Prevention, examination methods, and comprehensive treatment plans for erectile dysfunction

While a happy and fulfilling marriage cannot be maintained solely by sexual function, a healthy and harmonious sex life plays a vital role in sustaining the relationship between spouses and building a loving family bond. Research indicates that disharmony in sexual life has become one of the leading causes of divorce today. Therefore, it is crucial for every family to actively prevent erectile dysfunction. So, how can erectile dysfunction be prevented?

(1) Maintain a cheerful mood: Erectile dysfunction is closely related to mental and psychological factors. Therefore, you should always maintain a good mood. When you encounter troubles, you should be able to think things through and let them go. Avoid worry, depression, irritability, and anger. In particular, long-term emotional suppression will seriously affect the normal erection of the penis.

(2) Healthy diet: Develop good living habits, eat in moderation, and maintain regular daily routines. Do not drink alcohol in large quantities or for a long time. Your diet should be nutritious, scientifically balanced, and less spicy, fatty, and sweet foods. You can use some dietary therapy under the guidance of a doctor.

(3) Moderation in sexual activity: Unmarried young men should have a proper attitude towards sexual relationships, avoid reading pornographic books and watching pornographic videos, cultivate good living habits, and avoid excessive masturbation. When they first have a sexual partner, due to the novelty and stimulation, they often have sex excessively, sometimes 3-4 times a day, which can easily lead to symptoms such as prostatitis and pelvic and perineal discomfort. They should be careful to exercise restraint. Unmarried men often do not have a fixed and quiet place for sexual intercourse, and some may experience erectile dysfunction, premature ejaculation, etc. At this time, they should not blame themselves, but have confidence in themselves. The female partner is also very important. Often, a dissatisfied look or disdainful expression from the female partner can be very damaging to the man. In this case, do not rush to have sex again to save face, because the outcome is often not ideal. You should pay attention to rest, find a quiet and familiar place, and if necessary, do sensate focus training, which can mostly restore normalcy.

(1) Blood and urine routine tests, biochemistry and liver and kidney function tests: Fasting blood glucose, blood lipids and liver and kidney function tests can detect diabetes, abnormal blood lipid metabolism and chronic liver and kidney diseases. These diseases can all cause erectile dysfunction.

(2) Sex hormone level testing can determine whether erectile dysfunction is caused by endocrine abnormalities, thereby enabling targeted treatment.

(3) Special Examinations: A small number of patients with erectile dysfunction (approximately 15%) do not respond to non-invasive treatments. To further understand the exact cause or mechanism of erectile dysfunction, some of the following examinations may be selectively performed: ① Nocturnal penile tumescence test (NPT). Clinically, this helps differentiate between psychogenic and organic ED. If nocturnal penile tumescence persists, it indicates a psychogenic condition. ② Intracavernosal injection of vasoactive drugs (ICI). Intracavernosal injection of vasoactive drugs can induce penile erection in patients with psychogenic, neurogenic, hormonal, and mild vascular ED, especially neurogenic ED. ③ Color Doppler ultrasound (CDU). This examination is non-invasive and can be performed on an outpatient basis. ④ Penile cavernosal manometry. This method is an effective way to diagnose venous erectile dysfunction. ⑤ Cavernosography. The clinical application of cavernosography has improved the understanding of venous ED and provided a basis for its treatment. ⑥ Selective penile arteriography. Arteriography remains the primary method for assessing the location and characterization of penile blood supply abnormalities. ⑦ Neurological testing for erectile dysfunction. The autonomic nervous system plays a crucial role in the neural transmission of the erectile response. ⑧ Corpus cavernosum biopsy. Pathological changes in the smooth muscle cells and cavernous spaces of the corpus cavernosum, such as a decrease in the number of smooth muscle cells, altered cell ultrastructure, and excessive proliferation of fibrous tissue, can reduce the compliance and elasticity of smooth muscle cells and cavernous sinuses, leading to insufficient arterial filling and incomplete venous occlusion, thus resulting in weak erections. Corpus cavernosum biopsy can directly evaluate cavernous body function and is essential in the etiological diagnosis of some patients with erectile dysfunction.

When erectile dysfunction occurs, some men are ashamed to seek medical help, causing significant psychological stress and strained relationships. This can easily create a vicious cycle, greatly impacting their physical and mental health, family life, and career. Therefore, when problems arise, we should face them bravely and seek medical attention proactively.

(1) Sexual psychotherapy: Since most patients with erectile dysfunction have psychological factors, psychotherapy is essential, and it is best for both partners to participate in sexual psychotherapy. Sensate focus training is currently the most important treatment method for psychogenic erectile dysfunction, applicable to the treatment of almost all sexual dysfunctions. Its purpose is to relieve anxiety, enhance communication and exchange between partners, improve skills in both verbal and non-verbal communication, and gradually improve the marital relationship and sexual function. The improvement rate of this method for erectile dysfunction is 20% to 81%. However, it must be said that in addition to medical treatment or psychotherapy provided by a doctor, the wife's support and care for her husband is irreplaceable.

When a husband suffers from erectile dysfunction, the wife should ideally: ① Be considerate, caring, and understanding. A wife's timely advice and guidance can alleviate her husband's feelings of inferiority and encourage him to actively accept treatment. A positive mindset leads to better treatment outcomes, and a deepening of the marital bond may also be key to overcoming erectile dysfunction. ② Supervise and provide meticulous care. Diet and exercise play a role in the prevention and treatment of erectile dysfunction. As a witness to her husband's daily life, the wife should supervise his dietary adjustments and exercise. Regarding diet, the wife should replace harmful stimulants like tobacco and alcohol with foods beneficial to male sexual function. Regarding exercise, the wife should encourage her husband to engage in appropriate physical exercise, primarily ensuring it is regular and consistent.

(2) Drug treatment: Oral medication is the simplest and most acceptable first-line treatment for erectile dysfunction.

Non-hormonal medications: Based on their site of action, they can be broadly classified as follows: ① Oral medications acting on the central nervous system, such as adrenergic receptor antagonists, dopamine receptor antagonists, and serotonin receptor antagonists. ② Oral medications acting on the periphery, such as PDE5 inhibitors (e.g., sildenafil, tadalafil, vardenafil), which are specific phosphodiesterase inhibitors that inhibit cGMP degradation, increase cGMP concentration, thereby relaxing smooth muscle and inducing penile erection. These medications are currently the first-line treatment for ED, with an overall effectiveness rate exceeding 70%. ③ Topical medications, such as creams and ointments, are the oldest methods for treating erectile dysfunction, but their effectiveness is uncertain.

Hormonal medications: Androgen replacement therapy is mainly used to treat endocrine-related erectile dysfunction, including ED caused by primary and secondary hypogonadism. ① Primary hypogonadism: Testicular tumors, Klinefelter syndrome, trauma, surgery, and other lesions can lead to decreased testosterone levels and increased levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Exogenous testosterone replacement therapy is most effective for these patients. ② Secondary hypogonadism: Secondary to hypothalamic and pituitary lesions, the lack of gonadotropins causes gonadal development arrest, resulting in decreased levels of testosterone, FSH, and LH. Supplementation with gonadotropins or gonadotropin-releasing hormone can improve libido and erectile function.

(3) Vacuum constriction device (VCD): The vacuum constriction device can be used for erectile dysfunction of any cause and is a second-line treatment for ED. However, the hemodynamics that cause an erection are different from those of a normal erection; there is no active relaxation of the corpora cavernosa and smooth muscle. Animal studies have shown that arterial blood flow does not increase after using a VCD, but venous return is significantly reduced, and the corpora cavernosa and penile skin become engorged with blood, leading to penile enlargement.

(4) Intracavernosal injection (ICI): Intracavernosal injection involves injecting vasodilators into the corpora cavernosa of the penis to induce engorgement and achieve an erection. Currently, the most commonly used drugs for treating erectile dysfunction via intracavernosal injection are papaverine, phentolamine, and prostaglandin E1, among others. This method is effective and has a rapid onset of action. With the widespread use of oral medications, this method, being invasive, has seen a decline in clinical application due to adverse reactions such as pain, bleeding, priapism, and penile fibrosis.

(5) Surgical treatment: With the advent of new drugs and increased understanding of the pathogenesis of erectile dysfunction, surgical treatment has gradually decreased. However, some patients with erectile dysfunction still require surgery, generally those who have not responded to other treatments. Surgical treatments include prosthesis implantation, vascular reconstruction, and vein ligation.