1. What is erectile dysfunction? Is it the same thing as impotence, premature ejaculation, or sexual dysfunction? Erectile dysfunction (ED) is the persistent inability of the penis to achieve and maintain an erection sufficient for satisfactory sexual intercourse over the past 3 months; it is one of the most common sexual dysfunctions in men. The term ED used to be “impotence”. In English, the word impotence is synonymous with “sexual impotence” and sometimes refers to a lack of specificity in male sexual dysfunction such as decreased libido, erectile dysfunction, and premature ejaculation. In addition, because “impotence” contains a derogatory meaning, it is replaced by the term ED. The Urology Department of Guangdong Provincial Hospital Zhu Shulun ED is a male sexual dysfunction, male sexual dysfunction also includes: hypoactive desire, premature ejaculation, non-ejaculation or retrograde ejaculation, orgasmic disorder, etc. Premature ejaculation refers to men losing the ability to control ejaculation during sexual intercourse, ejaculation before or just before penile insertion into the vagina; or one of the two men and one of the two women thinks that the time to reach ejaculation is too fast and unsatisfactory. ED patients can be accompanied by other sexual dysfunctions, the most common being premature ejaculation, which should be diagnosed and identified by taking a medical history. How many men suffer from ED and which men are prone to ED? ED is a common condition in middle-aged and older men. According to existing foreign research estimates, about half of men aged 40 to 70 years suffer from varying degrees of ED, of which about 10% are completely unable to get an erection; the prevalence of ED in urban men in China is 40%, of which about 5% are completely unable to get an erection. The likelihood of ED increases with age. The ED is not inevitable in older men. cardiovascular disease, hypertension, diabetes, hyperlipidemia, atherosclerosis patients are prone to ED. other people prone to ED are: liver and kidney insufficiency, endocrine diseases, neurological diseases, genitourinary diseases, psychiatric disorders, depression and other patients, as well as people taking drugs, smoking, alcohol, drug abuse, trauma, surgery, etc. 3. What is the erection of the penis? Inside the penis are two parallel penile corpus cavernosum and the urethral corpus cavernosum, which is located below it. The front of the urethral corpus cavernosum is enlarged to form the head of the penis. The corpus cavernosum is the main erectile tissue and is actually a vascular organ. The nature of penile erection is a series of neurovascular activities. When sexually stimulated, the nerves send impulse signals that cause the cavernous body of the penis to fill with blood and result in an erection. The normal male sleep state can also produce nocturnal erection, in the diagnosis of ED, the presence of nocturnal erection is an important basis for distinguishing between psychological and organic ED. 4. How does ED occur? The etiology of ED is complex, and factors affecting the psychological and physiological processes of erection may trigger ED. Injuries to the nerves and blood vessels related to erection at the somatic level may cause ED; locally in the penis, factors affecting the filling of the penile corpus cavernosum may cause ED. 5. What factors can cause ED? ED can be divided into psychological, organic and mixed categories according to the etiology. Organic ED can be divided into arterial, venous (cavernous), neurological, endocrine, injury, medical, drug, etc.. In the past, psychogenic ED was considered the most common, and with the improvement of diagnostic techniques, it is now generally believed that ED with organic factors stands for about 60% of all patients. The predisposing factors that lead to psychological ED are bad sexual experiences, lack of sexual knowledge, life stress, personality defects, etc. Partner relationship incompatibility, inadequate sexual stimulation, repression, anxiety, etc. are contributing factors to psychological ED. The most common cause of organic ED is atherosclerosis, and atherosclerosis-related hypertension, heart disease and its risk factors, including diabetes, hyperlipidemia, smoking, etc., are also risk factors for ED. ED may be the initial clinical manifestation of coronary heart disease, cerebrovascular disease, diabetes and other medical conditions, so the assessment of erectile function may reveal the above clinically quiescent but potentially progressive diseases. 6. How is ED diagnosed? The diagnosis of ED is not difficult and most patients can be diagnosed after taking a medical history, necessary physical examination and selective laboratory tests. a detailed history taken by the physician is the most important aspect of ED diagnosis. Patients should take the initiative to tell the doctor whether it is difficult to achieve or maintain an erection sufficient for penetration, the duration, frequency and degree of the disease; whether it is combined with other sexual dysfunctions such as hypoactive sexual desire and premature ejaculation; whether there is a nocturnal or morning erection; whether the onset is related to the partner, environment, scenario, etc.; whether there are chronic diseases, trauma and surgery, medication, smoking, alcohol abuse, etc.; the relationship with the partner, interpersonal relationships, etc. are important to the doctor. Diagnosis of the disease, analysis of the cause of the disease is also important. 7. Why do doctors ask ED patients to fill out questionnaires? ED complaints are highly subjective, so in order to have objectivity and comparability in patients’ evaluation of the degree of ED (including inter-patient comparisons and comparisons between patients before and after their own treatment), a variety of sexual function questionnaires have been introduced to rate patients’ erectile function and other aspects of sexual function. The commonly used questionnaire is the International Erectile Function Questionnaire (IIEF-5), which is simplified to 5 questions for ease of use and efficiency in the outpatient setting, and the Chinese Erectile Function Questionnaire-5 (CIEF-5), which is a valid tool for assessing the degree of ED. Patients may wish to rate themselves on the scale. (See Tables 1 and 2 in the Diagnosis section.) 8. What tests should be performed to diagnose ED? The first is a comprehensive examination, focusing on the male genital organs, with the aim of detecting neurological, cardiovascular, endocrine and reproductive disorders associated with ED. The first visit to the patient, blood and urine routine, liver and kidney function, blood glucose and lipid examination should be performed. Further hormone tests such as testosterone can be selected. Only “special” patients need “special” tests. Because most patients can be treated with oral medications, complex invasive tests are not necessary. Special tests available include: NPT, ICI, color Doppler dual-function ultrasound (CDDU), selective pubic arteriography, penile sponge body imaging and manometry, neuromyography, cavernosal biopsy, etc. 9. What are the treatment options for ED? The treatment of ED should be based on the principles of effectiveness, safety and convenience, so that sexual life can be performed in its natural state without interference. According to the global consensus of experts, ED treatment options include: General treatment: remove the factors that cause ED as much as possible First-line treatment: oral drug therapy, namely PDE5 inhibitors (sildenafil, vardenafil, tadalafil) Second-line treatment: intracavernosal injection of vasoactive drugs, intraurethral drug delivery, vacuum negative compression device and other local treatment Third-line treatment: surgical treatment In China, Chinese medicine Treatment also occupies a certain position 10. What are the common elements of treatment for different ED patients? ED patients should correct modifiable risk factors before receiving direct, targeted treatment. First, they should quit smoking, alcohol, and drug dependence to eliminate the effects of poor lifestyle habits on erectile function. Secondly, confidence should be built up and the understanding and cooperation of the partner should be sought. Thirdly commonly used hypertensive drugs, anti-arrhythmic drugs, antipsychotics, anti-estrogen drugs and steroids affect erectile function. If the condition allows, the dosage and type should be adjusted by a specialist to strive to minimize the negative effects of drugs on erectile function. 11. Why are PDE5 inhibitors the treatment of choice for ED? Since the first PDE5 inhibitor Viagra began clinical use in 1998, PDE5 inhibitors (sildenafil, vardenafil, tadalafil) have become the treatment of choice for ED because of their efficiency, safety and ease of use. the efficiency of all three PDE5 inhibitors is about 80%, and the adverse effects are mild to moderate and transient in nature. 12. What kind of patients are contraindicated to PDE5 inhibitors? Sildenafil, vardenafil and tadalafil are contraindicated in patients taking nitrate drugs, such as nitroglycerin and cardioplegia. Consult your doctor for details. 13. How to use PDE5 inhibitors in ED patients taking α-blockers? For ED patients who must use alpha blockers at the same time, in addition to strictly observing the interval between the two drugs, highly selective alpha blockers should be chosen as much as possible. To avoid complications such as hypotension, refer to the corresponding drug instructions or follow medical advice if necessary. What should I do if PDE5 inhibitors are ineffective or contraindicated? Second-line treatments such as intracavernosal injection of vasoactive drugs, intraurethral administration, and vacuum negative compression devices are available. Compared with oral drug therapy, second-line treatment has the disadvantages of inconvenience, interference with the normal conduct of sexual activity and relative invasiveness. 15. Is there surgery for ED? Surgery is the third line of treatment for ED and is indicated for patients with severe ED for whom other treatments have failed. Surgery includes penile prosthesis implantation and revascularization surgery.