes of erectile dysfunction, usually due to fatigue, stress, or alcohol abuse. Occasional breakdowns should not be overestimated. However, if the problem persists, a urologist should be consulted.


The ability to erect is just one of the many aspects of male sexual function. The sexual response cycle has four stages: a man's main desire, erection, orgasm, and relaxation. Everyone can change differently.

The causes of erectile dysfunction are divided into organic, psychogenic and mixed, they can be found with combined factors. Organic problems like diabetes, cancer, arteriosclerosis, and neurological damage can often lead to psychological complications, for example. It can also be secondary and appear as the first manifestation of various disorders such as hypertension, diabetes, cardiovascular disease, and kidney failure.

Psychologically induced erectile dysfunction can manifest itself in various ways, or delayed ejaculation, painful ejaculation, and even impotence. There may also be loss of libido (sexual desire), lack of orgasm, and sexual phobias (fears), all from anxiety, depression, or guilt. An individual who has an unpleasant experience, such as losing an erection from having sex or ejaculating too early, moves on to the next relationship, remembers these "failures" and becomes anxious. This creates a new defect, creating a vicious cycle.

Organic causes are subdivided according to etiology. Vasculogenic are more common, especially changes in flow, arteriosclerosis, and trauma (causing damage to blood vessels). Neurogenic causes are diabetic neuropathy, multiple sclerosis, alcohol abuse, trauma, spinal cord and nerve damage from radical prostatectomy (surgery to remove the prostate). Since the causes are primary or secondary hormonal hypoandrogenism (disturbances of male hormones).

Erectile dysfunction can also occur, due to the use and abuse of drugs such as marijuana, alcohol, heroin, cocaine, barbiturates, antidepressants.

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Associated disorders

ED presents several risk factors such as advanced age, diabetes, hypertension, peripheral vascular disease; neurological diseases, endocrine disorders, spinal cord injury, radical pelvic surgery, radiation therapy, alcoholism, smoking, use of marijuana and / or cocaine; use of antihypertensives, tranquilizers and psychotropic substances; relationship problems with the partner, stress, anxiety and fear of failure, depression, obsessive-compulsive personality, sexual deviation. You can click here to get more information about how to solve  Erectile Dysfunction.


The objectives of the initial evaluation of the patient are to determine the probable cause of the erectile dysfunction and to identify the organic or psychological factors that may influence the associated therapy.

A detailed medical interview is the most important factor in evaluating patients with this problem. The history should identify the duration, progression, and severity of erectile dysfunction and associated factors.

Once you have identified a problem in the patient's sexual performance, the next step is to differentiate it from other sexual problems such as loss of libido and ejaculation disorders.

The physical examination consists of evaluating the patient's health status, with special attention to cardiovascular, neurological and genitourinary aspects, due to their contribution to erection. The neurological evaluation should include a perception of your patient's anxiety or depression. Since the evaluation of genital herpes is aimed at detecting local abnormalities.

Some are basic laboratory tests to identify disorders that can cause erectile dysfunction.


In case of psychogenic erectile dysfunction, psychotherapy is indicated. Several factors must be evaluated by the urologist and if possible by an expert in psychology or psychiatry. Factors such as physical, psychiatric, psychological, conflict with the partner and sexual insufficiency must be addressed to the couple.

Penile injections were the first to be effective and objective, with few or no side effects, with a significant improvement in erection, even with severe organic OF. This was the main complication, painful erections. It also had the disadvantage of limiting the time of limitation of erections and the frequency of application (3 times a week). This method tends to be abandoned with the advancement of technology.

With the advancement of treatment, some oral medications are available in the market. They are:

- Viagra (Sildenafil) from Pfizer: acts on the penis by relaxing the muscles and increasing blood flow to the area. Effective in cases of partial impotence, ensuring erection 40 to 60 minutes after ingestion of the drug, with stimulation of the penis. Its effect can last up to six hours.There are side reactions such as headache, nasal congestion, facial flushing, and dyspepsia. Cardiac patients, especially on nitrate drug treatment (Sustrate, Monocordil, Isordil, Nitradisc, Nitroderm TTS, Isocord, Isosorbide, Nitroglycerin) cannot take this drug.

- Uprima (apomorphine), from Abbott Laboratories, acts on the central nervous system, facilitating the conduction of sexual stimulation from the brain to the penis. Generates an erection 10-20 minutes after oral sublingual administration. It can cause headache, nausea, dizziness, fainting, and flushing, but can be used by heart patients.

- Cialis (Tadalafil), manufactured by Eli Lilly, acts directly on the penis by inhibiting the enzyme phosphodiesterase. It leads to an erection in 30 minutes and lasts up to 36 hours. It can cause headache, gastric intolerance, nasal congestion, back pain, muscle pain, dizziness, and flushing. Like Viagra, it cannot be used for heart disease while using nitrates.

- Levitra (Vardenafil) from Bayer and Glaxo, also acts directly and selectively on the penis, inhibiting the phosphodiesterase enzyme, with fewer side effects (headache, redness and runny nose). It leads to an erection in 15 minutes and lasts up to 8 hours. Like Viagra and Cialis, they cannot be used for heart disease while using nitrates. One of the main advantages is the most affordable price and the sale in individual packages.

Although pharmacological treatments are mentioned, some patients may not adapt and require treatment with mechanical devices such as vacuum erection devices or inflatable or malleable penile implants. Others may need surgery to repair the vascular arteries that supply blood to the penis, in specific cases.

Because erectile dysfunction can have many causes, there are several treatments that work through different mechanisms, with specific contraindications, a urologist should be consulted.