Risk factors and drug treatment for erectile dysfunction (hormonal and non-hormonal)
Risk factors for erectile dysfunction
It is currently believed that the likelihood of developing erectile dysfunction increases with age. International reports indicate that the prevalence of erectile dysfunction in men aged 20-30 is 7%, while the prevalence in men aged 70-79 is 57%.
However, while the likelihood of developing erectile dysfunction increases with age, it is not an inevitable part of aging and there is no need to panic. Some healthy older men still maintain good penile erection, demonstrating that age is not the primary factor leading to impotence.
Studies have shown that many physical illnesses can also lead to erectile dysfunction.
The relationship between cardiovascular disease and erectile dysfunction is relatively certain. Patients with heart disease, hypertension, and hyperlipidemia have a significantly higher rate of erectile dysfunction. Studies have shown that higher serum total cholesterol and lower protein levels are associated with a greater likelihood of erectile dysfunction. It is also important to note that erectile dysfunction may be a precursor to systemic atherosclerosis.
Diabetes can cause vascular and nerve damage, making it one of the diseases most closely related to erectile dysfunction. The prevalence of erectile dysfunction among diabetic patients is approximately 50%. Those who have had diabetes for more than 10 years are twice as likely to develop erectile dysfunction compared to those who have had it for less than 5 years. Furthermore, poor blood sugar control and smoking both increase the risk.
More than 40% of patients with chronic renal insufficiency also have erectile dysfunction.
Micronutrient deficiency can lead to gonadal hypoplasia and decreased sexual function, which can result in impotence.
Disorders of the central or peripheral nervous system, such as multiple sclerosis, stroke, demyelinating diseases, and Alzheimer's disease, are all associated with erectile dysfunction.
Endocrine changes in the body, such as hypopituitarism, hypogonadism, hyperprolactinemia, adrenal gland disease, hyperthyroidism, and hypothyroidism, are related to erectile dysfunction.
Prostate diseases and genital malformations can lead to erectile dysfunction.
The likelihood of peptic ulcer disease being accompanied by erectile dysfunction is 18%. Arthritis, allergies, alcoholic cirrhosis, and chronic obstructive pulmonary disease are also closely related to erectile dysfunction.
In addition, psychological factors such as marital discord, family disputes, initial sexual failure, and fear of pregnancy from premarital sex, as well as mental illnesses such as schizophrenia and depression, are all related to erectile dysfunction. Sexual dysfunction can also cause mental abnormalities such as depression and anxiety. It is worth emphasizing that normal sexual function also experiences physiological fluctuations. Temporary erectile dysfunction may occur when stimulated by factors such as emotional instability, poor health, or dissatisfaction from the female partner; such occasional phenomena should not be considered pathological. Only when the influence of the above-mentioned factors is ruled out, and repeated failures of intercourse occur under normal sexual stimulation, can it be considered erectile dysfunction.
Diuretics, antihypertensive drugs, medications for heart disease, tranquilizers, antidepressants, hormones, anticholinergics, and medications for treating peptic ulcers can all cause erectile dysfunction.
Some unhealthy lifestyle habits can also lead to erectile dysfunction.
Smoking: It has been proven that smoking is a significant risk factor for erectile dysfunction, especially in patients with certain diseases, where smoking further increases the incidence of erectile dysfunction. The prevalence of complete erectile dysfunction is 56% in smokers and 21% in non-smokers with heart disease; the prevalence is 20% in smokers and 8.5% in non-smokers with hypertension.
Alcohol abuse: People often believe that alcohol can enhance libido. Modern research shows that alcohol can cause erectile dysfunction by interfering with the nervous, cardiovascular, and endocrine systems. Statistics show that the prevalence of erectile dysfunction in liver disease patients who abuse alcohol is 70% and that in non-alcoholic patients is 25%, and half of them still fail to regain erectile function even after years of abstinence.
Drug abuse: Studies have shown that the prevalence of erectile dysfunction among heroin users is 32.2%.
In addition, any trauma or surgery that damages the nerve supply and blood supply to the penis, such as spinal cord injury or surgery, pelvic fracture combined with urethral trauma, abdominoperineal radical resection for rectal cancer, retroperitoneal lymph node dissection, aortic reconstruction, or pelvic radiotherapy for prostate cancer, can easily cause erectile dysfunction.
Drug treatment for erectile dysfunction
Medications for treating erectile dysfunction can be divided into three categories: hormonal drugs, non-hormonal drugs, and topical drugs.
Hormonal medications are suitable for treating primary and secondary hypogonadism.
Testosterone propionate 25 mg, injected intramuscularly every other day, for 5-7 times as one course of treatment.
Human chorionic gonadotropin 1000 units, intramuscular injection 1-2 times per week, for 2-4 weeks.
The following are types of non-hormonal drugs:
Yohimbine (Erectile Dysfunction): An alkaloid extracted from the bark of the yohimbine tree in Africa, it is a reversible α2-adrenergic receptor antagonist. This drug dilates penile arteries, increases penile blood flow, and induces penile erection to achieve the therapeutic effect. It began use in the 1960s, with an efficacy rate of 46% for psychogenic erectile dysfunction, but no effect on organic erectile dysfunction. Dosage: 5.4 mg three times daily. Side effects include occasional mild agitation, dizziness, headache, skin flushing, and tremors. If side effects are significant, the dosage should be halved.
Phentolamine: A non-selective alpha-adrenergic receptor antagonist that dilates penile arteries, increasing blood flow to the penis and thus achieving a full erection. Oral administration is less effective than intracavernosal injection. It has been used to treat erectile dysfunction since 1988, with an efficacy rate of 30%–50%.
Apomorphine: a dopamine agonist that can stimulate sex-related dopamine receptors in the central nervous system and dilate blood vessels in the corpora cavernosa of the penis. It has an efficacy rate of 32% to 60% for psychogenic erectile dysfunction. Common side effects include nausea, vomiting, sweating, drowsiness, and dizziness. This drug has no effect on libido.
Bromocriptine: An oral dopamine-active drug used to treat hyperprolactinemia with sexual dysfunction. Treatment requires serum testosterone levels to be within the normal range. Its use is often limited due to side effects such as nausea, vomiting, and hypotension.
Sildenafil: A specific phosphodiesterase-5 inhibitor that inhibits cGMP degradation, increases cGMP concentration, and promotes relaxation of the corpus cavernosum smooth muscle. It is effective for psychogenic, organic, and mixed erectile dysfunction, and does not affect libido or sexual interest; normal sexual stimulation is still required to initiate sexual activity. The main adverse reactions are tolerable reactions such as headache, nasal congestion, and facial flushing. It is contraindicated in patients taking nitroglycerin due to insufficient myocardial blood supply, and should be used with caution in patients with poor cardiac function. Taking 50-100 mg of sildenafil one hour before sexual activity yields an efficacy rate of 60%-70%.
Topical medications include creams and ointments, and their main mechanism of action is to relax penile smooth muscle and dilate blood vessels.
Nitroglycerin (2% ointment): It can only help the penis become engorged and rarely achieves a full erection. Side effects include dizziness, headache, and low blood pressure. If intercourse is performed without a condom after taking this medication, the female partner may experience dizziness and headache.
Three-in-one cream: Contains 3% aminophylline, 0.25% isosorbide dinitrate, and 0.05% codergocrine. Apply to the glans and shaft of the penis 15 minutes before intercourse. It has an effectiveness rate of 60% and no obvious side effects.
Prostaglandin E₁: a 0.01% gel formulation that can increase the diameter and blood flow of the penile cavernous arteries.