Hard facts: How to treat erectile dysfunction

In this guide, Prof. Rafi Heruti explains the condition, its causes, and the possible ways to treat it, ranging from prescription medication to experimental radio wave therapy

Dr. Itay Gal|
Impotence is one of the common medical issues in the world, but many men are hesitant to seek help and treatment for it.
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So, what exactly is impotence, and how can it be treated? Prof. Rafi Heruti, a sexologist and specialist in sexual rehabilitation, provided Ynet with an authoritative guide on the issue and how to tackle it.
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אימפוטנציה אין-אונות
אימפוטנציה אין-אונות
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How is impotence defined? In recent years, the medical term has been changed to Erectile Dysfunction to prevent the derogatory nature of the word “impotence.” It refers to the difficulty in achieving a full, rigid erection or maintaining an erection during penetration.
"The term is subjective and up for interpretation," says Prof. Heruti, "but a man who previously had a normal and satisfactory erection can describe whether the degree of rigidity is normal based on his experiences."
How does an erection occur? The penis consists mainly of small blood vessels located within three cylindrical bodies. When the small blood vessels fill with blood, they become rigid. An enzyme called phosphodiesterase 5 allows blood to exit the penis, preventing a constant erection.
When the enzyme is inhibited, blood continues to fill the blood vessels in the genital organ, maintaining the erection.
What are the causes of erectile dysfunction? The disorders can be divided into medical and psychological causes. "When the issue persists for years," explains Prof. Heruti, "and the patient says it’s progressively worsening, both during masturbation and intercourse, it suggests a medical origin, especially with risk factors such as high blood pressure, diabetes, high levels of fats in the blood, smoking, alcohol or drug use, or chronic diseases.”
“Additional medical reasons include neurological conditions such as multiple sclerosis or spinal cord injuries,” he adds. “When the problem only occurs in specific situations or when it’s reduced during masturbation, the issue is likely of psychological origin, such as performance anxiety."
What tests are performed in initial testing for erectile dysfunction? The doctor needs to examine the patient’s medical risk factors including high blood pressure, body mass index, smoking, alcohol use, and medical history of chronic diseases or injuries. In most cases, blood tests are also performed to detect anemia and assess sugar and fat levels, thyroid function, and testosterone levels.
What medications are available for treating erectile dysfunction? Medications are based on the phosphodiesterase 5 enzyme, which allows blood to exit the penis. Inhibiting it keeps the blood vessels inside the penis filled, thus maintaining an erection. The first medication approved in Israel, in 1998, was Viagra. Following that, Cialis, Levitra, Stendra, Tadam, and others have been approved.
What are the recommended dosages for treatment? The medications are divided into three main dosage intensities: low, moderate, and high. "Generally, I start with a moderate dosage medication that can be adjusted if needed," Prof. Heruti says.
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ויאגרה לטיפול באימפוטנציה
ויאגרה לטיפול באימפוטנציה
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"The medications can be taken daily, up to once a day, and they take effect within half an hour to an hour. Men who need to function sexually almost daily can use Cialis or Tadam, which can be taken daily at low dosages. They last for 36 hours, three times longer than other medications, and eliminate the need to medicate right before sexual activity."
Are the medications only viable for one sexual activity? The medications last for 12 to 36 hours, and during this time frame, they’ll induce an erection whenever a man is sexually stimulated.
"The medication doesn't stop working after ejaculation," Prof. Heruti explains. "Continued sexual stimulation will lead to an erection. If there’s no sexual stimulation, the medication won’t cause a forced erection.”
Who should avoid these medications? Since the medications cause blood vessel dilation, they aren’t recommended to those taking medications from the nitrate family, which are commonly used for heart patients to dilate blood vessels, but are also present in recreational drugs.
Combining a medication for erectile dysfunction with nitrate-containing substances can cause a drop in blood pressure and a risk of losing consciousness. The medications are also prohibited during the first six weeks after a heart attack or stroke and for patients suffering from retinitis pigmentosa, an eye condition.
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What other treatments exist for erectile dysfunction? Before Viagra, there was widespread use of injections: the patient would learn to inject a combination of substances that promote blood flow to the penis, with dosages adjusted to prevent prolonged erections. Injections are still used today and are effective for 75% of patients.
Another treatment option is using a vacuum pump: the patient places a cylinder device over the penis, and the pump creates a vacuum that draws blood into the penis, while a rubber ring maintains the blood in the vessels from escaping. This method is suitable for men who can’t use medication.
Why and when to see a sexologist When the issue is of psychological origins, such as performance anxiety, it should be addressed with the help of a sexologist rather than medication. According to Prof. Heruti, even when the cause is medical, seeing a sexologist can be beneficial because erectile dysfunction can affect self-image and sexual confidence, potentially impacting a relationship.
How effective are electrical devices for treating erectile dysfunction? Some clinics offer shockwave treatment, and there are also treatment devices using radio waves. Prof. Heruti explains that “shockwave treatment is only intended for cases where the source of the problem is physical and vascular, like in clogged arteries. There are studies indicating the effectiveness of shockwaves, but they don’t cure the issue.
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“As for radio waves, more experience and research need to be accumulated to ascertain their effectiveness. These treatments can improve blood flow to the penis, but they aren’t suitable when the problem is emotional like in performance anxiety, or neurological like a spinal injury.
Is there a discreet treatment option? The treatment is always discreet. Sexual health professionals have a therapeutic approach that allows for sensitive and targeted treatment. The initial consultation can be done via video without having to visit a clinic.
"Sexual health and intimacy are essential parts of a person’s quality of life," says Prof. Heruti. "If there’s a problem with sexual function in general and erectile dysfunction in particular, it’s advisable to seek a sexual health center where they can address the issue with complete discretion."
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