According to incomplete statistics, more than half of the male population aged 40 to 70 in China is more or less troubled by ED, which to some extent affects their lives and work. With the improvement of national living conditions and the development of sexual medicine, its treatment has become an urgent requirement for more and more people. The unveiling of ED treatment Erectile dysfunction, commonly known as impotence, has even been called “the saddest role on the stage of a man’s life”. Patients are not only mentally very painful, their inner world is often extremely contradictory: the lack of manhood “masculinity”, and desperately want to get help, but it is difficult to say, refused to seek medical attention; on the one hand, fear is “terminal disease”, on the other hand, afraid to take drugs will form dependence On the one hand, they worry that it is a “terminal disease”, on the other hand, they are afraid that they will become dependent on medication, that they have to take medication for life, and even think that only surgery can cure it. Only a full understanding of the means of treatment, to reduce fear, the courage to take steps to finally overcome the disease and regain happiness. ED causes are divided into two main categories According to the presence or absence of organ tissue damage, ED is divided into two main categories, psychological and organic. Psychological impotence related tissue without lesions, generally due to occasional overwork, mental tension, fear and anxiety, trauma, psychological pressure after one or two failed sex, especially when the sexual partner can not understand or another blame, this psychological burden will increase, forming a “failure – pressure – failure again The vicious cycle of “failure-stress-failure again”. The most direct causes of psychological impotence are the following: 1, lack of sexual knowledge, such as parents’ wrong sexual orientation to their children, over-exaggerating the dangers of masturbation, etc.; 2, spousal tension; 3, too much stress in life or mental and emotional abnormalities, such as depression, anxiety neurosis, etc.; 4, lack of self-confidence, such as dissatisfaction with their penis length, career setbacks. The common features of these patients are: normal vascular nerve function, nocturnal and morning erections, erection after sexual stimulation, and some can complete masturbation. Organic impotence is mainly caused by lesions of the associated neurological, vascular and endocrine systems, and the main causes are: 1, after penile trauma, penile anatomical defects such as penile shortening, penile curvature, abnormal penile position, urethral cleft, hypospadias, bipenis, testicular fibrosis, etc. 2, endocrine system disease, common is the decline in gonadal function, androgen reduction, and then diabetes, some data reported nearly 40% to 60% of diabetic patients have varying degrees of impotence, the mechanism is related to diabetes leading to blockage of the internal penile artery and parasympathetic nerve function, and other hyperlipidemia, hypertension, coronary heart disease, hyperprolactinemia, hyper- or hypothyroidism, adrenal tumors The other are hyperlipidemia, hypertension, coronary artery disease, hyperprolactinemia, hypothyroidism or hypothyroidism, adrenal gland tumors, pituitary lesions, testicular dysplasia, etc. 3, drugs, such as anti-anxiety drugs, hypnotic sedatives, hormonal drugs. 4, long-term smoking, alcoholism, drug abuse. Choosing reasonable treatment Before treatment, patients should consider whether there are suspected factors affecting sexual function, such as drugs, long-term overwork, anxiety, negative life events, bad habits, etc. This is helpful to help identify the cause and target treatment. During the consultation, the doctor can determine whether the patient has an organic or functional lesion through detailed history taking and various examinations. For example, androgen deficiency is one of the causes of ED, and androgen supplementation is effective when other causes are ruled out and testicular function is confirmed to be declining, such as with aerobic exercise will be more effective; and for young ED patients caused by trauma, the first choice is to take vascular surgery, with an efficiency of up to 60-70%. 70 percent. However, ED usually involves many aspects, organic patients may have two or more causes, but also usually combined with varying degrees of psychological disorders, and psychological patients may not always be able to clearly perceive their own condition or accurately describe. Therefore, in clinical practice, the cause of ED patients may not be obvious, not easy to find, which requires a reasonable choice of “three lines” strategy according to individual circumstances, the gradual use of various therapies is the key to effective treatment. The first line of treatment includes psychosexual therapy, medication and negative pressure therapy. This therapy is suitable for the early treatment of patients with different degrees and causes of psychological impotence and some organic impotence. 1.Sexual psychotherapy mainly focuses on various subjective and objective factors that have been found to possibly affect erection, educating patients on various aspects, correcting their misconceptions disease and providing specific guidance, or helping patients to express their sexual requirements without fear. At the same time, couples are asked to check each other’s sexual organs after going home to increase their understanding of sexual organs and remove their sexual shyness. However, because psychosexual therapy needs to find out the factors that clearly affect the psychology, it may take a lot of time and the efficacy is uncertain, the overall effect is poor, so the patient’s compliance is not good, generally only as an auxiliary treatment. 2, drug therapy is applicable to all patients with psychological impotence, as well as the early treatment and combined treatment of organic impotence. The more commonly used drugs are phosphodiesterase inhibitors, such as the familiar “Viagra”. The main principle is that phosphodiesterase 5 is an enzyme that is widely distributed in the cavernous tissue of the penis, and if the activity of this enzyme is inhibited, it can lead to increased blood flow in the penile arteries, relaxation of the smooth muscle of the cavernous sinus, penile engorgement, and thus induce erection. However, active coronary heart disease, congenital heart disease with cardiac insufficiency, hypotension, heart is significantly enlarged, the use of compound drugs anti-hypertension patients must be used with caution, and such drugs are contraindicated and long-acting or short-acting nitrate drugs combined. 3, negative pressure therapy is the main principle of negative pressure on the cavernous body of the penis, so that blood into the penis, the root of the penis placed negative pressure ring to prevent blood flow back, to maintain the erection of the penis. Negative pressure therapy is generally used in patients who do not want to use medication and have contraindications to medication. It is also more acceptable to older patients because of its simple mechanism of action. In conclusion: First-line treatment is effective in breaking the vicious cycle of patients’ psychological well-being, restoring their confidence, achieving treatment goals more quickly, and is non-invasive with few side effects, and therefore is the treatment of choice. For patients who are ineffective or unsatisfied with the treatment, second-line treatment is recommended. Second-line: highly effective, but not curative Second-line treatment includes intracavernosal drug injections and transurethral medication, and is indicated for all patients with psychogenic erectile dysfunction who have failed first-line treatment, as well as a proportion of patients with organic erectile dysfunction, and should be selected at the right time according to the patient’s condition. Most patients are sensitive to injection therapy, with an efficiency of up to 60-90%. Erections appear 5-15 minutes after injection, and the duration of erection varies depending on the injected dose, even with the risk of causing a persistent erection. For patients who cannot master self-injection therapy, their sexual partners can be instructed to perform cavernous injections. Patient self-perception and education are essential factors in the use of cavernous injection therapy, and the new auto-injector pen may reduce fear of drug injection. If an erection persists for up to 4 hours, immediate treatment should be performed to avoid damage to the corpus cavernosum leading to permanent irreversible erectile dysfunction. Transurethral use of prostate E1 in semi-solid form, combined with the use of a tourniquet at the root of the penis to increase penile stiffness, for the treatment of erectile dysfunction can be satisfactory in approximately 70% of patients; this therapy is less clinically effective than cavernous injections, but also relatively less invasive to the body. Side effects are penile pain and hypotension. In conclusion: Second-line therapy is not curative for most patients with impotence, but it is still acceptable to many patients because of its simplicity and remarkable effectiveness. Third-line therapy is recommended for patients for whom first- and second-line treatments have failed, or for those who wish to permanently resolve erectile dysfunction. Third line: permanent, invasive and irreversible Third line treatment, i.e. penile prosthesis implantation, is an invasive treatment and it must be understood before treatment that it is the ultimate irreversible treatment option, qualitatively different from the previous two types of treatment, and couples should also have a full understanding of prosthesis implantation, otherwise the desired effect will not be achieved. To sum up: the third line of treatment is applicable to all causes of organic impotence, usually after the first two types of treatment is ineffective, or there are clear indications for surgery, such as due to penile trauma or anatomical abnormalities after repair still have erectile dysfunction, or a few stubborn functional impotence by oral and injectable drug therapy, etc. ineffective, are feasible prosthesis implantation. Prosthetic implant surgery Prosthetic implant surgery is generally used in two types of prosthesis: flexible and expandable prosthesis. At present, the most commonly used is the expandable prosthesis. With expandable prosthesis, the extension of the penis, penile shape and sexual intercourse can achieve very satisfactory results after the erection of the squeeze fluid pump. The main disadvantage is that it is expensive. For diabetic patients with erectile dysfunction, there is a greater chance of post-operative infection, so it should be chosen with care.