Erectile dysfunction, especially the reduced rigidity of the penis during erection, is usually caused by multiple factors. In this leaflet you can read more about the causes and treatments. You can also read about what you can do yourself.

The erection

Normal functioning

When a sexual stimulus is given (a thought, a touch, etc.), the brain sends a signal to the penis via the nerves. The penis contains erectile tissue that fills with blood. The filled erectile tissue presses the veins closed somewhat so that the blood cannot flow back into the body. The enzyme PDE-5 plays an important role in this system. This enzyme is released when sexual stimulation decreases or when the man has had an orgasm. The erectile tissue empties and the penis becomes flaccid.

Erectile dysfunction

When the erection no longer works optimally, we speak of erectile dysfunction. This is common among men of all ages.

Erectile dysfunction is in fact a collective term, because although the symptom is the same, there can be several causes, including:

  • Psyche
    This cause almost always plays a role, even if someone is not fully aware of it. Stress, tension within the relationship, reduced self-confidence or disappointment can all cause the erection not to occur, not to be complete or to disappear quickly.
  • Nerves
    When nerves are damaged, they cannot transmit the signal from the brain to the penis properly. This can be caused by surgery or radiation of organs in the lower abdomen, a neurological disorder and to a lesser extent diabetes mellitus.
  • Blood vessels
    In order to fill the erectile tissue properly, it is important that the blood vessels function well. This function can be disrupted by heart and vascular diseases, diabetes mellitus, smoking, obesity, aging.
  • Medication use
    Some medications affect the erection.
  • Peyronie's disease
    Due to the curvature, sex can be less pleasant and self-confidence can be reduced, which can result in erections of lower quality and duration.

Treatments

Because the causes of erectile dysfunction are multiple, treatment is different for each person. It starts with a good conversation to find out which causes may play a role in your situation. There are things you can do without the help of a healthcare professional. When this is not enough a healthcare professional, usually a urologist, will advise you medical help. Below you can see what treatment options are available.

Treatments without a healthcare professional

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Lifestyle

A first step in improving erections is improving your lifestyle. Are smoking, alcohol or drug use or being overweight causing your erectile dysfunction? Then treatment without lifestyle improvement is 'mopping with the tap open'. It is then important to first start with a healthy lifestyle.

Sexologist

Because a psychological cause usually plays a role, guidance from a sexologist is very helpful. This concerns questions such as: how do I talk to my partner about sex? How do I view my body? What do I expect from sex? How do I ensure that I do not come too quickly? These topics and more can sometimes play such a role that sexological help resolves a large part of the complaints. Sexological guidance is not reimbursed by the health insurer. You can find a sexologist near you at www.nvvs.info.

Vacuum pump

A vacuum pump (also called a penis pump) is a device: a cylinder that is placed over the penis. By creating a vacuum with a pump, the erectile tissue in the penis is helped to fill with blood. The penis pump is used when you want to be sexually active. The vacuum pump must be purchased by yourself.

Elator

The Elator is an external device that supports the penis during sexual activity. The Elator can be ordered online. It is a one-time purchase that some men benefit from for a long time.

Medicinal treatments

Medical treatments can be started and supervised by your general practitionar. For more complex questions, your GP will refer you to a urologist or nurse practitioner at the hospital.

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Oral medication

If a vacuum pump does not work sufficiently, your urologist can prescribe tablets such as Viagra or Cialis. These medications inhibit the enzyme PDE-5, making it easier to induce an erection and making it last longer. The tablets do not work without a sexual stimulus. It is therefore important to be sexually active right after taking them. The tablets are not reimbursed by your health insurance provider.

Alprostadil in the urethra

Alprodastil is a medication that is inserted into the urethra. It causes the blood vessels in the penis to open up, resulting in an erection. Alprostadil can be used once every 24 hours, approximately 15 minutes before sexual activity. After administration, the penis must be held vertically so that the gel can spread through the urethra. Alprostadil is not reimbursed by your health insurance provider.

Androskat

In some cases, the above treatments are not possible or effective. In that case, the urologist can prescribe Androskat injection therapy. This medication is injected into the penis by yourself at the time you want to be sexually active. The dosage is gradually being increased under the supervision of a healthcare professional. More information can be found in the specific folder about Androskat. Androskat is not reimbursed by the health insurance provider.

Surgical treatment

If the above treatments are not successful, you may be eligible for surgical treatment: an erection prosthesis. A urologist will assess this. A referral to Amsterdam UMC or another centre where urologists perform the operation is therefore required.

Erection prosthesis

A final option is an erection prosthesis (also called a penile prosthesis). There are two types of prostheses: rods that provide constant stiffness but are flexible (semirigid), and cylinders that must be actively pumped up to obtain an erection (hydraulic).

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In both types, the rods or cylinders are placed in the erectile tissue. In the case of the hydraulic prosthesis, a reservoir is placed in the lower abdomen. In both cases, this is an irreversible operation after which spontaneous erections are never possible again. A prosthesis lasts approximately 10-15 years, which means that multiple operations may be necessary.