Erection / impotence
What is Andrology
Andrology is the field of medical practice that explores male genitalia, that is, the prostate, testis, penis and their pathologies.
What tests if erectile difficulties fail to resolve with viagra, levitra or cialis ?
After a consultation with full patient questioning and a complete clinical examination, three tests are customarily prescribed :
1°) A general biological work-up including glycemia and bioavailable testosterone involving a simple blood test at a medical analyses laboratory.
2°) A corpora cavernosa test (in our specialised centre) to assess the reaction of erectile tissue. This test is not painful.
3°) Possibly, additional tests to assess the status of your arteries or veins in the penis, and perhaps a recording of your nocturnal erections. They make it possible to specify :
a) the causes of the erectile dysfuntion
b) the degree
These tests make it possible to single out the various organic factors responsible for erectile dysfunction.
What treatment can you expect ?
Treatment will naturally depend on the various causes found (each one calls for appropriate treatment) and the degree of erectile dysfunction.
Treatment basically ranges from simple vasodilators, psychostimulants, erection facilitators (medicinal or mechanical), intra-cavernosal injections (initially by the andrologist, then by the patient himself) to surgical treatment (vascular procedures, physiological or inflatable prosthesis).
Additional sexological therapy is often indispensible (owing to the frequency of associated, psychogenic functional factors), together with personal development techniques.
ANATOMICAL and PHYSIOLOGICAL UPDATE
An erection is a vascular phenomenon linked to the filling of the corpora cavernosa, which calls for intact arteries, nerves, veins and all the cells making up the corpora cavernosa.
Cerebral pathways, psycho-vegetative equilibrium and production of the cerebral neuromediators responsible for the filling of the corpora cavernosa must also work normally.
CAUSES OF ERECTILE DYSFUNCTION :
The organic factors :
- Insufficient arterial inflow
- Venous insufficiency
- Hormonal causes
- Neurological causes
- Alterations of erectile fibre
A search for all these organic causes will systematically be carried out by questioning the patient and conducting a thorough examination; a precise questionnaire may also be used to avoid overly subjective attitudes.
« Psychogenic » factors will systematically be looked for, irrespective of whether organic factors can be incriminated or not.
Iatrogenic factors will also be sought :
Hypertensives, lipid-lowering drugs, neuroleptics...
IN PRACTICE, OUR DIAGNOSTIC AND THERAPEUTIC PROCEDURE IS AS FOLLOWS :
When the erectile dysfunction fails to respond to simple symptomatic treatment (viagra and/or sex therapy), two tests are systematic :
1°) A general biological work-up including glycemia and bioavailable testosterone
2°) A corpora cavernosa test to assess the reaction of erectile tissue.
3°) Other additional tests are sometimes prescribed depending on the case.
THE TREATMENT OF ORGANIC AND PSYCHOLOGICAL FACTORS :
Treatment begins with intra-cavernosa injection (ICI) combined with sexological support.
In benign psychogenic forms, treatment is usually effective after a few injections and consultation with a sexologist.
ASSOCIATED MEDICAL TREATMENT:
- Eliminate any iatrogenic factors,
- Hormone treatment in the event of low bioavailable testosterone levels,
- Distal arterial factor : vasodilator,
- Adjuvant psychostimulating treatment.
- Stress management technique, to develop full mental potential and consequently sexual.
3. POSSIBLE EFFECTS OF TREATMENT : rapid cure, dependence on treatment, forms that fail to resolve.
In the event of dependence on injections, or in cases that fail to resolve, the organic factors will be reconsidered :
a - Arterial factor :
A colour duplex scan, or even an arteriography, may be necessary to detail the status of the arteries.
b - a large venous leak may be diagnosed by means of cavernosometry, cavernosography.
If no curable organic factor is found
1°) in the event of dependence on ICIs : learn how to self-inject
2°) sometimes, intra cavernous cocktail injection ( dimix, trimix, quadrimix...) could be used.
3°) In the event of erectile dysfunction that fails to respond to ICIs, and in the absence of a cause that can be cured medically or surgically, intra-cavernosa prosthesis may exceptionally be proposed.