Erectile dysfunction

Most men treated for Erectile Dysfunction manage to regain satisfactory sexuality. To do this, the cause (s) of the dysfunction as well as the risk factors must be identified by a doctor.

If there is an underlying disease, it will be treated, and the man will also receive treatment to improve his erectile function.

If the dysfunction is not related to a specific health problem, its treatment may include improved life habits (see the Prevention section), a therapy cognitive-behavioral or consultation with a sexologist (see Sex therapy below) and, often, treatment with drugs.

Cognitive-behavioral therapy

This approach to individual psychotherapy helps to explore and understand the problem by analyzing in particular cognitions, that is to say the thoughts, expectations and beliefs of the person vis-à-vis sexuality. These thoughts have many influences: lived experiences, family history, social conventions, etc. For example, a man may fear that sexuality will stop with age, and believe that an experience where he does not achieve an erection is a sign of permanent decline. He may think his wife is moving away from him for this very reason. Consult a psychologist or sex therapist familiar with this approach (see Sex therapy below).

pharmaceuticals

Sildenafil (Viagra®) and other IPDE-5. Since the late 1990s, the first-line treatment for oral erectile dysfunction is contradicted by oral administration are phosphodiesterase type 5 (IPDE-5) inhibitors – sildenafil (Viagra®), vardenafil (Levitra ®) and tadalafil (Cialis®) or avanafil (Spedra®). This class of drugs available only by prescription relaxes the muscles of the arteries in the penis. This increases the flow of blood, and allows erection when there is sexual stimulation. Thus, IPDE-5 are not aphrodisiacs and the sexual stimulation is needed for the medicine to work. There are various dosages and durations of action. For example, if the duration of action is 4 hours, we have a 4-hour window of action during which we can have one or more sexual relations (the erection does not last 4 hours). These drugs are effective in 70% of cases but are less effective in chronic disease such as diabetes.

benefits contraindications apply given the potential for drug interactions. Check with your doctor.

Intraurethral treatment. In cases where IPDE-5 is ineffective or when its use is contraindicated, the doctor may prescribe vasoactive substances (for example, alprostadil) which the man learns to administer himself into the urethra. at the end of the penis 5 to 30 minutes before sexual activity. These drugs are administered as mini-suppositories to be introduced into the urinary meatus (Muse® device) or cream (Vitaros®). It is a simple and interesting alternative for the 30% of men for whom tablet drugs are ineffective.

Penile injections (intracavernous injections). This prescription-only treatment, since the early 1980s, involves injecting a drug (alprostadil) into one side of the penis. This medication works by relaxing the muscles in the arteries in the penis, which increases the flow of blood within 5 to 20 minutes. With this treatment, the rigidity of the penis is achieved even in the absence of sexual stimulation and lasts about 1 hour. This treatment is increasingly used in men for whom tablet, cream or mini-suppository treatment is not effective. This treatment is effective in 85% of men, and it is most of the time in men who do not respond to treatment with medication in tablets (Viagra® or Sildenafil, Cialis®, Levitra®, Spedra®), cream (Vitaros®), or in mini-suppositories (Muse®))

Testosterone. If erectile dysfunction is caused byhypogonadisme (leading to an abnormal drop in testosterone), so that the production of sex hormones by the testes is low, hormonal treatment with testosterone may be considered. However, it is only effective in a third of cases to regain functional erections.

Penile devices. When previous treatments do not work or are unsuitable, mechanical devices can be used. Cock rings whose role is to tighten the base of the penis to maintain an erection can be effective without the inconvenience of substances contained in drugs. When the penis ring is not sufficient, the vacuum pump, also called vacuum, creates a vacuum in a cylinder placed around the penis, which results in an erection held by an elastic compression penis ring slipped at the base of the penis.

Penile implants. There are also various types penile implants requiring surgery to permanently implant flexible inflatable rods into the penis. It is an extremely effective solution when other possibilities do not work.

Decreased desire

Faced with a decrease in sexual desire, the first thing to do is a medical check-up, to detect risk factors for desire disorder, list the drugs taken, the surgeries undergone, the chronic diseases present. Depending on this assessment, one treatment or several treatments can be implemented. Besides the difficulties of desire linked to medical problems, psychological problems may be present. The proposed treatment then consists of personal or couple therapy work.

La classic therapy consists of a program of consultations with a psychiatrist, a psychologist or a sexologist during which we work to identify the blockages, their fears, dysfunctional thoughts in order to adopt the attitudes and behaviors allowing them to be overcome. See Cognitive Behavioral Therapy and Sex Therapy.

Premature ejaculation

In the event of premature ejaculation, the services of a doctor who can prescribe medication to delay ejaculation are usually sought. This is dapoxetine (Priligy®). This is valid when ejaculation is really very fast (less than 1 minute after penetration). At the same time, it is useful to consult a sex therapist or psychologist who uses counseling and behavioral therapy techniques. The subject and his (or his) partner will be made to practice various methods of relaxation and self-control, for example by breathing exercises aimed at reducing the speed of the rise of sexual arousal and muscle relaxation exercises.

The doctor can teach the technique of squeeze (compression of the glans or the base of the penis), stop and go or perineal rehabilitation by Kegel exercises, a technique that allows the subject to identify the “point of no return” and to control the triggering of the ejaculatory reflex.

The use of a condom or cream anesthetic has the effect of reducing the sensitivity of the penis, which may help delay ejaculation. In the case of using anesthetic cream, wearing a condom is recommended so as not to numb the vagina and to facilitate absorption of the cream.

Peyronie’s disease

Sex therapy

When a doctor agrees with his patient that psychological factors are involved in one or another type of sexual dysfunction, he usually advises seeing a sex therapist. Most sex therapists work in private practice. These can be individual or couple sessions. These sessions can help calm the frustration and the tensions or marital conflicts caused by the difficulties experienced in sexual life. They will also help increase self-esteem, which is often abused in such cases. There are 5 main approaches in sex therapy:

• la cognitive-behavioral therapy, which aims to break the vicious cycle of negative thoughts about sexuality by detecting these thoughts and trying to defuse them, as well as modifying behavior.
• l’systematic approach, which looks at the interaction of spouses and their effect on their sex life;
• theanalytical approach, who tries to resolve internal conflicts at the origin of sexual problems by analyzing the imagination and erotic fantasies;
• l’existential approach, where the person is encouraged to discover their perceptions of their sexual difficulties and to get to know themselves better;
• thesexocorporeal approach, which takes into account the inseparable links body – emotions – intellect, and which aims for a satisfying sexuality both on a personal and relational level.