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Erectile dysfunction and premature ejaculation

ERECTILE DYSFUNCTION
Erectile dysfunction (ED) is a condition much more common than one might think and affects many men. Medically, ED is the persistent or recurrent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. ED can occur even in the presence of normal sexual desire and the ability to achieve orgasm and ejaculate. Talking to a doctor (general practitioner or uro-andrology specialist) is the best way to address this problem, as it could be a symptom of significant conditions such as diabetes, hypertension, cardiovascular diseases, or consequences of pelvic surgery.
For the diagnosis of ED, a thorough medical history and some blood tests are necessary. In some selected cases, it may be necessary to perform:
Nocturnal Penile Rigidity Measurement:
A specific instrument evaluates the presence or absence of nocturnal erections, which every man normally has unconsciously during sleep. It is performed over 2 consecutive nights.
Dynamic Penile Color Doppler Ultrasound:
To evaluate the vascular component of the penis, the presence of alterations in the structures of the corpora cavernosa (fibrosis, plaques), penile arterial flow, and the penile veno-occlusive mechanism.
Intracavernous Pharmacological Erection Test:
Examines the erectile response after intracavernous injection of a vasoactive drug at a standardized dosage.
Today, it is possible to cure 100% of ED cases through modifications of unhealthy lifestyles, oral therapy, intraurethral therapy, PRP, stem cells, low-intensity shockwave therapy, intracavernous injection therapy, and penile prosthetic surgery. All the options described are available in the centers where I work. Premature ejaculation is one of the most difficult male sexual disorders to define. In simple terms, one can speak of premature ejaculation when a man has difficulty voluntarily controlling ejaculation, which occurs before he or his partner desire it, often before the partner has reached orgasm. There is no “normal” duration of sexual intercourse from penetration to ejaculation, which varies from couple to couple. The important thing is to establish whether the duration of ejaculation in the couple in question affects the quality of the relationship and the satisfaction of the partners.
PREMATURE EJACULATION
Premature ejaculation can be present since birth, referred to as primary or lifelong premature ejaculation, or it can appear later in life following conditions such as prostatitis or thyroid disorders; in this case, it is called the secondary form.
The treatment of premature ejaculation usually includes various strategies, such as counseling, behavioral therapy, and psychosexual support. It’s important that the treatment involves both partners and that the andrologist works in collaboration with other professionals.
To date, the only oral medication with indication is dapoxetine, which however has reduced efficacy and a low percentage of treated patients.
Sprays based on a mix of two active ingredients—lidocaine and prilocaine—are used, to be applied 5 minutes before intercourse.
Our group has proposed the use of hyaluronic acid at the MONAVER triangle level (MONAVER = MONDAINI and AVERSA), that is, myself and Professor Antonio Aversa, as we have recently published. In England, a device called IN2 is already available, proposed by an Israeli startup, which has seen myself as the coordinator of international research. Therefore, we are still far from a definitive solution, but combining these drugs and devices can yield interesting results.