Erectile dysfunction - ED

Erectile dysfunction is a medically defined term as a partial or complete inability to hold erection in penis in a sufficient erection for sexual intercourse. The dysfunction appears when the cavernous bodies are insufficiently filled with blood, which precludes activation of the keeping mechanism of erection. It affects about 50% of men after 50th year of life, but sometimes it can occur between 25-40 years of age. Most men have problem with erection for a certain period of time in their life.



  • When you don’t observe morning erection.
  • When you cannot achieve erection during stimulation.
  • When you cannot keep erection till ejaculation or you get erection right before ejaculation.
  • When it’s not a one-time event, but repetitive problem and lowered sex drive.
  • When there is problem in one of these phases: ability to achieve erection, sufficient erection, ability to hold erection.


Why is it important to visit doctor as soon as possible? ED can signalize other more severe problems. And if you start treating your problem immediately, your condition will get faster better.

ED can be split into two categories: psychogenic (20%) and structural (80%), alternatively their combination. Studies show that most dysfunctions have somatic cause.

  • Lifestyle - depression, stress and anxiety, lack of movement, obesity and unhealthy diet, big workload, smoking, excessive alcohol drinking.
  • Metabolic and systematic diseases - diabetes mellitus, prostate and colorectal cancer, cardiovascular diseases, obesity, high cholesterol levels, atherosclerosis, hypertension (high blood pressure), thyroid diseases.
  • Nervous system diseases - multiple sclerosis, damaged spinal cord, Parkinson disease, epilepsy, Alzheimer’s disease.
  • Injuries - Peyronie's disease, traumas in the area of pelvis and tailbone.
  • Psychological causes - problems at work, high workload, bad relationship situation, stress, depression, lack of sleep and relaxation…


Prevention should be on the first place, because it is always better to avoid the disorders, than to deal with them in a long term with a complicated treatment. The most effective way is to avoid the risk factors which are: substance abuse such as alcohol and tobacco, overweight, psychological stress and lack of sleep.
Atherosclerosis is one of the most spreaded cause of erectile dysfunction, therefore try to avoid factors which cause it. Treat your body with enough movement, relaxation and quality sleep. Healthy nutritional diet and enough liquids is alpha and omega for a healthy lifestyle and also prevention against all systemic diseases. If you know about genetically inherited diseases in your family such as: cardiovascular diseases, diabetes, kidney diseases, or you already suffer from some disease increase the preventive measures. If you use medicaments, which can cause erectile dysfunction, consult it with your doctor.


Presently there is a wide spectrum of options in treatment of ED in early stage, when the cavernous bodies are not permanently damaged, the treatment is fairly simple and relatively fast.


Prescribed drugs (Viagra, Cialis, Levitra, Spedra, etc…) are primary solution for doctors right after prevention and changed lifestyle. But it has to be consulted with doctor which drugs to use, in order to prevent unwanted effects. These drugs cannot be combined with nitrates (used in treatment of cardiovascular diseases). Clinical studies have proved following undesired effects: redness in face, headaches, digestion problems, heart palpitation, nausea, congested nasal cavity, pain on the chest during sexual intercourse, and temporary or permanent loss of sight on one or both eyes (in extreme cases). Wrong combination of drugs may induce priapism condition (long lasting and painful erection) which can damage the cavernous bodies after 4 hours.


Erection hardness score

  • 1st stage - penis is larger than usually, but not firm enough.
  • 2nd stage - penis is firm, but not enough for penetration.
  • 3rd stage - penis is sufficiently hard for penetration, but not completely hard.
  • 4th stage - penis is completely hard and rigid.

Drugs treating ED come with a scale for evaluating whether the treatment is successful or not. “Score” achieved on the scale serves for evaluation prescribed amount by doctor.

Intracavernous treatment

Intracavernous treatment is applied with injection directly into cavernous bodies, it is used if the drug of treatment form is ineffective. Prostaglandin E is used in product Caverject and others. The advantage is that after instruction every patient is able to apply it by himself. It is also highly effective. Disadvantage is the unpleasant form of application, and high risk of unwanted effects, especially in form of priapism (condition of constant painful erection, without any previous erotic stimulation).

Vacuum constriction devices

It is another option in form of special vacuum chambers. The result of created vacuum in the chamber leads to increased blood circulation which usually leads to erection. Afterwards a rubber circle is put on the root of the penishm which restrains the outflow of blood. This way the erection is kept. The disadvantage is the short effectivity, low comfort and price of the device.

Focused shock wave therapy

Focused shock wave therapy is one of the modern ways of treatment, and most effective among the mentioned treatments. It is a non-invasive form of treatment, friendly to digestive system, minimizing side effects and providing comfort after the therapy. It is used for its positive effects on regeneration, blood supply and supporting metabolism in the area of application, which is ideal if you feel pain or the cavernous bodies are damaged.

Operative treatment

Last option is used when all the other had no effect. The principle is solution is about removing the cavernous bodies and replacing them with special implants, which are either semirigid (partly flexible) or inflatable. The first type keeps a constant erection, the second one has a special mechanism securing erection according to patient’s wish. Disadvantage is financially very challenging.

Despite the fact that ED is very sensitive problematics, it pays off to deal with the problem in time. The access to informations about prevention and treatment is very easy nowadays. Prolong your health by not closing you eyes to your problems.

Author: FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

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