Not rising to the occasion (sexually) is one of men’s biggest fears. The erectile dysfunction It affects one in five men between 25 and 70 years old. A prevalence that increases significantly with age until reaching 50% among those over 70 years of age. Nor should you get overwhelmed when it happens punctually, but if the situation becomes habitual for at least six monthsyou have to consult with the specialist. First, because it can be the first warning sign of some other pathology and, second, because it has a solution. «Erectile dysfunction is the inability to have a satisfactory erection that allows adequate sexual intercourse. The fact that it happens once or twice is not significant. It must be maintained for at least three months,” explains the doctor. Françoise Hairstyleurologist and andrologist, specialist in male sexual health, head of Service at the Olympia Medical-Surgical Center and the Ruber Juan Bravo 39 Hospital Complex.
Most of the time, what is behind it are organic causes. “The most common thing is that they are patients with cardiovascular problemslike diabetes, hypertension, cholesterol, but they don’t know it. They come to us because cardiovascular disease is reflected first in the pene, where the arteries are very thin. Erectile dysfunction acts as the tip of the iceberg,” he points out.
The problem is that, many times, they are patients who have been suffering from these pathologies for years, without knowing it, because they are painless and, unlike women, this culture of revision is still lacking in men. «We must insist on prevention. Get a general check-up from the age of 40-45: take your blood pressure at home and look at your blood glucose and lipid profile once a year. In case of anomalies, it will allow us to take measures, prevent future cardiovascular events and erection problems. If you do nothing, you are facing the risk of having a pathology that is often difficult to solve after so many years in these conditions,” warns Dr. Peinado.
Aging is also a circumstance that influences erectile dysfunction, but many patients are surprised when episodes begin at 50 years old. «You see them in consultation with significant abdominal obesity, without physical activity, and with poor metabolic health. Erectile dysfunction is a reflection of your situation, which, if it does not change, will get worse,” continues the expert. That is why it is important, as part of the treatment, to change your lifestyle. You also have to be realistic with expectations, depending on age. Aging affects the erection, just as other health problems associated with wear and tear appear. «You cannot be like 20 years old and many men do not assume this. They want to have that erection capacity of 25-30 years old. The matter is more complicated at the moment, where many men, who associate the ability to erect with a symbol of masculinity, have new and much younger partners,” explains the expert.
Younger patients
The first major peak in erection problems usually occurs after the age of 45-50. Although the experts consulted for this report recognize that they increasingly serve younger people. In this age group, there are organic, but also psychological reasons behind it. «It is a general reflection of the metabolic situation, since there are more and more young people with diabetes; the amount of anxiolytics and antidepressants they take; or hair drugs, such as finasteride. And all together with the level of demand of young people for the image projection they want to have,” says the head of Service at the Olympia Medical-Surgical Center and the Ruber Juan Bravo 39 Hospital Complex.
He Dr. José Enrique Roblesa specialist in Urology at the University of Navarra Clinic, confirms that, a few years ago, they did not imagine that they would have inquiries from young people in their twenties. Although these patients must also be studied properly from a cardiovascular point of view because it can be an early marker, the specialist points out that behind these consultations what there is usually a problem of «expectations are higher than realities. “They want to be machines and we are not.”
Furthermore, the youngest have broken the taboo and do not hesitate to consult with a specialist. The first-line treatment for erectile dysfunction is oral drugs, such as Viagra and its derivatives, with which, in general, a good response is obtained. The specialist prescribes one or the other depending on the patient’s age, number of relationships, etc. If they don’t work well, there are other options. The second line is injections with drugs into the penis. They have a high success rate, but also a dropout rate because the application system is not the most convenient. And when there is no response to any drug, a penile prosthesis is considered. «It is a two-cylinder device that is inserted into the penis, with a small pump inside the scrotum. You can’t see anything from the outside. And the patient can have the erections he wants, for as long as he wants. It is a definitive solution,” says Dr. Peinado.
March 27, 1998 is a historic date for men around the world. It was the day it began to be marketed. Viagrathe name by which the first pill against male erectile dysfunction is known. The discovery of this drug was a product of chance. The pharmaceutical company Pfizer realized this when it was working on a treatment to combat hypertension and heart problems. In those trials, it was detected that sildenafil citrate, which is a powerful vasodilator, increased blood flow inside the penis, thus causing an erection. Since then, three other oral drugs from the same family have been added: tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra). And as we have already mentioned, beyond pills, there are other solutions for cases in which the patient cannot take them or they do not give the expected result: drug injections into the penis and, as a last option, the prosthesis.
Botox study
Although there has not been another equally revolutionary discovery in this area since 1998, solutions to erectile dysfunction continue to be studied. The Department of Urology at the Clínica Universidad de Navarra has launched a trial that seeks to reverse impotence with an injection of Onabotulinumtoxin A (Botox) in the corpora cavernosa of the penis. The objective, according to Dr. José Enrique Robles, is to find “an effective, safe and long-lasting treatment. “We trust that its effectiveness can be maintained, at least, for six months after the injection.”
The origin of this essay is to look for an alternative to oral medication, which does not always work and which, in addition, needs to be taken on demand, depending on the time it takes to take effect, so you have to plan your relationships and that takes away part of it. of spontaneity. The Botox injection, which would be given every six months, “promises good results with little effort and little invasiveness. From what we know and can intuit, the probability of a favorable response is around 60%. It is a good percentage, but not infallible,” acknowledges Dr. Robles.
The clinical trial, which will include more than 100 patients over 30 years of age, with a poor or mediocre response to oral medication, will include a control group that will be administered a placebo. The procedure is outpatient, without side effects and practically painless. The main advantage of this new treatment under study compared to those already known is that it avoid taking medication every day or prior to sexual activity. Botox is known for its safety and effectiveness, since it has been applied in various fields of medicine. «Erection is a phenomenon that requires the dilation of the arteries of the penis so that it increases in size and consistency. What the drug (Botox) does is relax those muscles in the blood vessels, increases blood flow and creates the conditions to obtain and maintain an erection. In itself, the drug does not produce an erection, it requires sexual stimulation,” explains the CUN specialist.
In addition, to all of the above, there are other treatments, which have less evidence or work only in very specific patients, explains the Dr. Eduardo García Cruza specialist in Urology, such as “low intensity shock waves, which have been in the clinical pipeline and have been available for 15 years. “There is plenty of evidence on when to use it.” «Other treatments with less experience are platelet-rich plasma or radiofrequency. They are promising in studies, but there is a lack of evidence to know which patients will benefit the most. And then the stem cells, but it is in a very experimental state,” lists the expert.
Prevention
The three specialists agree that erectile dysfunction can be prevented or, at least delayed, if a proper lifestylewith a Mediterranean diet, regular physical exercise, quality rest, stress control and avoidance of toxins such as tobacco and alcohol.
Aging is not a condemnation in itself. Dr. Eduardo García Cruz assures that one in four men over 80 years old have good erections and a sexually active life. To all the previous recommendations, this specialist adds another more current one: “those who are now 20 years old should try avoid porn as much as possible. “It can cause erection or desire problems.”
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