Erectile dysfunction is a widespread and feared health problem in the male population, which can have different causes. These causes range from purely biological-medical to psychological causes and all their mixed forms. For this reason, the therapies need to be multifactorial and interdisciplinary. (Almost) always psychotherapeutic support is necessary. Even in case of purely organic causes, the erectile dysfunction always generates psychological stress in the person concerned and in their relationship with the partner. Conversely, problems within the relationship or other psychological disorders can cause an erectile dysfunction even without organic diseases and risk factors.

Different types of erectile dysfunction
We differentiate between temporary, intermittent and permanent erectile dysfunction according to duration and occurrence. We distinguish between a psychogenic erectile dysfunction with psychological causes and somatogenic forms with organic causes. In reality, we are often dealing with mixed forms, and as already mentioned, even the purely organic erectile dysfunction is always accompanied by psychological problems.

Causes of erectile dysfunction
Since a complex interaction of nervous, hormonal and psychological functions is necessary for a complete and lasting erection, the causes of a disorder can be very different. In many cases, there are several causal factors at the same time:

Organic causes/ risk factors:
– increased blood sugar, diabetes
– arteriosceloris
– arterial hypertension (high blood pressure)
– renal insufficiency (impaired kidney function)
– obesity
– high cholesterol
– urological disorders
– neurological disorders, for example multiple sclerosis
– nerve injuries

Psychological disorders:
– chronic stress and burnout syndrome
– different forms of depressive disorders
– psychosocial problem within the partnership

Medications
– antiandrogens (drugs that inhibit the effects of male hormones)
– anabolic steroids (substances that lead to an accelerated muscle building (used in bodybuilding and animal husbandry (ingestion by eating meat), unauthorized use in doping).
– Antidepressants
– Antihypertensive drugs (especially betablockers, clonidine)
– H2 receptor antagonists (gastric acid inhibition *, e.g. cimetidine, ranitine, famotidine)
– Corticosteroids

Alcohol

Smoking

*These are not the same drugs as proton pump inhibitors (pantoprazole, lansoprazole, omeprazole, which are more often prescribed)

Therapy
First and foremost therapy should consist of identifying and elimination the above mentioned risk factors:
– Treatment of organic diseases
– If possible change of the causal medication
– Stress reduction
– Psychotherapeutic support for psychological problems
– Healthy lifestyle with sports, healthy nutrition and enough sleep
– Smoking cessation
– Reduction of alcohol consumption

Pharmacological therapy
In some cases, pharmacological therapy may be necessary temporarily or over a longer period. The following drugs are available at the moment:
– Phoshodiesterase-5-Inhibitor (best known as Sildenafil (Viagra))
– Yohimbine
– Prostaglandins
Contraindications should be excluded before using these drugs. The use should only take place under medical supervision.

Surgical interventions