Erectile Dysfunction

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rectile dysfunction can be described as a total inability to achieve an erection, an intermittent disability or a tendency to maintain only brief erections.

Patterns of erectile dysfunction
In older men, erectile dysfunction usually has a physical cause, such as illness, injury or side effect of other drugs. Any disorder that causes nerve damage or impairs blood flow in the penis has the potential to cause erectile dysfunction. The incidence increases with age. Approximately 5% of men who are 40 years old and between 15 and 25% of men who are 60 years old experience erectile dysfunction. However, it is not an inevitable consequence of aging.

Erectile dysfunction is treatable at any age and the knowledge of this fact has been increasing. Many more men have sought medical help and have returned to having normal sexual activity thanks to the greater effectiveness of treatments against erectile dysfunction. Urologists are responsible for addressing the problem, generally.

Although erectile dysfunction is more common in men older than 65 years, as noted, this disorder can occur at any age. It is very important to emphasize that an occasional episode of erectile dysfunction is something perfectly normal that happens to most men. In fact, most of the cases should not be cause for concern. With increasing age, it is also normal to experience changes in erectile function. Erections may take longer to develop, not be as firm or require a more direct stimulation to occur. Men also notice that their orgasms are less intense, the volume of the ejaculate is smaller and the recovery time increases between erections.

When erectile dysfunction proves to have a pattern or becomes a persistent problem, it can deteriorate a man’s self-image and affect his sex life. It can also be a sign of an emotional or physical problem that requires treatment.

Treatments include;

• weight loss and increased exercise (this may reduced the risk of erectile dysfunction by up to 70%)
• treatment of any hormone abnormality (testosterone treatment is only indicated if your testosterone levels are low and may be harmful if your the levels are normal);
• lifestyle modification (e.g. reduce stress, stop smoking, reduce alcohol consumption & stop illicit drugs);
• treatment of any anatomical abnormality if present (e.g. circumcision, frenuloplasty, penile straightening);
• psychological support if necessary.

First line treatment will be medication with a phosphodiesterase inhibitor such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) or avanafil (Spedra). These drugs only work when used together with sexual stimulation and will have no effect on your sex drive. There is no evidence that these drugs are dangerous if you have underlying heart disease. However, they should not be used if you are taking nitrates (e.g. GTN, isosorbide) for angina

Other second Line Treatments

• Penile injections to produce erections
• Medicated urethral system for erection (MUSE)
• Vacuum erection assistance devices (VEDs)
• Vascular surgery/angioplasty
• Penile prostheses

Chronic Testicular Pain

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rostatitis is the most common parenchymal urinary infection in men between the second and fourth decades of life.
The term prostatitis comprises a broad spectrum of nonspecific symptoms of the lower genitourinary tract.

Chronic prostatitis has multiple hypotheses regarding its origin, it is believed that they can happen due to an obstruction, intraductal reflux, infectious causes such as consequence of prostatic anatomy.

In the case of chronic prostatitis syndromes, we find that sometimes the symptoms are scarce or nonexistent and only involve alterations in the semen that condition infertility.

On other occasions, sexual manifestations predominate, such as total or partial loss of erection, painful ejaculation, premature ejaculation or haemospermia (presence of blood in semen).

But the most common is the existence of pelvic pain and urinary symptoms. The pain is referred to different areas: suprapubic, perineal, lumbosacral, scrotal, penile, inner side of the thighs. The most frequent urinary disorders are obstructive (onset of voiding difficulty, decreased caliber, post-void residual urine and even acute urinary retention) or irritative (imperiousness, passing frequent of small amounts of urine, painful urination or tenesmus). Finally, in case of chronic prostatitis the symptoms last for at least 3 months and, given the similarity with the clinical and pathological process of benign prostatic hyperplasia, it is sometimes difficult to distinguish between these two entities.

Medical treatment
In summary, in addition to the use of antimicrobials, and although obstruction of the bladder neck is an infrequent complication of the prostatitis syndrome, drugs that produce an opening of the urethrovesical exit region may help to alleviate both the obstructive and irritative symptoms of these patients. and to improve the deteriorated quality of life that they present.

Chronic Testicular Pain

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hronic testicular pain or chronic orchialgia is defined as constant or intermittent testicular pain, unilateral or bilateral, lasting 3 months or more, affecting the daily activities of the patient until they seek medical attention. Some authors report that in 25% of cases of orchialgia cannot identify a specific etiology.

The specific causes of chronic orchialgia include infectious processes such as urethritis and prostatitis, testicular tumors, inguinal hernias, hydrocele, spermatocele, varicocele, referred pain, traumatisms, intermittent testicular torsion, prostatodynia / non-bacterial prostatitis and neuromuscular dysfunction of the pelvic floor (chronic genital pain). The management of patients with chronic genital pain is complex. Some of these patients typically attend anxiety, they are tense and frequently worried about the possibility of being carriers of some serious pathology. Usually, they have already been treated without achieving positive results.

Medical management
When considering treatment options in patients with chronic orchialgia, it should be initiated with non-surgical options. The use of jockstrap and the modification of postural habits and the pattern of exercise. Antibiotic, anti-inflammatory, analgesic agents or a combination of these are used.

Surgical management
When medical management does not resolve the clinical condition, or if the patient has an obvious surgical pathology, doctors can consider surgical treatment for pain control. In this regard, it is important that the patient is aware that the surgery does not guarantee adequate symptomatic control and that before the surgical decision is has been offered adequate medical treatment.

Surgical options for the treatment of chronic orchialgia include corrective procedures for specific pathologies such as varicocele cure, hydrocele cure, orchidopexy, vascular anastomosis, and even removal of non-absorbable suture material in postoperative orchialgia.

Chronic Pelvic Pain

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hronic pelvic pain (CPP) is one that is located at the level of the lower abdomen, the pelvis or intrapelvic structures, persisting for at least six months, which occurs continuously or intermittently.
If it is not acute and the mechanisms of central pain sensitization are well documented, pain is understood as chronic regardless of the elapsed time. In all cases, it is frequently associated with negative consequences in the cognitive, behavioral, sexual and emotional areas.
Chronic pelvic pain is a complex condition in which symptoms of the reproductive, urological, gastrointestinal, abdominal wall, pelvic floor, and psycho-social factors are frequently intermingled, so an exhaustive clinical history becomes very important.

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ultidisciplinary management of pain
CPP is a symptomatic complex that can originate from gastrointestinal, urological, reproductive, musculoskeletal or neurological diseases. When the cause of the pain is evident, the treatment is directed to treat it. However, a subgroup of patients persists with pain despite treatment of the underlying cause.  It is in this context that the multidisciplinary management of CPP, with the planned and interactive participation of different specialists (urologist, gynecologist, gastroenterologist, coloproctologist, pain specialist, psychiatrist, psychologist, kinesiology among others) is very important in both the study and treatment.

Multimodal therapy is redirected to treat the pain and the underlying cause -if it exists- and all those biological, psychological and environmental factors that are influencing.

A proper therapy of this condition includes medical treatment (non-steroidal anti-inflammatory drugs, opioids, antidepressants, neuromodulators, muscle relaxants, alpha blockers), but also psychotherapy, non-pharmacological therapy of the pelvic floor (biofeedback, myofascial massage), pelvic floor pharmacological therapy (injections in points trigger, botulinum toxin), bladder instillations, neuromodulation and surgical interventions (adhesiolysis, uterine neuroablation, presacral neurectomy) when appropriate.

At The Harley Street Hospital, we have the best specialists who can help you to treat chronic pelvic pain effectively. Book a consultation.