Salient points

Erectile dysfunction

Erectile dysfunction affects a lot of men and is more common than it is presumed. ED is the persistent and recurring inability of achieving or maintaining an erection which is sufficient for a satisfactory sexual performance. Erection is a complex phenomenon that causes changes in the muscles, nerves and blood vessels of the penis. It means that ED occurs when the penis has insufficient blood supply to maintain erection. ED is possible even in the case of normal sexual desire, orgasm and ejaculation. The best way to address the problem is to talk to a doctor (the general practitioner or a specialist in uro-andrology) as ED is a symptom that needs a diagnosis. As a matter of fact such symptoms could conceal important pathologies such as diabetes, hypertension, cardiovascular diseases or consequence of pelvic surgery.

For the diagnosis it is necessary to have an accurate medical history, blood tests and in some cases:

1. Dynamic colour Doppler ultrasound of the penis: a specific instrument which assesses the presence or absence of nocturnal erections that usually occur to every man unconsciously during his sleep. It is performed during two consecutive nights.
2. Ecocolordoppler penieno dinamico: it consists in evaluating the vascular component of the penis, the structural changes in the corpora cavernosa (fibrosis, plaques), the arterial flow as well as the venous outflow and the occlusive mechanism of the penis.
3. Drug test through intracavernous injection: this assesses the erectile reaction following an intracavernous injection of a vasoactive drug at a standard dose.

Today it is possible to treat 100% of the cases by:

Changing incorrect lifestyles

Oral therapy

Intraurethral therapy

Extracorporeal shockwave therapy at low intensity

Intracavernous injective therapy

Penile prosthetic surgery

Premature ejaculation

Premature ejaculation is the most difficult to define in male sexual problems. To put it simply we talk about premature ejaculation when there are recurring and persistent difficulties in controlling ejaculation voluntarily; when it occurs after minimal stimulation and before one desires it and frequently before the partner reaches orgasm.

It is hard and not very useful to define the “normal” duration of sexual intercourse that is from the penetration to the ejaculation. However, for those who are interested in numbers a recent study highlighted that there are couples for whom this is just a little bit more than one minute without being a problem, while for others it is more than 30 minutes. The average duration is about 5-6 minutes.

Apart from extreme cases when ejaculation occurs before penetration (“ante-portam”) or just a few seconds thereafter, while acknowledging such cases it is essential to establish whether, in a particular couple, the timing of the ejaculation reduces the quality of the sexual intercourse and the satisfaction of one or both partners.

Certain type of premature ejaculation could be characteristic of the first sexual intercourses of young males. This tends to regress over time as experience grows. In other cases premature ejaculation occurs later, after many years of normal and satisfactory timing (this is called secondary premature ejaculation). The origin of the problem is often psychological, loss of confidence at conscious or subconscious level, in one’s ability of maintaining erection for the duration of the whole sexual intercourse. More rarely premature ejaculation is caused by anatomical anomalies such as shortness of the frenum of the penis or inflammatory pathologies of the prostate. The role of the andrologist is essential also in these circumstances as the correct diagnosis can completely remedy the problem with a simple medication or by a small operation.

The treatment for premature ejaculation employs different approaches. These could be combined with at varying degrees depending on the patient’s need.
Counselling refers to all treatments combined by a specialist in order to assist the patient to regain his proper sexual potential which is necessary to restore his normal sexual activity. It is vital to keep in mind that premature ejaculation is a problem that affects a couple, therefore it’s essential to get both partners involved in its treatment. “Behavioural therapy” is aseries of progressive exercises for a couple to improve the control of the timing of ejaculation. In more resistant cases the support of a psycho-sexologist can be useful. Therefore it is important for an andrologist to be able to organise to get other professionals involved.

Retarding condoms and creams were used widely in the past, based on anaesthetic substances that reduce the intensity of sensations of the glans. The huge disadvantage of these treatments is that the effect of anaesthesia is hard to be dosed properly and the prolongation of the timing of ejaculation can cause loss of pleasure or even reduction of the strength of erection.

Until recently there was not any medication for oral administration which could be used solely for premature ejaculation. There were only medications used in treatments for other diseases, which could facilitate, if taken continuously for a long time, a certain prolongation of the timing of the ejaculation. However, they have unpleasant side effects. Today a dedicated medicine is available, which can be taken as and when necessary before sexual intercourse, without the need of continuous therapy. Preclinical tests and during the first years of its use this medicine showed to be efficient and safe especially for more serious cases of premature ejaculation. The main drawback with this drug therapy is that its efficacy is limited to the hours following the taking of the pill, so that therapy on its own is not capable of remedying the problem indefinitely.  

Where I operate:

www.villadonatello.it
www.arsmedicacasadicura.it
www.casadicuraleonardo.com

Related videos:

https://www.youtube.com/watch?v=JWt673zwrS0
https://www.youtube.com/watch?v=jYAqPpUYCOg